California settlement puts school nurses in an untenable position

The recent agreement between the California Department of Education and the American Diabetes Association allowing unlicensed personnel to give insulin is not in the best interest of students with diabetes, according to AFT Healthcare.

"This agreement provides a false sense of security," says Juanita Hogan, a school nurse from Pittsburgh and a member of AFT Healthcare's program and policy council.

Unlicensed school staff cannot be expected to assess and treat students with diabetes after a brief training session, said AFT Healthcare in response to the settlement. Even medical personnel who do not continually practice their skills have trouble staying proficient, which may lead to medical errors.

For the past several years, the union has been fighting the ADA over allowing unlicensed school staff to administer insulin to students.

The agreement, which came in late August, ends a lawsuit filed in 2005 by four families and the ADA, which alleged some school districts in California were not providing students with diabetes the services they were legally entitled to receive at school, including insulin administration.

In California, the law requires insulin to be administered by a school nurse or other healthcare professional. If they are not available, other options are permitted, including allowing students to self-administer their insulin, or having family members or friends do it. In emergencies, an unlicensed school employee who has been trained can give insulin.

With the settlement, there is a new option: An unlicensed school employee who volunteers can be trained to administer insulin in the absence of a school nurse or other school health professional. Volunteers are to be trained and supervised by a registered nurse and or physician.

AFT Healthcare believes the state department of education overstepped its bounds by agreeing to this option. The California Nursing Practice Act says that nurses may not delegate the administration of medication to an unlicensed person, except for medical assistants who are directly supervised.

Training nonmedical school staff to care for students with diabetes puts school nurses at risk of losing their licenses for violating the Nursing Practice Act.

School nurses also could be considered liable or negligent in the event of an error made by a nonlicensed school employee. In addition, school districts and staff members who vol-unteer to provide this care may be subject to liability or negligence charges.

AFT Healthcare has called on the ADA to work with it and other organizations to advocate for the best possible care for students with chronic conditions, including diabetes. This only can be achieved by hiring adequate numbers of school nurses, says AFT Healthcare.

A lower standard of care
Nancy Spradling, executive director of the California School Nurses Organization (CSNO), one of the organizations working with AFT Healthcare, says her group supports the right of students to receive appropriate care. "But when it comes to administering insulin—which does have the ability to kill-it should be done by licensed personnel," says Spradling.

This settlement is an agreement for a lower standard of care, Spradling warns. "The care provided is only as safe as the person administering it," she points out.

In September, CSNO met with state superintendent Jack O'Connell and his staff, and agreed to issue a clarification of the settlement that calls on school districts to exhaust all of their options before resorting to training unlicensed employees.

"There are a lot of nurses out there and it never occurred to many school districts to look for a school nurse," says Spradling. "If we just had more school nurses, all children could get the proper care."

In the meantime, CSNO has encouraged nurses to get guidance from the district's legal counsel and the state board of nursing before agreeing to train anyone. AFT Healthcare is monitoring the progress of a lawsuit recently filed by the America Nurses Association against the California Department of Education regarding the settlement.

"It is not just a matter of giving an injection," said ANA CEO Linda Stierle in a statement, "because the registered nurse engages in an evaluation of the student's health and needs, both before and after administering insulin. Mistakes can have grave consequences."

To learn out more about AFT Healthcare's position on caring for students with diabetes, visit www.aft.org/topics/diabetes.