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View Full Version : CA - school nurse objections could stall settlement


Ellen
08-26-2007, 08:32 PM
http://www.pe.com/localnews/inland/stories/PE_News_Local_S_diabetes26.2037813.html0

3:13 PM PDT on Saturday, August 25, 2007


By CLAUDIA BUSTAMANTE and SHIRIN PARSAVAND
The Press-Enterprise

Video: Watch a school nurse assist a student (http://www.pe.com/video/index.html?nvid=169542)
Nurses' concerns about training non-medical staff to inject insulin could hamper a recent agreement meant to protect the rights of diabetic students.
Earlier this month, the California Department of Education and the American Diabetes Association reached a settlement in a lawsuit that reinforced laws that have existed for more than 30 years to protect diabetic students. Among the protections, students must have access on their campus to diabetes-related services, such as blood testing and insulin injections.
If no nurse, family member or other trained employee is available, then a volunteer without medical experience can be trained to inject insulin. However, a shortage of qualified school nurses -- there are about 2,800 statewide -- and liability concerns about training non-medical staff to inject insulin could stymie the settlement.
Last week, the California School Nurses Organization sent a letter advising school nurses to seek guidance from district lawyers before proceeding. Executive Director Nancy Spradling said nurses were concerned about losing their licenses should they train non-medical staff.
Diabetic children should receive equal educational opportunities, but not at the cost of their health, Spradling said, adding that insulin injections should be monitored by licensed personnel.
"If you don't do the calculations correctly, you can kill them or cause them to go into a coma," she said.
A key concern for the organization is that districts will not exhaust other resources before asking nurses to train non-medical staff.
Arlene Mayerson, directing attorney for the Disability Rights Education and Defense Fund, which represented the diabetes association, said California has one of the lowest nurse-to-student ratios.
"The nurses could really sabotage this thing if they're refusing to train people and are also not available," Mayerson said.
At the 55,000-student San Bernardino City Unified School District, 78 students have diabetes, including 26 who need help with injections, said Angela Jones, health services coordinator.
Jones said the district's 26 nurses provide the injections. She said non-medical staff members have been reluctant to take on other medical procedures out of fear that something will go wrong. Jones anticipated that would be the case if they were asked to perform insulin injections.
Lynda Steinbeck with the Juvenile Diabetes Research Foundation said her office is flooded with calls this time of year from parents.
"We have everything from wonderful, wonderful experiences to literally parents crying on the phone and everything in between," said Steinbeck, executive director of the foundation's Inland Empire chapter.
The biggest obstacle is educating schools about the child's needs and the laws, Steinbeck said.
"Whether that's out of fear or simply not wanting to deal with it, it's always a fight," she said.
Even without the settlement, Lake Elsinore Unified School District is providing care for its diabetic population.
The district has about eight nurses on multiple campuses looking after them.
The district's high proportion of diabetic students, 70 of 22,000 students, prompts officials to take them seriously, said Brad Trottman, the district's assistant director of special education.
The majority of middle and high school students can monitor themselves, so nurses are concentrated in elementary schools, Trottman said. The district also is hiring another nurse to cover students at its newest campus.
The district's attention has put Jeanine Boone at ease this year. Boone's daughter, Jessica, 9, was diagnosed with type 1 diabetes in May 2006 when she went into a coma and had to be hospitalized for four days.
Last school year, a substitute teacher did not let Jessica leave the classroom to check her blood sugar when she wasn't feeling well, Boone said.
No such problems have occurred so far this year at Tuscany Hills Elementary School, where new Principal Jeff Marks has done everything possible to ensure her daughter's safety, Boone said.
Jessica is now in two fourth-grade classes -- one in the morning and one in the afternoon -- to ensure that if one teacher is absent another on campus is familiar with her needs.
Other parents haven't had the same luck with schools.
Abigail Flath was diagnosed with type 1 diabetes when she was 15 months old. Shortly after, she also was diagnosed with celiac disease, a digestive disease.
Abigail's mother, Tabitha Wilms, said Palm Springs Unified School District officials told her last year that a school nurse was unavailable for the Head Start program. For six months, Wilms said she went to school with her daughter every day to test her blood sugar and make sure she had her injections.
Wilms came across the same issue this year when she registered her daughter for kindergarten at Edward L. Wenzlaff Elementary School in Desert Hot Springs.
Officials told Wilms that a nurse was unavailable and that she would have to come to the school to look after Abigail, Wilms said.
"I want to keep my job, but I want my daughter to be alive when I get off work," she said.
The district's nurse shortage mandated it adopt a policy that parents of students who were too young to inject themselves would have to come to campus to inject their children, said Jane Mills, district director of child welfare and attendance. For the 2006-07 school year, three nurses were on staff for 24,000 students. This school year, the district will have seven registered nurses.
"I know that our current policies are not in alignment so we'll have to quickly adjust them," said Mills, who will meet with her staff Wednesday to discuss the settlement. "This is all very new and we're trying to get our hands around it," she said.
Reach Claudia Bustamante at 951-375-3740 or cbustamante@PE.com (cbustamante@PE.com)
Reach Shirin Parsavand at 951-368-9645 or sparsavand@PE.com (sparsavand@PE.com)
New Settlement
Earlier this month, the California Department of Education and the American Diabetes Association agreed to ensure every diabetic child the same opportunities as their peers, including:
Districts cannot centralize diabetes-related services at one school. They must be available at every school.
Districts must identify and evaluate diabetic students.
Financial burden is no defense for not providing services.
If no school nurse or authorized personnel is available, a volunteer with adequate training can administer insulin.
Source: California DEpartment of education, Disability Rights Education and Defense Fund

Brensdad
08-26-2007, 10:20 PM
Typical union. How many of us were experts at injecting insulin before our kids were diagnosed? And we all managed to pick it up just fine.

Kaylee's Mommy
08-27-2007, 12:31 AM
I was talking to a friend of mine about this today.. she was argueing that a nurse needs to be there for Kaylee.. that someone needs a medical background.. I said, well, idon't have a medical background and either does Matt.. she said, ya but....

my thought on this is that if the nurses don't want to delegate then each school needs to provide a full time nurse.. I'd be happy to have a full time nurse for Kaylee.. But they can't have their cake and eat it to.. they can't have the law stating that they aren't allowed to delegate because they don't feel comfortable with handing that off.. but then not higher enough nurses.. if that is the law.. I'm fine with that.. but then I shouldn't have to fight to have a full time nurse available to kaylee.. I WILL NOT delegate it to anyone (as the law states in this state right now.. I CAN delegate but the nurse can NOT.. and they can't MAKE me delegate.. I WILL NOT delegate and release the school of their liability..) If they want to make the laws so that someone other than a nurse can give insulin and glucagon.. thats fine too.. I can train them my way and not have to worry about some arrogant nurse who thinks they know it all.. I don't care as long as there is one person to take care of Kaylee on a daily basis.. I don't want 5 people doing her care daily.. there are bound to be mistakes made.. but there have got to be at least 3 or 4 other people in the school that know how to take care of her, just in case that one person is out..

they also can not make me go to the school to take care of Kaylee.. so.. anyway they look at it they have got to higher SOMEONE to take care of Kaylee.. and any other diabetic kids that are in the school..

I still have a year before I really have to deal with this school nurse BS.. but I'm starting early.. and I've heard through the grape vine the laws will be changing in our state soon.. (although Iwas told not to 'broadcast it.. my guess is that they are going to follow this CA law.. ).. this stuff just irritates me to no end...

Stacey Nagel
08-27-2007, 01:05 AM
Typical union. How many of us were experts at injecting insulin before our kids were diagnosed? And we all managed to pick it up just fine.

I gave Jesse 2 injections in the hospital before we were sent home.. and one shot was at 6:30 am.. they woke us, and in my sleepy state had to inject him... i was a wreck...

Kaylee's Mommy
08-27-2007, 01:22 AM
I gave Jesse 2 injections in the hospital before we were sent home.. and one shot was at 6:30 am.. they woke us, and in my sleepy state had to inject him... i was a wreck...

Kaylee wasn't sent to a hospital.. we went from her pedi to the endo's office.. I learned how to do an injection at 5:30pm and we were sent home that night (Kaylee has a low that night too.. we freaked out!)..

rickst29
08-27-2007, 02:00 AM
If we encourage AMATEURS to do insulin at schools, where will it end?


high school drop-outs giving us flu shots in the fall, because "It's so easy, a CAVEMAN could do it" ???
Endos replaced by Candy-Stripers, because the volunteer High Schoolers cost less? (And hey, anyone can tell you "don't eat sugar".)
appendectomies from fast food employees, because "cutting into a friend is a lot like chopping onions, and I'd love to do EVEN MORE good things for our restaurant visitors when they need extra help."


:eek:

I'm with the nurses, AND the kids. Sorry, but money needs to be spent to provide QUALIFIED care. History teachers, Phy Ed teachers, and English teachers who never went to nursing school aren't qualified, even if they'd like to be "helpful". :mad:

LantusFiend
08-27-2007, 02:05 AM
Diabetes is not that rare; there's gotta be somebody in most schools who isn't a nurse but who has diabetes or has a little brother with diabetes or whatever and knows how to inject. I know I'm not directly impacted because I was old enough to take care of it myself, but I really don't think you need a nurse to do it. I mean, it's not as though nurses didn't make mistakes either.

deafmack
08-27-2007, 05:40 AM
If we encourage AMATEURS to do insulin at schools, where will it end?


high school drop-outs giving us flu shots in the fall, because "It's so easy, a CAVEMAN could do it" ???
Endos replaced by Candy-Stripers, because the volunteer High Schoolers cost less? (And hey, anyone can tell you "don't eat sugar".)
appendectomies from fast food employees, because "cutting into a friend is a lot like chopping onions, and I'd love to do EVEN MORE good things for our restaurant visitors when they need extra help."


:eek:

I'm with the nurses, AND the kids. Sorry, but money needs to be spent to provide QUALIFIED care. History teachers, Phy Ed teachers, and English teachers who never went to nursing school aren't qualified, even if they'd like to be "helpful". :mad:

First of all I understand your concerns but believe me having an RN after one's name does not make them qualified to deal with insulin and diabetes. They need to be trained to each child's individual needs as well. All parents give their kids insulin every day. While I agree there needs to be a nurse in every school that obviously is not the case many of the times and the school personnel needs to know what to do and since parents have been dealing with this and dosing for insulin very correctly most of the time there is no reason why another person cannot learn to do the same thing if properly trained by certified personnel.

Tamara Gamble
08-27-2007, 08:11 AM
Thank you for keeping us posted Ellen.

Quite frankly, I don't think that you need to be a nurse, I do feel that you need to be trained. I was trained and Ty is doing very well. I have seen alot of problems with school nurses thinking that they know better than the doctors and parents. They tend to interfere quite a bit and try to have protocol changed based on their belief whether it be old fashioned thinking or new technology, it's a crap shoot.

I need someone who cares enough about my son to be trained based on what our protocol is and follow it. Not someone who thinks that they know better than everyone else and makes things more difficult.

I think the key is educating our children enough to take care of themselves and use the school in case of emergency and for support as needed ie high or low. This is how we do it. I can be reached 24/7.

We have a health aide. It's kind of funny, he is the school janitor but he is fearless (infusion sites etc) and he is a volunteer firefighter with extensive medical training so we hit the jack pot as far as I'm concerned. When I trained him, he felt it was no big shakes and asked if he could have his own personal binder to keep with him so he could really study everything regularly as Ty does pretty much everything himself, so he didn't want to fall out of practice. Couldn't ask for more. We call him Mad Jack. Love the guy. I have no doubt that my son will come home from school everyday.

Tami

Ellen
08-27-2007, 08:12 AM
If we encourage AMATEURS to do insulin at schools, where will it end?
.....
I'm with the nurses, AND the kids. Sorry, but money needs to be spent to provide QUALIFIED care. History teachers, Phy Ed teachers, and English teachers who never went to nursing school aren't qualified, even if they'd like to be "helpful". :mad:

The fact is, the school system will not hire sufficient nurses to be there for every child with diabetes in the public schools. It will take a lot of time to advocate for extra funding as well as hiring. Most school districts don't have the money to do so. The children need assistance today.

zimbie45
08-27-2007, 08:53 AM
My hubby and me are born and raised in California, We moved to az and 5 months later my daugher was dx and in the hospital... we have been here 3 years.. We would love to move back to family in california.. THis is why we have not and will not.. I know california schools.. I get more protection for her here in arizona.. That is sad to say in some aspects. !

CAGrandma
08-28-2007, 09:07 AM
My guess is that schools would love to have a nurse on every campus for a variety of reasons. It is a question of money and availability. So what would we cut back on to pay for that many nurses? And where would we get them from? There is a huge shortage of nurses in California, and probably in the rest of the country as well. California hospitals are encouraging nurses from other countries to immigrate, regardless of their language skills.

A nurse on every campus will never happen - so where does that leave the child with diabetes? Or the child with other chronic health issues? If the nurses union persists in this campaign they are actually putting their desires ahead of the welfare of the children while claiming to be only concerned with the children.

Oh, and as a practical matter, even if there is a nurse on campus, what happens during after school activities or field trips? What happens if there is more than one child needing attention at the same time?

Giving insulin or monitoring a pump bolus is not brain surgery. We're not asking for trained lay people (other than parents) to modify carb ratios, give split boluses, adjust basal rates, determine trends, etc. All we are asking is that they learn to measure units in a syringe or push buttons on a meter, count carbs and know when to call for help. Teachers are all college graduates and can probably learn that.