By Shawn Kennedy, MA, RN, editorial director and interim editor-in-chief
A scenario is playing out in California that may have far-reaching consequences for nursing and for school children with diabetes. At issue is a move by the California Department of Education to allow non-nurse, unlicensed school personnel—teachers, aides, administrators, and others—to administer insulin to children while at school or at school functions if licensed personnel are unavailable.
In a joint press release issued by the the American Nurses Association (ANA) and the National Association of School Nurses (NASN) on August 14, one day before a public hearing on the matter, ANA president Becky Patton reaffirmed the associations’ commitment to ensuring safe care for children. She also said, “California’s department of education does not have the right to redefine the scope of practice for registered nurses and train unqualified personnel to administer insulin when this is not permitted by state law.”
The backstory: In 2007, the California Department of Education issued a legal advisory to public schools, announcing that unlicensed personnel could be trained to administer insulin to children with diabetes. In response, the ANA, the NASN, ANA/California (the state affiliate of ANA), and the California Nurses Association filed a lawsuit against the state, opposing the advisory.
Testifying in October 2008 on behalf of the American Diabetes Association (ADA), which opposed the position of these nursing organizations, Linda Siminerio, PhD, RN, CDE, a noted diabetes specialist from the University of Pittsburgh said, “While I certainly value the many roles that school nurses play to keep students with diabetes—and all students—healthy and would strongly support there being more school nurses in our nation’s schools, that does not mean that a trained unlicensed school employee cannot safely administer insulin to a student with diabetes when a school nurse is not present.” But the court sided with the nursing groups.
The California Department of Education appealed the case in February, and until the appeal is decided, the original court ruling is “stayed,” meaning that schools can follow the advisory and allow unlicensed personnel to administer insulin. The ADA joined the appeal because, they argued, “the schools had failed to provide adequate health services to students with diabetes and because the state failed to ensure that local school districts met their legal obligations to provide diabetes care.”
The Association of California School Administrators also opposes the ruling, noting that “[w]hile the health and safety of students is of the utmost importance, the fiscal reality is that there simply isn’t enough money to have a school nurse in every district.”
The real issue. While this particular controversy focuses on the administration of insulin, the real issue is why the department of education can disregard its duty to provide adequate funding to ensure appropriate health services to students. What’s next: will nursing homes and hospitals be allowed to claim financial hardship to forego legal mandates for staffing? Will the nursing shortage be an excuse to replace nurses with less qualified and minimally trained (and therefore lower paid) workers? This harks back to the 1980s, when one attempt put forth to solve budget problems and the shortage that existed at that time (an attempt that was supported by the American Medical Association) was to replace many hospital RN positions with lower-trained and lower-paid “RCTs”—registered care technologists. Vigorous protests by the ANA and consumer groups prevented that from happening.
Every child deserves to have a school nurse available; they deserve to have someone who is prepared to do more than just read instructions and follow a script. Administering insulin is only one small (but important) piece of what school nurses do.