The American Nurses Association expressed disappointment with an Aug. 12 ruling by the California Supreme Court that allows unlicensed school personnel in the state to administer insulin shots to students.
Two lower courts previously had ruled that the California Department of Educations attempt to sidestep the states Nursing Practice Act by allowing unlicensed personnel to administer shots was unlawful. The states highest court overturned those rulings.
“California law expressly permits trained, unlicensed school personnel to administer prescription medications such as insulin in accordance with the written statements of a students treating physician and parents and expressly exempts persons who thus carry out physicians medical orders from law prohibiting the unauthorized practice of nursing,” the court wrote.
“Through these provisions, state law in effect leaves to each students physician, with parental consent, the question whether insulin may be safely and appropriately be administered by unlicensed school personnel, and reflects the practical reality that most insulin administered outside of hospitals and other clinical settings is in fact administered by laypersons. The nurses arguments to the contrary lack merit.”
The ANA, California Nurses Association and California School Nurses Organization argued that Californias Nursing Practice Act “specifically defines administration of medication as a nursing function that cannot be performed by unlicensed individuals, except in certain circumstances that do not apply in this case,” according to a previous fact sheet from the ANA.
In response to the ruling, the ANA stated: “From the start, ANA and ANA/California have fought to ensure that children with diabetes and other conditions that require healthcare services receive the level of care in school promised to them by law. This decision lowers this level of care for children who are entitled to receive healthcare services at school and puts them at risk for medication errors that could have severe health consequences.”
The ANA also worries that the ruling could have consequences for nursing practice nationwide: “This decision also sets a disturbing precedent for California and the nation. In essence, the reversal of the lower court decisions permits a state agency other than the Board of Nursing to control the scope of nursing practice. Moreover, the California Supreme Court has essentially decided that state healthcare licensing laws meant to protect patients can be ignored to the detriment of vulnerable populations.”
The American Diabetes Association, which argued against the ANAs position, stated its satisfaction with the courts ruling: The “decision made it clear that state law is not an obstacle to children with diabetes receiving the proper care and the insulin they need to be healthy and medically safe at school.”
About 14,000 school-age children in California have diabetes, according to the courts statement. Among California schools, 5% have full-time nurses, 69% have part-time nurses and 26% have no nurse.
The legal battle began in 2005, when parents of four students with diabetes filed a federal lawsuit against California, leading to a settlement in which the state conceded that unlicensed but trained school personnel could administer insulin shots.
That prompted the ANA to file suit. It won in lower court and again after the diabetes association appealed.
After prevailing, the diabetes association stated that school nurses must continue to play a central role in diabetes treatment for students: “The courts decision in no way lessens that role, as school nurses oversee diabetes care in schools, and coordinate and provide training to other school personnel so they can administer insulin when the school nurse is not available.”
Noting it has been involved with the case since 2007, the ANA said it is considering future options that may include appealing the case to the U.S. Supreme Court.
The court ruling is available as a PDF: www.courts.ca.gov/opinions/documents/S184583.PDF.