How does a school nurse care for four diabetic students, who need insulin administered with adult supervision, in three different schools? I cannot be present on each campus at one time, and the district will not hire a substitute nurse.
A complete response to your question is beyond the scope of this column. However, generally, there may be many solutions to the problem you raise as the only school nurse covering three schools when you have four diabetic students who need insulin administered with adult supervision. One simple solution is that one of the parents, or another adult family member (such as a grandmother), come to the school and administer the insulin. This solution has worked in some school districts without difficulty.
A second solution is if the student is old enough, and is doing so at home, the student can self-administer insulin with the supervision of an adult (for example, a teacher) who is willing to perform this task and is trained by you in insulin administration. Also important to include here would be the importance of training the adult who is performing this task to be skilled in understanding the importance and results of blood glucose testing prior to the student’s self-administration of insulin.
Some states allow the delegation of insulin administration to unlicensed persons who are adequately trained and supervised by the school nurse.
One way in which you can become more versed in options available in a situation like yours is to visit the National Association of School Nurses website. It provides a wealth of information on school nursing, including downloadable resources, conferences and position statements on school nursing practice. Three that might be helpful to you initially are: Diabetes Management in the School Setting (2012), Nursing Delegation to Unlicensed Assistive Personnel in the School Setting (2014) and Medication Administration in the School Setting (2012), all available under the Policy and Advocacy tab.
In addition to the published resources available on the NASN website, the following text would be helpful to you: Schwab and Gelfman (editors), “Legal Issues in School Health Services: A Guide for School Administrators, School Attorneys, School Nurses.” (2005). The text provides needed information on the topic of your concern, including forms, policies developed by schools for working with diabetic students, and policies for the delegation of medication administration to others in the school setting.
You should consider becoming a member of the NASN if you are not already. Membership benefits include educational programs, resources and research, advocacy and outreach, and partnerships with other professional organizations.