What are the implications for a school nurse if an insulin-dependent high school student’s parent will not sign a consent for insulin nor send any doctor’s orders to the school? Is the student able to care for herself without an order from a physician? I am anticipating this might happen next year and just need some information.
Dear Nancy replies:
You are farsighted in trying to get information about this situation before being confronted with it at the beginning of next year’s school term. Although a specific answer is not something that can be done in this column, some general comments can be made.
First, your high school’s policy on students possessing syringes and medications during the school day/year should be consulted. Although many of these policies are aimed at illegal drug use and non-prescription medications, unfortunately, a diabetic student may fall under its mandates.
You did not mention what the doctor’s orders were to cover: That the student could inject her own insulin? That you, as the school nurse, were to administer the insulin injections? That you, as the school nurse, are to keep the syringes and insulin in your office? Whatever the order is to reflect, these issues need to be analyzed and resolved.
There also is the issue of this student being a high school student and hopefully providing her own care and doing the injections herself. Although the length of her diagnosis is not known, it is hoped if it is one of reasonable duration, the student should be caring for herself and not being dependent on others to do so.
It might be helpful for you to read more about this issue. One excellent resource is the National Association of School Nurses (www.nasn.org), especially its position statements. Another is a text by Schwab and Gelfman, Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, School Nurses (Authors Press, 2005).
The whole issue of which school personnel (other than the school nurse) should administer insulin has been very controversial. The National Association of School Nurses has been very involved in the issue. You also may want to explore this aspect of the administration of insulin in the school setting, including decided cases in various states, one of which is California.