Running head: SCHOOL PERSONNEL TO ADMINISTER INSULIN TO CHILDREN 1

Allowing Unlicensed School Personnel to Administer Insulin to Children: A Questionable Policy

Nia Edwards

Chamberlain College of Nursing

NR506: Healthcare Policy

January 2015

Running head: SCHOOL PERSONNEL TO ADMINISTER INSULIN TO CHILDREN 2

School Personnel to Administer Insulin to Children :The New Policy

In August of 2013, the California courts made the decision to allow school employees

who have no healthcare training to administer insulin injections to diabetic students (Mintz,

2013, p1). The defendant was Tom Torlakson, the superintendent of public instruction vs. the

American Nurses Association. Tom Torlakson was backed by the American Diabetes

Association as well as many parents of the children (Walsh & Lambert, 2013, p1). The main

arguments of both plaintiffs and defendants will be explored. A brief explanation of diabetes and

its care will be explained. How the policy effects the nursing profession will be covered. The

reasons for why this policy needs to be changed will be revealed.

Background

Studies show that 1 out of 400 children and adolescents have been diagnosed with

diabetes type 1 in the United States (Wood, 2013, pg 339). Type 1 diabetes involves one's body

not making enough or any insulin to sustain them. Because of this most type 1 diabetics have

ranging blood sugar levels which need to be closely monitored and treated with insulin when

necessary (Nair, 2007, pg 124) Insulin can be needed at any time: during class, recess, or on a

field trip, etc. One of the main issues to be aware of is hypoglycemia. This can occur when a

child receives too much insulin, their blood sugar drops. Some of the signs seen in the child

could be: tachycardia, seizures, weakness, exhaustion or coma (Rodrigues, 2014, pg2).

Hyperglycemia can occur if the child is not given enough insulin, if the blood sugar goes over

300 then the child is in danger of a life threatening complication called diabetic ketoacidosis.

Some symptoms of this are: nausea, vomiting, thirst or a fruity odor on the breath (Onyiriuka &

Ifebi, 2013, pg1). If a child's diabetes is not managed early enough, then it can lead to long term

problems such as: neuropathy, retinopathy, nephropathy, heart attack or strokes (Rodrigues,

Running head: SCHOOL PERSONNEL TO ADMINISTER INSULIN TO CHILDREN 3

2014, pg 1). Originally it was the law for only trained nurses to administer insulin to these

students (Freeborn, Loucks, Dyches, Roper, Mandleco, 2013, p11). Many nurses were laid off,

and new ones were not hired to replace them, which caused an issue for the students care. Under

several acts public schools must comply with medical services to ensure that children can reach

their educational potential( American Nurses Association v. Tom Torlakson, 2013, pg 3). Since

the students were not getting the care they deserved, the parents began suing the schools in 2005.

( American Nurses Association v. Tom Torlakson, 2013, pg 5). In response, to this the schools

began asking their nurses to train school employees to administer insulin to the students. The

nurses refused, because the Nursing Practice Act "permits only licensed health care providers to

administer insulin in schools." (American Nurses Association v. Tom Torlakson, 2013, pg 4). It

also states that if the nurses were to delegate the students care to unlicensed school personnel,

then the nurses would be held accountable for any issues that the personnel caused. (American

Nurses Association v. Tom Torlakson, 2013, pg 4).

Nurses Point of View

During this court case, many nurses voiced their opinions about the importance of having

nurses administer insulin to children. Unlicensed school employees have no education about

diabetes. This law states that basically anybody who is employed at a school can give insulin to

the students, this includes teachers, counselors aides, office staff and principals (Disability

Rights Education & Defense Fund, 2013, pg 2). If the child starts showing signs of

hyperglycemia or hypoglycemia, they may not realize that it is happening or if they do, they do

not know how to respond. "Nurses are needed because insulin is on the top 10 list of Institute for

Safe Medication Practices most dangerous drugs." (Spradling, 2010, pg 4). If insulin is not

administered properly it can lead to a crises situation. Nurses are able to perform assessments on

Running head: SCHOOL PERSONNEL TO ADMINISTER INSULIN TO CHILDREN 4

the diabetic students, are able to manage their insulin dosages, and know what steps need to be

taken by examining the students symptoms. Unlicensed school employees do not know this.

School employees cannot diagnose illnesses or prescribe medication, because they are not

licensed doctors. School employees cannot operate on people, because they are not licensed

surgeons. School office employees are not teaching the classes, because they do not have

licenses to teach children. Therefore, school employees should not be managing students insulin,

because they are not licensed nurses. Nurses are lifelong learners, they are always continuing

their education through continuing education courses, higher degree education or other forms of

education. Before nurses even get their degrees, they spend many years learning about the

anatomy, physiology and pharmacology of diabetes and many other health problems. Nurses are

able to appropriately care for diabetics, as well as to continue teaching them on how to manage

their diabetes. School employees are unable to do this. In a study where 125 teachers were

questioned about their diabetic knowledge, 40 of them knew absolutely nothing of the disease

(Aycan, Onder, Cetinkaya, Bilgili, Yildirm, Bas, Kendirci, and Agladioglu, 2012, pg 200). If a

diabetic was in the hospital, two nurses would check the insulin dosing before one nurse would

administer it to them ( Pickar, Graham, Swart, & Swedish, 2011, pg 206). The unit secretary

does not administer insulin in the hospital instead of a nurse. So, a school secretary should not

administer insulin instead of a school nurse.

Defendants Point of View

One of the points that was made by the defendants in the court case, was that there are

simply not enough nurses to treat all of the students in the schools. "The United States

Department of Health and Human Services suggests a standard of 1 school nurse for 750

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students. The ratio is more like 1 school nurse for 3800 students." (Wood, 2013, pg 340).

However, it is not that there are not enough school nurses in existence. It is that school districts

have not made them a true funding precedence. Both Registered Nurses and Licensed Vocational

Nurses have the education necessary to treat diabetic children. Theses nurses do have to get hired

into the positions, though. The school district has to make the decision if having nursing services

as a priority or not. (Spradling, 2010, pg 3). Many of the children's parents were in agreement for

having unlicensed school employees give insulin to their children. One of reasons for this is that

whenever a nurse was not available, the parents would have to leave their places of employment

and go to their child's school and administer the insulin. For students whose blood sugars were

constantly moving around, the parents would go to the school so frequently, that they were in

danger of losing their jobs. However, this would not have been an issue, if there were always

enough school nurses.

Impact on Nursing

Nurses spend many years going to school so that they are well educated on health

concerns such as diabetes. This is why they are able to safely administer insulin to school

children. Now all of a sudden it is alright for someone who has no nursing background to

perform nursing functions. Nurses are basically being replaced by people who have less

education than them. Nurses not only learn about diseases, but that also learn critical thinking

skills and how to use nursing judgment. A nurse knows when a medication should be held or

altered by monitoring the patient's status. By giving people the responsibility to administer

insulin who cannot adequately perform these nursing tasks, this is devaluing the practice the

nursing.

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Recommendation

There is too much information that the school employees are not aware of. School

employees do not know about insulin. They do not know the difference between fast acting and

intermediate acting insulin. They do not know the safe way to draw up two types of insulin in

one syringe, or which types of syringes should be used. The student can have a different school

employee every day administering insulin to them. In other states like Virginia that have changed

their policies, the school employees have made errors in insulin administration which made the

parents take their children out of the schools. (Wise & Sears, 2013, pg 2). The school employees

do not know about how to accurately document insulin administration. They do not know that

the injection sites must be rotated. This puts the children at risk for lipohyertrophy, which is an

accumulation of extra fat which results from multiple insulin injections in the same place

(Gelder, 2014, pg 34). Many of the school staff do not feel comfortable due to the fear of

something happening to the child. There was a study done where diabetic children were

questioned about their teacher's care. One student stated that they were denied physical activity

and that their teachers were extremely fearful of getting in trouble if something had happened to

her (Kratzer, 2012, pg 41).

Considering all if the evidence that was reviewed in the court case, what is most

important is the safety of the children. Having unlicensed school personnel administer insulin to

children is not in their best interest. It is only a matter of time before a sentinel event occurs in a

school. The law should be changed before it is too late, before a child's life is at stake. If schools

manage their budgets accordingly, they can afford to have nurses on staff who able to take

proper care of these children.

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Conclusion

In conclusion, what everyone should be considered about is safety of the children. They

should not be focused on how much it would cost to hire all of the nurses required. Both parties

explained their rationales for their sides. However, the American Nurses Association is focused

on the benefits of the children. This being said it would be ideal for the California law to be

altered so that only licensed professional nurses be the ones to administer insulin to the students.

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References

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