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Parents question nurse’s treatment of student with diabetes

A reader and her husband sent me an email saying they are concerned about the care their 7-year-old daughter received at a public school. Their daughter has diabetes, and apparently the school nurse administered insulin to her three times during the daughter’s hypoglycemic episodes.

The school denies these incidents occurred, but the reader states they have the logs to prove it. The reader also states other deviations from the standard of care occurred, but she did not provide details.

School nurses face daily challenges in their practice, one of which is caring for insulin-dependent students. Several federal laws require diabetic students to have the care they need while in school. They include the Americans with Disabilities Act, Guidance and Training on the Americans With Disabilities Act and The Education for All Handicapped Children Act of 1975 (now known as the Individuals with Disabilities Education Improvement Act).

Many states also have specific statutes relating to diabetic students and the care they receive while in school. At a minimum, the laws require that each student has an Individualized Education Plan, Individualized Health Plan, and an Emergency Care Plan developed by the school nurse in conjunction with the student, family, and orders and management guidance in the Diabetes Medical Management Plan.

The reader did not share what, if any, actions they took to rectify this situation, but it can be assumed that they shared their concerns with the school administrator and with members of the student’s IHP and ECP to no avail.

If the parents did not discuss this issue with the school superintendent, this would be an important step in correcting the problem, since the school may be liable if an injury or death occurs due to the nurse’s conduct.

Did the nurses have the correct training?

It is quite odd that a school nurse would give insulin when hypoglycemia exists. Because this is so contrary to what any nurse, including a school nurse, would do, one has to question whether the nurse is qualified to care for diabetic students. As a result, reporting the situation to the state board of nursing for review would help to remedy the situation.

After investigating what happened, if the state board determines that the school nurse in not qualified to care for diabetic students, it may require the nurse to take a course, either in an academic setting or through a professional association such as the National Association of School Nurses.

The board will most likely take into consideration the American Association of Diabetes Educators’ Position Statement, “Management of Children With Diabetes In The School Setting.”

Or the board may determine this nurse has additional practice issues besides caring for a student with diabetes. In either event, providing a truthful and complete complaint to the board of nursing is most likely in order and would hopefully result in a quick solution so the student’s well-being is protected.

Although the circumstances surrounding the administration of insulin when the student was hypoglycemic were not included in the parents’ question, it sounds as though another problem must be considered: The student’s ECP, if one existed, was not followed by the school nurse. Or, if one did exist, it may be faulty.

Although not the focus of this situation, it is important to note that one of the roles of the school nurse is to help a diabetic student become independent in his or her care. In other words, with the consent of the family, the involvement of the primary healthcare provider and consistent with school policy, a diabetic student eventually can self-administer insulin based on self-determined blood glucose levels and becomes the manager of his or her own chronic disease.

The family may want to consult with a nurse attorney or attorney who practices educational law and focuses on students whose care while in the school setting is regulated by state and federal laws.

If you are a school nurse or a parent of a diabetic child in the school setting, you know how important the correct intervention of a hypoglycemic event is. There is little, if any, room for error.

 


Take these courses on diabetes management:

CE486: School RNs Lead Education Efforts for Students with Diabetes
 (1 contact hr)

Diabetes is one of the most common chronic diseases in school-age children. In the United States, about 208,000 people under the age of 20 have diabetes (about 0.25% of all people in this age group). Because of this incidence and the federal laws that guarantee students with disabilities access to public education, most school nurses already have students with diabetes on campus — or will in the future. For students with diabetes to have a successful school experience, school nurses must be well informed about the students’ special needs. The school nurse is the most appropriate person to coordinate the care of students with diabetes and to train school staff on diabetes-related tasks and ways to treat any diabetes-related emergency. This module informs nurses about significant factors in planning and initiating care in the school setting for students with diabetes. Overview of diabetes in children and adolescents. National Diabetes Education Program

60105: Understanding Insulin Management
 (1 contact hr)

Healthcare providers are increasingly involved in teaching patients to control diabetes through skillful insulin management. Through blood glucose self-monitoring and intensive insulin therapy, patients can learn to \\”think like a pancreas\\” and manage insulin therapy to match their lifestyles. This course begins with an explanation of the actions and types of insulin and describes common problems of blood glucose management with various insulin dosage regimens. It also contains criteria for assessing patients’ readiness to take control of their insulin management. Two approaches of insulin management are covered: the prospective and retrospective.

60168: A Healthcare Provider’s Guide to Diabetes
 (4 contact hrs)

Diabetes is a chronic condition that is reaching epidemic numbers. Every healthcare professional needs to be aware of current diabetes practices. The key components of diabetes management include medical nutrition therapy/meal planning, blood glucose monitoring, medication when indicated, physical activity/exercise, alcohol consumption within recommended limits and stress management. The purpose of this course is to communicate current information about diabetes, including new developments and changes from previous practice standards, which will enable healthcare professionals to provide safe, optimal care, and effective patient education.

By | 2018-10-26T20:30:08+00:00 November 5th, 2018|Categories: Nursing careers and jobs|5 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Nancy J. Brent, MS, JD, RN, Nurse.com's legal information columnist, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist.  Nancy Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice.  Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state.  Visit The American Association of Nurse Attorneys website to search its attorney referral database by state. To ask Nancy a question, email BrentsLaw@nurse.com.

5 Comments

  1. linda November 5, 2018 at 11:11 pm - Reply

    I was diagnosed as type 2 last year, my weight was 125kg, my doctor wanted me to start insulin and encouraged a diet with an alarming amount of carbs, so I went to boots and bought a blood sugar tester that I used every day, and started on a Atkins type diet. I.e no carbs….. and when I say no carbs I really mean none. So lots of meats and fish, eggs etc. I also got some useful information here http://mydiabetesway.com/7-steps-to-health-and-the-big-diabetes-lie-review I gradually started loosing weight at a rate of 3kg per month and Im now 94kg, I have never taken insulin and in a few months I will be my target weight. my lifestyle can never go back to carbs, but I can have some nowerdays without my blood sugar increasing, so if I want a curry I can have a Nan bread with it but no rice chips etc. And to be honest when you cut out carbs you can eat a lot of really tasty things that help lose weight a fry up without the beans is fine, lamb chops and kebabs without the bread etc. The only downside is because of the extra fat intake I need to be doing daily cardio. I really believe doctors are offered too many incentives by drug companies and tend to love writing prescriptions instead of encouraging a positive change in our lifestyles.

  2. I am wondering what the credentials of this nurse are. The qualifications for school nurses vary from state to state, and some states have no specific requirements for school nurses. In many states the school nurse is responsible for multiple buildings and if there is someone in the health office it may be unlicensed assistive personnel. Generally whoever is sitting behind that desk or manning that office is “the school nurse.”

    Some states have a required state certification for school nurses generally connected to teacher certification. NC requires school nurses to obtain national certification (NCSN) for practice within three years. That requires passing a standardized exam.

    To earn the NCSN credential, which reflects competence and professionalism, a registered nurse must demonstrate a high level of education, clinical practice, experience and knowledge.

  3. MBF November 6, 2018 at 10:55 pm - Reply

    Clearly, there is not enough information to guide a discussion of the care provided. If the child was experiencing a hypoglycemic event, then the administration of insulin would have put her/him into grave danger and EMS would have needed to be called especially after administering 3 doses of insulin.

  4. Joleen Goyins November 8, 2018 at 3:55 am - Reply

    Perhaps the problem is that most schools do not have a nurse on site most of the time. The nurse assigned to the school could have responsibility for multiple schools and thousands of students. I was a school nurse for almost 2 years and had three schools with approximately 3500 students. The person the parent may identify as the “nurse” is actually a health aide with probably a high school diploma. The nurse is responsible for delegating the care of the diabetic student to the aide. I live in Colorado and there is only one district in the entire state that puts a nurse in each school.

  5. Medofocus November 12, 2018 at 1:02 pm - Reply

    Thank you Nancy J. Brent. need to know more information on how diabetics management system working on our human body

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