How can I legally protect myself as a school nurse of three schools who has four diabetics all requiring insulin with adult supervision when I am not present on campus and the district will not hire a substitute nurse?
Your situation is not unlike the experiences of many other school nurses who are trying to provide school nurse services to students with varying medical problems and are unable to be in their schools at a particular time when specific nursing services are required of those students. This is an unfortunate situation and the problem seems never-ending, especially when financial constraints exist in school districts to hire qualified school health personnel.
The diabetic patient who is insulin dependent, whether through injections or on an insulin pump, raises unique concerns. Authorities on school nursing, including the National Association of School Nurses, offer suggestions. One is to have the parent of the student take the responsibility to administer the insulin to his or her child. Another is to have the student, if old enough and mature enough, self-administer the insulin. A third suggestion, if supported by the state nurse practice act, is to have the school nurse carefully train and regularly supervise another person in the school setting to administer the insulin. Yet another option is if your state has passed a law allowing trained and supervised “diabetic care technicians” to administer insulin and perform other care responsibilities required by an insulin dependent diabetic student.
There is no question that under the Individuals with Disabilities Education Act, the Americans With Disabilities Act, and other federal and state laws, students with disabilities must be provided the care they need to be in school. Of course, how that all occurs is the subject of continuing debate.
You might want to consult with a nurse attorney or attorney in your state to obtain a specific opinion as to your options and potential legal liabilities. You can prepare for that consultation by visiting the NASN’s website. In addition, a comprehensive text describing legal issues facing school nurses is Schwab and Gelfman’s Legal Issues In School Health Services: A Resource For School Administrators, School Attorneys, School Nurses (Authors Choice Press, 2005).