Nurses take on schools over insulin shots (Obama is against the nurses union)

[Omaha Steve]

http://abclocal.go.com/kfsn/story?section=news/politics&id=9120710

Wednesday, May 29, 2013

Nannette Miranda

SACRAMENTO, Calif. (KFSN) -- The nurses union is fighting an effort by the California Department of Education. They don't want non-nurses allowed to give insulin shots to diabetic kids at school and the California Supreme Court hears the case on Wednesday.

When Megan Libal's third grade daughter was diagnosed with diabetes, her child's school didn't have a full time nurse to administer insulin, so Megan quit her job to give the shots herself.

"For about four to seven months, we didn't have a consistent nurse. So my family and I had to make a decision," said Megan Libal, the mother of a diabetic child. "So we made a decision that I would stay home and take care of her."

The California Supreme Court will be deciding a case that could change the lives of families living with diabetic children: should a trained, but unlicensed non-medical worker be able to give insulin shots to public school students?

This FULL story at link.


OP by alp227 Mon May-30-11 01:27 PM


The Obama info: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x105599

Obama administration steps into insulin shot fight
The Obama administration has stepped into a California case involving 14,000 diabetic schoolchildren, urging the state's top court to let school employees give insulin shots if no nurses are available.

Two lower courts have ruled that California law allows only licensed doctors and nurses to administer medication, including insulin, except in emergencies. But U.S. Justice Department lawyers say that given the state's shortage of nurses, that would effectively deny care to thousands of children and violate their rights under federal disability laws.

Prohibiting trained non-nursing employees from giving insulin injections "creates a serious obstacle to the ability of California schools to comply with their federal obligations" to educate children with disabilities, the Justice Department argued in a May 18 filing with the state Supreme Court.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/0...

[nadinbrzezinski]

1. Steve on this one the nurses are wrong

The other choice is home schooling those kids. They need the insulin, no ifs or buts...and not all have access to an insulin pump.

And no, schools are not going to hire nurses either.

[malaise]

3. Yep no insulin can mean death

This is a hard one to call

[uppityperson]

7. The wrong dose or type of insulin can quickly cause death. No insulin takes a while.

Problem with no insulin is causing kidney and eye damage moreso than death, more of a long term problem than immediate. Problem with giving insulin is there are different types and giving the wrong amount or type can cause their blood sugar to drop and go into shock or die.

[malaise]

8. I think schools should have a qualified nurse

and everything you say makes sense but what happens when the children need insulin and there is no qualified person to deliver it. That is just as dangerous.

[Ilsa]

181. 911. And as dangerous as

Hyperglycemia is, hypoglycemia is more dangerous. So are asthma attacks. School nurses call EMS for situations they can't handle with what they've got.

[magical thyme]

220. you can die either way: hyperglycemia or hypoglycemia

We had a non-compliant type 1 in DKA in the ED last week with serum glucose >700 and positive for acetone; urine glucose >1000 and positive for ketones.

The ABG pH was 6.9. Nobody could believe it because below 7.0 is not compatible with life, so re-drew and re-tested both venous and arterial. 6.9 on both.

[Ilsa]

225. Very true. And sometimes the parents

of these kids are noncompliant in helping them develop independence.

[Yo_Mama]

10. A realistic alternative might be

To have specially trained nurses staffing a line, and training medical assistants to give the shots.

Even one nurse in a larger school district might not be able to handle the load if there were multiple cases. The kids all eat at about the same time so the pipeline can kind of jam up.

Not allowing the insulin to be given is going to cause kids damage, and not making arrangements for the kids to have someone trained to give it in school really denies them their access to an education.

There aren't enough well-trained nurses to go around. It would be better to have some centralized offices supervising and checking up on specially trained staff, designing procedures, etc. One of the major risks would be mixing up insulin, so a very knowledgeable central staff could

Not having some one there to give the shot can also cause the kid to tip over and die, and sometimes kids will come to school and something will go wrong (like vomiting or illness) and the kids can also tip over and die.

[uppityperson]

27. There are plenty of trained nurses but funding them is another thing.

If a kid is sick or vomiting, they will be in danger of "tip over and die" from too MUCH insulin. Not from too little. If a kid gets too MUCH insulin they can indeed "tip over and die" where too little causes other issues gradually (retina and kidney damage) which are awful.

I wish they would fun enough nurses but it is the same problem as in too many clinics these days. Nurses cost more (and are worth more) than med assistants. So they hire ma's who can do less.

I agree that a school district should have RNs or NPs (nurse practitioners) on staff, but they can also supervise MAs or Nurse Assistants (acronym varies by state, CNA, NAC, etc) who do more of the grunt work. Like in hospitals or health care centers of all sorts.

[Yo_Mama]

78. Yeah, you give them the morning insulin & send them to school

and then if they get sick they could get in trouble. Someone at the school should have glucose tablets and be able to deal with it as well.

There are more reasons to have school nurses than just this, though.

I don't see why a two-tiered system couldn't work for schools. What's important is a quick and knowledgeable response.

[MiniMe]

145. There could be rules that address those things

Such as the insulin would have to be provided by the parents, and strict instructions on the dosage. That would take care the wrong type of insulin problem.

[uppityperson]

189. It is not quite that simple. If a kid is sick, their blood sugar levels can change dramatically

and the usual dosage may cause problems. The kid may eat differently and that cause problems. There are reactions, interactions, it depends on health, exercise, diet. It isn't just "give me the right dosage" but there is a lot more to it than that.

It isn't such a simple thing and that is why having a nurse or other such trained medical professional around is a really good idea.

[Jennicut]

245. Depends how high you are. DKA can cause death.

Diabetic ketoacidosis. Danger is in over 300 mg/dl. I got up there a few times.

[Omaha Steve]

4. It all started when flu vaccine was given by accident to several students instead of insulin

Fortunately there were no deaths. And there is a shortage of nurses in CA.

Perhaps a higher standard of training for the person that will be administering the shots would help?

[nadinbrzezinski]

13. You know how easy really it is?

A fifteen year old is able to self administer.

You need somebody there that knows what to do if a kid gets too much and gets low blood sugar. An EMT can do that, let alone a paramedic. People on insulin know the signs too and should carry fast acting sugar pills.

[uppityperson]

30. There is no shortage of nurses in CA. There is a shortage of nurses who will work high stress jobs

for shit wages and under-staffing though.

There are plenty of nurses.

[patrice]

68. In my last job that's what we were ALL about: a higher standard of training than what is

conventionally available for CNAs & CMAs. We were trying to elevate that field professionally, so that nurses could be relieved of some things in order to have more time and opportunity to do other things that require their specific nursing expertise.

[HiPointDem]

87. i won't comment on your personal anecdote, but giving more job duties to lower-paid, less-trained

Last edited Sun Jun 2, 2013, 10:00 PM - Edit history (1)

personnel is *all* about driving down wages. In every field, everywhere.

As is turning skills into mechanized sub-routines. always has been, always will be.

[patrice]

96. Perhaps you'll pardon me if I take the words of at least some professionals actually in the field at

slightly higher value than yours.

[HiPointDem]

97. i expected nothing else, based on your take on this matter.

[patrice]

99. You seem to be un-necessarily hostile. I think we agree on the core issues more than you

seem to want to pretend that we do and I'm too tired to argue with you. Perhaps you should ask yourself if you have some kind of ownership issue here.

[HiPointDem]

157. says the person who wrote:

96. Perhaps you'll pardon me if I take the words of at least some professionals actually in the field at slightly higher value than yours.


which is the first post in which any 'hostility' is noticeable in this subthread.

physician heal thyself

[proud2BlibKansan]

113. Well I'm a teacher and I will not give a shot to a kid at school

Last edited Wed Jun 5, 2013, 10:03 AM - Edit history (1)

I don't feel qualified to do so. Don't tell me it's easy. I won't do it.

We had this same issue in our school district. And after teachers and other school personnel refused to give shots and to change catheters, guess what? The district hired a nurse for every school.

[nadinbrzezinski]

119. Read the suit.

Mom will do it.

It's not the janitor, not a teacher.

The mother wants to do it.

In an ideal world I want a nurse, not just because of the kids with diabetes, but the slew of other kids who need other meds. But until then, mom should be able to.

FYI, early in the history of insulin, gent passed recently, and I mean first patient on insulin, he walked home every lunch period, got lunch, got tested and got his shot.

Now that was damn complicated. The sugar test was urine. The syringes were not yet designed, and units were still a mystery. His mom was not a nurse, not even a CNA. She was told how to do this.

[proud2BlibKansan]

122. And what if Mom can't do it?

This needs to be the responsibility of the school nurse.

[nadinbrzezinski]

138. What if you don't have a nurse?

Many districts are strapped...I keep the teacher, or the nurse...yup, that's reality.

The suit is talking of medically trained people. It could be a CNA, it could be a Paramedic. California will never ever ask the teacher or the janitor...way, and I mean this, wwwwaaaaayyyy too many liability issues.

The union is against it for the same reason they opposed (with doctors mind you) first the training of EMTs and then Paramedics back in the 1960s. They were afraid of losing ER positions to lesser trained personnel...it never really came to be...except at not for profit community hospitals and clinics, where volunteer EMT's are used to take vitals and intake interviews.

In an ideal world I would restore every nurse, teacher and other positions...at double current pay. We don't invest in schools. But truly, in the current environment CNA's at up to ten schools, under the supervision of one nurse will have to do. Or in cases like this, mom injecting the kid. Which is the matter of the case in question.

FYI, in Hawaii we knew a family with a type one diabetes patient...she went to school every day, since the school had no nurse. Yup, mom did it. If mom was sick and could not, kid staid home.

The other choice is to home school these kids. I am sure many would love that by the way.

[HiPointDem]

161. baloney.

[proud2BlibKansan]

166. You hire a nurse. That's what you do.

They found the money in my district. It's a lot cheaper than paying off a legal settlement.

[nadinbrzezinski]

170. Yeah that's the theory

In practice they'll fire a teacher or two and hire the nurse.

Especially in a few districts in this state.

I see you did not address the CNA fears. They chose the wrong fight. There are many ways they could make the point without taking the mother of a diabetic child. Personally I hope the mother sues the district under the ADA if what I think would be their preferred result would come to be.

And mom is quite motivated to do a good job by the way.

[uppityperson]

193. Administering insulin and monitoring for reactions is not in the CNA Scope of Practice.

CNAs are trained to do some things and not others. Insulin administration and monitoring for reactions is not in their Scope of Practice.

(edited to change "code of practice" to "scope of practice" as I had a mind fart)

[cprise]

213. Oh, much better to have Mom quit her job then.

In practice they'll fire a teacher or two and hire the nurse.

In practice, our government will put bankers on quantitative easing and leave nurses and students both to twist in the wind.

[Scootaloo]

215. So long as no one touches the football budget!

[uppityperson]

125. "should a trained, but unlicensed non-medical worker be able to give insulin shots to public school"

Read the article.

[HiPointDem]

159. the suit is about opening it up to be done by non-nurses, not just 'mom'. mom has always

been free to come get her kid, take him off school grounds, and give him a shot. or even on school grounds in many cases.

the suit is not really about moms.

[liberal_at_heart]

203. they wanted you to change catheters? That is outrageous.

Good for you and the other fellow nurses who forced them to do the right thing an hire a nurse.

[proud2BlibKansan]

221. Yep

Family was making legal threats so the district finally hired a nurse and then put nurses (RNs) in every building.

[Aerows]

263. That's pure insanity

to expect teachers to change catheters. That's a lawsuit waiting to happen.

[LWolf]

219. No, the other choice is to hire nurses.

They used to, and they can again. My state does.

[TreasonousBastard]

2. Are the nurses primarily interested in the kids' health or...

job protection? One article said the schools are short around 7,000 nurses, who will not magically appear if they win their case. What then?

So, if the nurses win and proclaim this great union victory, how many kids will hurt from not getting their insulin compared to those who are hurt from getting it from the "wrong" people?

I understand that fighting for more nursing jobs and better conditions may not be working too well, but this is a nasty and dangerous backdoor way to get improvements.

[FarPoint]

21. The Board of Nursing and

Nursing Association or Union, they are intrested in the delivery of care to the client / patient
Nurses provide a Standard of Care via licensure. The problem is that non medical professionals are making medical decisions....delegating medical care. That is inappropriate.

[uppityperson]

33. Exactly. thank you. nt

[HiPointDem]

28. There's no nursing shortage in california. Schools are short of nurses because those positions

are being defunded.

[HiPointDem]

39. If you are so interested in kids' health, you should be interested in having school nurses, rather

than having already stressed education personnel doing nursing work on an assembly-line basis.

The OP is a crock of shit. There is no nursing shortage in california, and diabetes isn't the only medical issue in the schools.

[arely staircase]

118. Exactly, but it does sound like there is a shortage of wanting to pay for nurses

nt

[HiPointDem]

148. there's never a shortage of capitalists wanting to drive labor into the ground.

[arely staircase]

169. agreed

I am a teacher in Texas and Perry misses no opportunity to screw us on behalf of his benefactors. I would think this problem about shots could be solved by negotiating with the unions. Things are often more complicated than superficial press reports.

[TreasonousBastard]

126. I think there should be more school nurses. There should be more...

chemistry teachers, too, but making ridiculous demands will not get the kids their insulin.

Demanding more nurses, and paying for them, is the right thing, but until they show up what are the kids supposed to do?

The usual answer to this type of question is that this sort of thing will simply normalize the lack of nurses and make it tougher to hire any more. True dat, but attack the real problem and don't use sick kids as pawns.

[uppityperson]

128. Well, if you can't get a trained medical person, just give it to the office secretary. After all,

the kids have to do something until nurses "show up". Right?

[TreasonousBastard]

208. That's about it. Only nurses should...

do it, but if there are no nurses around, what do you do then?

Really-- aside from saying there should be nurses, what's your answer?

[MattBaggins]

152. Having school Nurses is not a ridiculous demand.

[TreasonousBastard]

209. Missing the point...

"School nurses should do this."

"OK, but what if there are no school nurses?"

"School nurses should still do it."

How does that make sense?

Arguing for more school nurses makes a lot of sense, but until they show up, who gives the diabetic kids their insulin?

[HiPointDem]

226. i guess they'll have to have mom take a long lunch and take the kid off school property.

how do you feel about non-medical personnel changing catheters, as one of the teacher posters was asked to do at her school?

this is what it comes to when you open that door.

it's not the responsibility of schools to do medical care.

[Aerows]

262. Under no circumstance

should a teacher have to change a catheter. That's ridiculous.

[MineralMan]

5. Parents give insulin shots all the time.

Learning to administer insulin properly does not require a nursing license. If nurses are not available and a child needs an insulin shot, what is supposed to happen, do you suppose?

This isn't anti-union. It's just common sense. Insulin injections are not difficult. Most kids start giving them to themselves at a pretty young age, even. This is not a union issue. It is a health and safety issue. Same with epipen injections. If people waited for a school nurse, odds are they might die, since those nurses are scarce as hen's teeth these days in most school districts.

[FarPoint]

48. That is like saying someone can be a brain surgeon

if they can drill a hole into a coconut....My point is not the physical action of administration alone...one must include the clinical concept behind the dosage and to all that this implies.

No, the injection technique is not difficult in itself.....understanding the dosage, the disease of diabetes, current client assessment including blood glucose level from an accurately calibrated glucometer,the diet intake pre-post injection of a juvenile diabetic....that's just off the top of my head for necessary data collection prior to administration of insulin to a labile diabetic as in a diabetic child. Then, the legal liability is another chapter on it's own.

That's my take on the subject at the moment.

[likesmountains 52]

110. This ^^^^^^. Sure, just about anyone can give a shot..

it takes a little more skill (sarcasm) to know when, why, if it's necessary to make an adjustment and know signs and symptoms of hypoglycemia and hyperglycemia.

[MineralMan]

111. And you do not think someone can be trained

adequately, just as parents are? Really?

[FarPoint]

259. Yes I do....

A nurse has been formally trained for this task. A nurse is licensed by a governing board in each state which tells the public that this nurse is competent and responsible to administer insulin, following physician orders, in a public or clinical setting. It identifies that this nurse practices a standard of care.

Lets think about it...your suggesting there be non-medical employees at the school shown how to administer insulin....this tells me the non-medical staff member, be it voluntary or a delegated task would be practicing medicine without a license.

Another thought. If the public does not demand nurses be staffed for such duties and accept the below standard clinical care then...it will never change...it will not be a temporary setting as the bell was rung and this is a downward tailspin thereafter...

Parents or family caregivers are trained to administer insulin...that relationship has a different liability dynamic where they assume the risk and responsibility. A school employee does not fall into this category as they can not practice nursing without a license.

[MineralMan]

261. You're thinking theoretically, and I'm thinking practically.

School districts have cut way, way back on nurses. I don't think that's going to change anytime soon. In many districts, even large ones, there's a single nurse for all schools in the district. That nurse is not available for immediate services at any of the schools.

Given that, and given the need for people who can deal with emergent situations, it's clear that the school nurse in such districts is not the person who is available to cope with such needs. The need is real. The nursing situation is real. So, given the realities of insulin dosage calculation and the responsibility for the well-being of students, the schools have only a couple of realistic choices. They could call 911 for every kid who needs an insulin shot or they can have someone trained to administer insulin.

For children over a certain age, the child him or herself already knows how to give him or herself the proper dosage. I'm sure schools already provide a means for them to do so, but there are children who are too young to deal with their own insulin injections.

The training is not complex, really. Schools are full of people who have the intellectual capacity to absorb that training. There is a shortage of nurses, due to the school's cutting back on nurses. So, what do you suppose their options are?

They should hire a nurse for every school. That's not in dispute. They will not. That is also not in dispute. Kids occasionally need an emergency insulin shot to protect their health, and they're at school much of the day.

I'm not saying there shouldn't be a nurse. I'm saying that there is not a nurse. The problem remains.

[HiPointDem]

163. it's also about having the knowledge well-integrated enough at a deep enough level to do all

those things for multiple children, with multiple issues, using different types of insulins and different dosages, as well as take care of the myriad of other medical issues that might arise at a school.

teaching someone to give a shot (which *is* very easy with the new technology, you just stick in fatty tissue) is the *least* of it.

[usGovOwesUs3Trillion]

53. But it won't be parents giving the shots to their children...

could be the janitor, I suppose... anyways, I would prefer a trained nurse handle medical issues with my child, just like i prefer a janitor to keep the lights and heat on.

this sounds like just another attempt to skimp on public services to me... and divert the money to the military, banking, and political industrial complex... a sad state that has been going on for decades

[MineralMan]

112. No, it will not be a janitor.

It will be a person who is trained, just as every parent of a diabetic child is trained. Do you suppose that people at a school are incapable of such training, but parents are capable? How odd.

[Fumesucker]

116. Such trained people exist now

They are called "nurses".

[HiPointDem]

165. +1. what they mean is 'train' people to do one tiny subroutine, like a machine, without the

background of medical knowledge that supports that subroutine.

it's like in a factory, where instead of skilled people, you break down the task so one person turns a screw all day without knowing how the machines work.

that approach doesn't work in medicine.

[MattBaggins]

160. No the teachers are not as qualified as a parent

The most important part of taking insulin is knowing the signs of too much or too little. When a parent gives that insulin at home they know the child's averages and what to expect. They do not give insulin to one child and then can watch and monitor them. They do not have to watch 30 kids at once. A nurse is better qualified to concentrate on just the kids in need. They can better determine what the child is about to eat, how much that child usually eats and how they respond to insulin and exercise.

[Ilsa]

180. Parents go through extensive training

of all aspects of diabetes when their child is diagnosed. It occurs over weeks. Sometimes retraining is necessary on the details. That's not the kind of training that nonlicensed school personnel do. Delivering insulin is "invasive", and should be done by persons with the right training or motivation for accuracy, ie, the parents.

The only way I'd even consider letting a nonlicensed person administer insulin is if it was a novolog dial-a-dose pen. Even then, a sliding scale is usually used, dependent on a blood glucose reading.

BTW, epipens dont require dosage calculations.

[uppityperson]

6. Last link isn't complete. Thinking back to when I first worked as a nurse, had to have a 2nd one

check the amount before giving insulin. We've come a long way but I would worry about liability if allowing someone to give insulin. It would take a fair amount of training, why not just hire a nurse?

"Insulin as a medication can be fatal if given wrong. It's a hormone. Too much insulin can cause fatality and can cause it fairly quickly," said Davis-Alldritt.
(clip)

"It's easy to give a shot, but it's not easy to do the assessment on whether or not that child has been successfully treated with the medication they've been given," said Davis-Alldritt.

However, I wish there were more school nurses. Cutting them was a bad idea as they do a lot, can do a lot (our could).

[Laelth]

9. I ordinarily support labor. This time, however, is an exception.

That said, I am relying on the assertion that there truly is a shortage of nurses in California. In other words, if the schools simply lack money to pay the nurses, I say hire them and let them do the work. If there's truly a shortage, however, trained professionals who are not nurses will have to do.

-Laelth

[Omaha Steve]

11. It is a true shortage

IF they raised the nurses wages, I'm sure non-California nurses would move there.

[HiPointDem]

23. Schools don't want to hire nurses and its not because of a shortage of nurses, it's because of

a shortage of funding and will.

This article is education deform propaganda.

Why should education personnel be giving kids shots? If anything goes wrong (as it has already under such policies), the liability, for one thing. Insulin administered wrongly (or not administered) can KILL.

Obama's stance is crap, but not surprising in the least; he's all about education deform, union-busting, lowest-common-denominator crap.

[uppityperson]

37. Seriously. Liability is a big issue here. Yes, kids need their lifesaving medicine BUT they need it

given by a parent or health care person.

[HiPointDem]

41. It's a *huge* issue, especially with school budgets already stressed. And it plays right into

the hands of education deformers: another angle from which to attack public schools, which serve a disproportionate number of special needs students with difficult medical issues.

"Just have the teacher calculate Johnny's IV feed, it's just simple math"

makes me sick.

[uppityperson]

45. Friend of mine was a music teacher in elementary school. Got hrs cut, things added, ended up

being music teacher for 6 grades (was 4), school librarian for 6 grades, then they wanted to add giving kids medicine during the day at which point was told "no way, think of the liability). Retirement happened finally.

School budgets are stressed but there is a reason nurses go to school for 2-6 years.

And "shortage" my shiny butt.

[uppityperson]

34. "IF they raised the nurses wages" is the telling thing. There are plenty of nurses, just few who wil

do high stress, high responsibility jobs with low wages and understaffing. There are plenty of nurses in CA.

[HiPointDem]

44. school nurse postions are being cut, entirely defunded. thus we get propaganda articles like

this instead of the actual facts.

'well, we'd like to have a nurse but there just aren't any...'

no, you cut the position & are trying to make it up on the cheap.

[HiPointDem]

32. There's no shortage.

[DevonRex]

137. There are whole districts that can't afford nurses. Money is the problem.

Not a shortage of nurses. So diabetic kids in poor districts can't even go to school the way it is now. Which is why DOJ is enforcing ADA. Hopefully it will shake some money out of state funds for the nurses. If not then the kids, by Federal law, can't be denied an education because of diabetes. Thus the push for maybe some other trained person to be able to do it.

[FarCenter]

12. Seems like a third grader could give themselves injections?

[nadinbrzezinski]

16. Third graders under supervision regularly do, in fact

The tricky part is the units/carb dose. A math mistake can be deadly. But kids learn the self administering part that early.

[FarPoint]

59. Figure skating looks easy too...

but it certainly involves more that wearing a pair of blades. Non-medicall individuals only know what they see...immitating a clinical skill looks easy and techically can and has been done.....

Understanding the concept behind the action is what is missing in this scenerio. Letting an ordinary stranger, unlicensed, to administrate insulin to a child is dangerous and a liability as well. This is an area that is regulated by a Nursing Board...to protect the patient and society...the Board of Nursing was established for this very reason.

[nadinbrzezinski]

77. Diabetics are trained to self administer

And kids are encouraged to take charge of insulin administration, fully, as soon as they are mature to do it. Adults self administer insulin regularly too. Those dependent on insulin also know they need to test sugar levels regularly.

Hell, I administered insulin to my father more than once and my mom did so as well.

Diabetic kids regularly do this as early as 15, all of it. And third graders learn to inject as part of treatment...

or do we issue diabetics a nurse with the pen? (New fangled device, easier than the syringe)

[FarPoint]

82. I'm not in support of non-medical personnel administering insulin.

Granted; self education in widespread and can be successful and new technology has simplified the administration. I can not support non-medical employees providing diabetic management to school children with diabetes. That duty solely lies with a licensed nurse.

I will always fall back on the Standard of Care guidelines from Nursing because it is regulated for client/patient safety, that is it's purpose. Especially with children as they are one of our vulnerable groups. I believe this issue along with the disease of diabetes has been marginalized, simplified when it should never be assume to be a simple disease.

[nadinbrzezinski]

85. So you think we should issue a nurse

with the patient given that most of it is done in the home setting? Or should we just have all insulin dependent diabetics 24/7/365 in the hospital?

And yes, I know how dangerous it can be...it is one dangerous drug and you can die. I take an oral medication which has a very nasty effect, potentially as well, hypoglycemia...within 90 minutes if not taken with food. I suppose I need a nurse. Oh wait, doc took tje time, and I took the extra time to do extra research into it.

You might not like it, but in the real world most diabetics self administer at home. Good patients are very aware of the signs and symptoms of hypoglycemia, been there done that, both with dad and me, and have glucose at home. Preferably metered, but a nice glass of juice will do the trick, or a cold glass of coke. Most of these patients were indeed educated on it by doctors and nurses who specialize in diabetes treatment.

Most emergencies, I promise you, do not reach unconsciousness, or inability to swallow. But do reach the take the tablets...stage...been there, done that too.

[HiPointDem]

88. your discussion of what's done at home by adults is completely beside the point.

[FarPoint]

89. To answer your question...

Last edited Wed Jun 5, 2013, 05:13 AM - Edit history (1)

Yes, they need a nurse in a school setting to administer insulin to children. Not the janitor. A nurse could make rounds in a school district and accomplish several clinical needs.

[uppityperson]

90. And what someone does at home is different than at school.

Yes, parents medicate kids all the time and older kids medicate themselves at home. However, school is a different thing and having someone educated and experienced enough to make sure the kids are safe is a good thing.

[nadinbrzezinski]

95. Alas the suit is not talking of the janitor

They are talking of a mother, trained by their medical provider since they don't have that nurse available.

In an ideal world every school should have a nurse, I prefer to live in reality.

[uppityperson]

92. But nadin, you are not a school child but a highly trained Professional. Big difference between what

you do at home and keeping kids safe at school.

[HiPointDem]

227. also what you do to yourself & what you do to someone else's children.

[supernova]

18. Was just thinking this

It seems that the older a kid gets, they could, with adult supervision, give themselves the right dose. Diabetes is not unmanagable. In fact, they should be learning how to care for themselves.

Not every school can afford an RN. I think this is not a workable POV for the nurses' union. There are bigger battles to fight and this is a bad one.

[MattBaggins]

164. This is not by any means a bad fight

wrong wrong wrong

Every school should have a full time Nurse and even pediatricians that visit at least weekly.

[FarPoint]

65. Technique...yes, it is not difficult...

Clinical concept....not so much....Like...what to do if given the wrong dose say too much insulin?

Example what if the layperson read 80 units when it should of been 30 units? Now what does one do? What if the child felt ill...went to the restroom and then went into insulin shock and no one knew? It can happen within 1 hour; who is responsible?

What if the insulin is based upon a glucometer reading and the glucometer was not calibrated correctly or at all? The meter could give a false high reading....resulting in an OD of insulin. A nurse would check the glucometer daily and would recognize signs and symptoms.


I want a nurse giving children their insulin...not the janitor.

[rl6214]

14. As a type one diabetic myself and the father of a type one diabetic

A nurse is not necessary to administer an insulin shot.

[uppityperson]

38. Would you be ok having a school secretary give your kid insulin?

Maybe have a licensed health care person draw up the correct dosage, have a weeks worth in a box for the kid to self inject at school?

[Ilsa]

187. It doesn't work that way for many diabetics.

They may take a fairly stable dosage injection of long-acting insulin every morning at home but need correcting dosages during the day depending on how much exercise they've gotten, how well they ate at lunch etc. There are dosages reliant on sliding scales of blood glucose levels, etc.

I wouldn't want the office secretary making decisions about that for my child.

[uppityperson]

190. I agree and have been saying that throughout this thread.

I thought I didn't need the sarcasm smilie but was wrong. Sorry.

[Ilsa]

192. I haven't been able to keep up with

Which poster is on what side.
Sorry!!!

[FarPoint]

83. The knowledge about the disease

and what variables in daily life effect diabetes are known to you and your father.....I do not believe non medical personnel have this insight.

[MattBaggins]

167. As an insulin dependent diabetic.. yes they are

You think nothing of it because you know your and your child's diets and insulin needs inside and out. It is simple to you. It will not be simple to a teacher who needs to give 5 different levels of five different types of insulin to five different children while they have to monitor and teach 30 kids.

[WinkyDink]

15. "unlicensed non-medical worker"? 1. What could go wrong? 2. Who could have predicted...?

[dballance]

17. I Really Can't Support the Nurses on This One.

I believe the insulin injections are subcutaneous and not intravenous so the non-nurse doesn't have to find a vein. These days, there are also those "pens" where all you have to do is dial the dosage and hit the skin with it. I know a couple of my friends have these and they work well. I don't know if those are available for children or just adults. They're no more difficult to use than an Epi-Pen which, I hope, every school has on hand for allergic reactions.

Even if the non-nurse has to draw the insulin from some sort of ampule or vial it's not terribly difficult to get the dosage correct in the syringe. I've done this in the past quite easily.

Sure, I'd love to see all schools have a nurse on staff full-time. I'd like to see them continue to have art class, music class and libraries too. Unfortunately, that's not all possible in the current environment.

[MattBaggins]

168. It is not that simple

[usGovOwesUs3Trillion]

19. the new normal... schools can't afford nurses

where has all the money gone?

It looks like we need to take a hard look at our current system and make some changes... begging with putting people ahead of profits.

[X_Digger]

22. We never had a nurse at school, in the 70's-80's

We saw a nurse every couple of years- a hearing test, the girls were checked for scoliosis at about age 12 if I recall correctly, and I believe there was at least one vision test.

[HiPointDem]

25. we did. in the 50s.

[X_Digger]

29. Perhaps it was the size.. I was in a rural area.

There were about 300 kids in my elementary school (K-7), my graduating high school class was ~120.

[FarCenter]

26. No nurse in elementary school

Of course, there was only the teacher and about 14 students.

In high school, there was a school nurse, but I believe that there was no coverage if she was off. Having start to end of day coverage on every day requires multiple nurses.

[HiPointDem]

42. "Having start to end of day coverage on every day requires multiple nurses." = how's that?

[FarCenter]

46. You need another nurse when the primary nurse is off sick, family emergency, etc.

And you may need coverage from the time kids begin arriving until the time after-school activities end, which may be more than a normal workday.

You probably need a full time nurse employee, plus some part time and on call fill nurses, maybe arranged with local medical offices or hospitals. Of course, I'm not sure whether CA requires special certs to work in schools?

[uppityperson]

47. Sort of like teachers, right? Why do we need teachers?

[FarCenter]

50. You need teachers because it is a school.

But it is not a hospital or medical office.

[uppityperson]

51. No you don't. Teacher aids/assistants can do most teaching. Have 1 or 2 licensed teachers on staff

to supervise and the TAs can do most of the work. No need for licensed/certified teachers. Lots of parents home school their kids without being licensed. It isn't that hard.



but do you see the point?

[FarCenter]

56. If teachers aids/assistants are teaching, then they are teachers

My teachers in the early grades had one year of "normal" school beyond high school.

Credentialism is overrated.

[uppityperson]

64. No they are not. Teachers are licensed/certified different than TAs are. And times have changed

since you were a kid.

[HiPointDem]

52. Schools full of children with medical issues. I guess we should bus them to the hospital for

their tube feedings, insulin doses. etc.

and just call 911 for all medical emergencies.

[usGovOwesUs3Trillion]

43. thats when i went to school, and we always had one

and my kids have had one through k-12.

I will admit I don't know what the statistics are, but i would not be surprised if there is a downward trend since the 70s, considering all the other cuts in public spending there has been.

[HiPointDem]

49. Of course there's a downward trend. That's why propaganda articles like this are necessary, to

mystify what's actually being done to people.

[usGovOwesUs3Trillion]

57. yeah, that is what i suspected

fortunately we now have the internet to help educate ourselves to what is really going on, and then to pass the word.

[Xithras]

236. My kids attend a 30,000 student, 35+ campus district with ~10 shared nurses.

Most of the schools have nurses on campus only one or two days a week.

[HiPointDem]

20. There is no freaking nursing shortage in california.

More than four out of ten (43 percent) of California nurses, who were newly licensed as registered nurses in the previous 18 months, say they could not find a job, according to a recent survey paid for by the California Institute for Nursing & Health Care (CVBT, 2012).

http://allnurses.com/general-nursing-discussion/no-nursing-shortage-752411.html


I can't find a nursing job! Whatever happened to the nursing shortage? These new grads can't find jobs, after months of searching...The truth is, new nurses are graduating and struggling to find jobs. I want people to know how bad the situation is for us.

http://money.cnn.com/gallery/news/economy/2013/01/14/nursing-jobs-grads/index.html


California has seen an even more dramatic rise in the number of new nurses, said Joanne Spetz, a professor at the Institute for Health Policy Studies at UC San Francisco. "We are seeing a lot of young people entering the field, which is fabulous. These are the people we need to be moving into the nursing workforce."

More than 11,500 people graduated from California nursing schools in 2010, up from 5,300 in 2002, according to a report Spetz did for the California Board of Registered Nursing. Much of that is due to a concerted effort by hospitals, foundations and policymakers to expand nursing school slots, she said.

http://articles.latimes.com/2011/dec/06/local/la-me-nurse-shortage-20111206


Schools don't want to hire nurses, that's all.

And that has to do with budgets and education deform.

[uppityperson]

40. Thank you. That line is infuriating and wrong indeed. There are plenty of nurses, new grad and exper

experienced ones who can't find a job or are working understaffed for crap wages.

I got this from my PA when I asked why they hired MAs not RN/LPNs. He said personnel said they didn't get any applications but that is a total lie as I apply regularly. Why not hire me? Because MAs cost less. They do less, but after all who needs someone who can do more when the goal is to push people through as fast as possible?

Same with schools, including ours.

If they paid enough, if they saw a benefit in funding a RN , they would hire one. But it costs money so let's get by as best we can otherwise.

[Omaha Steve]

91. I stand corrected

THANK YOU!

[HiPointDem]

98. In these times one's first reaction to hearing of labor shortage should be to look for

evidence.

99% of the time it's a lie or exaggeration. And when the proposed 'solution' is to use low-paid workers or volunteers to do the same work, 100% of the time.

[DevonRex]

135. The article says it was a money shortage. Schools can't afford nurses.

Same article as the OP:

"State law says no, but in the midst of recent budget cuts, not all schools could afford a nurse. In some districts that actually have school nurses, the ratio is 6,000 students to 1 nurse. Consequently in 2007, the without Legislative approval the Department of Education allowed other school employees to give the shots. The President of the National Association of School Nurses, Linda Davis-Alldritt, says that move jeopardizes student safety.

"Insulin as a medication can be fatal if given wrong. It's a hormone. Too much insulin can cause fatality and can cause it fairly quickly," said Davis-Alldritt.

Critics of the nurses' unions, including the American Diabetes Association, say they're just trying to boost jobs and that insulin shots can be administered safely by other people."

[Aerows]

265. Can they better afford

lawsuits that will result when something goes wrong? Because if a child dies or becomes seriously ill, the parents are going to sue the shit out of the school.

[DevonRex]

270. We're on the same page here.

This is definitely DOJ forcing them to do something. Sometimes the lawsuit has to be forced before the schools see exactly what's at stake. Now all the parties are lining up and the schools and the state are getting it from all sides.

I think the nurses' union will force the state to come up with funding because a statewide strike would be catastrophic. Let's keep our fingers crossed since that would be the very best outcome.

[X_Digger]

24. I was giving insulin injections to my grandfather at 14.

And I had to teach my wife how to inject herself a couple years ago (she's a type 1.5* diabetic.)

It's not rocket science. If the choice is no insulin or having a trained non-nurse do it, I know which one I'd choose.



* ie, she's not type II, nor type I.. brought on by other chronic inflammatory disease- not insulin resistant, she's not producing insulin.)

[WinkyDink]

31. Isn't "family" a different category?

[HiPointDem]

35. +1. For one thing, they probably won't sue if you make a mistake. I can't believe the posters

on this thread.

[X_Digger]

36. Sure, but the training given to family members takes about an hour tops.

The nurse educator who came in to teach my wife spent more time on diet and counting carbs than how to calculate the dosage for adjustment shots.

It's simple math.. 2 units per 5 points of glucose above 150.

[HiPointDem]

62. Your wife presumably has a particular interest in her own health and access to medical care

if problems arise.

Presumably she does not have to administer a variety of types of insulin, at varying doses and schedules, to multiple children with a variety of confounding medical problems, as well as dealing with an even wider variety of other medical problems -- WHILE SHE IS ALSO DOING HER REGULAR JOB.

Presumably she won't sue herself if anything goes wrong, either.

It's ignorant to claim that a breadth of knowledge and experience can be replaced by teaching someone without such breadth of knowledge multiple mechanical routines.

Sure, 'an hour tops'.

[X_Digger]

100. There are only two general types of insulin..

One is a fast-acting, taken before meals, and one longer-lasting, that's taken at night before bedtime and maybe in the morning before school.

The only one schools would have to deal with is the fast-acting- and only if glucose levels are above a certain point.

Seriously, ask a diabetic friend what it takes to calculate dosage and administer it. The instruction sheet is less than half a page.

There are no complex calculus formulas, no alchemical calculations, no 'confounding medical problems' (that affect dosage of fast-acting insulin).

But hey, if the point is really about liability, then let the kids stay home, eh? Or let them get neuropathy, possibly blindness rather than risk a lawsuit. Much safer that way, right?

[uppityperson]

101. You are comparing kids in school to an adult at home. Why do you want to risk kids at school?

You see no liability issues with letting a non-medically trained person giving insulin at home. I see no problem with that either. But at school, yes it is a liability issue.

[X_Digger]

103. I'm comparing one adult to the other (other being the person in the school who would be trained.)

Buy hey, if the fear of lawsuits leads some kids to lose their feet or vision.. at least we're not going to get hit with a lawsuit, right?

[uppityperson]

106. So you agree having a trained medical professional is good. Not sure what your point is other than

to snark.

[X_Digger]

108. Of course it's better. But is the alternative to have *no* insulin absent a nurse?

I have a problem with that, yes.

Especially if the main objection to such is because of liability.

[MattBaggins]

175. "no 'confounding medical problems' (that affect dosage of fast-acting insulin)"

This statement is dangerously wrong.

[HiPointDem]

194. no, there are not only two types of insulin. You're misinformed.

[X_Digger]

198. Okay, a mix of the two, as well. But generally, yes.

As someone who's cared for multiple people with diabetes, and went to nursing school, I'm quite familiar with different kinds of insulin..

http://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/types-of-insulin/

Types of Insulin

There are three main groups of insulins: Fast-acting, Intermediate-acting and Long-acting insulin.

Long-acting is usually given at night (or in the morning as well for folks who split the dose) so wouldn't be involved with a kid at school.

Pre-meal bolusing is what kids would be doing, and is very easy to calculate.


Again.. it's not rocket science.

[HiPointDem]

202. there are more than 3 types of insulin.

[uppityperson]

196. There are"no 'confounding medical problems' (that affect dosage of fast-acting insulin)"? Seriously?

I mean, what? Of course there are. If you have a fever, or are sick in another way, or are taking other medicine, or have a multitude of "confounding medical problems". A LOT of medical problems affect the dosage of fast-acting insulin.

If you seriously believe that, you are VERY wrong.

Start by reading this reply in this thread.
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2938072
It's still difficult convincing myself that I need as much or more insulin when sick

Even when not eating, or very little.

First link I found
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-routines.html

Fine-Tuning Your Blood Glucose
Many factors affect your blood glucose levels, including the following:

What you eat
How much and when you exercise
Where you inject your insulin
When you take your insulin injections
Illness
Stress

[X_Digger]

199. Did you even read your own link?

Illness affects blood glucose, but not the dosing.

If you're still eating a regular meal of the same carb count, you dose the same bolus, regardless of whether or not you're ill. There's no magical formula that says, "If fever is over 101, reduce units by X, if over 102, add Y units." If you're screwing with your doses based on how you feel, you're playing with fire.

If you're puking your toenails up from the inside-out, and not eating, you don't dose fast-acting (so as not to go hypo).

As someone who's cared for multiple folks w/ diabetes (and went to nursing school to boot), I've been there, done that.

[uppityperson]

200. If you are a nurse, you should know that illness affects bs levels and hence may need a different

amount of insulin. Being sick, your body uses more energy and hence may need different amount of insulin as well as closer monitoring for ketones.

Of course there is no "magic formula" but there are medically prescribed dosage variations based on things like illnesses.

As someone who's cared for multiple folks c/diabetes, gone to, graduated nursing school and licensed/worked in several states, been there, done that.

ETA
http://diabetes.webmd.com/tc/sick-day-guidelines-for-people-with-diabetes-topic-overview?page=2

Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check blood sugar and urine ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends.
(clip)
Minor illnesses in people with diabetes-especially children with type 1 diabetes-can lead to very high blood sugar levels and possible emergencies. When children are sick, watch them closely for signs that they need immediate medical attention.
(clip)
It may not be necessary to call your doctor every time you or your child with diabetes has a mild illness, such as a cold. But it is a good idea to call for advice when you are sick and:

Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount of insulin in your sick-day plan.

Having worked as a nurse on the end being called, and in hospitals and SNFs, yes. Insulin is sometimes changed during times of illness.

[X_Digger]

204. Yes, that's true.. but it's the same formula, always (assuming you're still eating.)

You don't change your dose willy-nilly day-to-day. In consultation with a doctor, based on chronic conditions, sure.

Any nurse who decides on their own to change a patient's dose is in for an even larger lawsuit should things go south.

[uppityperson]

206. I will use small words. WHEN a kid gets sick, their blood sugar levels can vary and cause problems.

Sometimes their insulin dose may change.

I am not saying a nurse should "decide on their own to change a patient's dose" but addressing the fact that sick kids with diabetes need closer monitoring and can have big problems. There are things like illness and stress that affect blood sugar levels and ketones. A trained medical professional would be better to deal with this than a school staff member.

Do you understand?

And there are more than 2 kinds of insulin.

[X_Digger]

207. You dose fast-acting insulin based on two things- glucose level and expected meal size.

That's it. You don't change the dose based on anything else, short of consultation with a physician.

Long-acting, yes- you change that with illness, per a scale you discuss with your physician. But a school wouldn't be dealing with long-acting insulin unless it were an overnight trip.

[uppityperson]

217. Being sick can may affect the insulin amounts needed.

You said there are no confounding medical problems that will do so. That is wrong.

I do not know why you continue to say "don't change it except under order from a physician" as NO ONE is saying do that.

It is simple though. Sometimes there ARE medical problems that affect insulin dosage. You are wrong to say there are not.

[X_Digger]

223. That's the long-acting, not the fast-acting.

A dose that a school wouldn't be dealing with.

[HiPointDem]

228. you have no idea. don't generalize from your own experience.

[X_Digger]

230. Yes, I shouldn't generalize from what nursing schools teach. *snort*

Please enlighten us, as to what discretionary fast-acting dosage changes a nurse makes, based on something other than glucose level.

If there are none, then your whole line of codswallop falls apart. Based on your posts, you'd think kids were dying like mayflies because their incompetent parents don't have the magic ju-ju to properly administer insulin.

[uppityperson]

231. Not what I was taught in nursing school. Sometimes it is, sometimes it isn't.

When a person is sick, their glucose level can change and the insulin may need modification per doctor's order. Or it may remain the same. Generalizing to "all" is wrong. For you, no change. For someone else, there may be a change.

If the doctor's order is sliding scale based on bs level and the level changes due to illness, then so does the amount of insulin needed.

If your "nursing school" didn't teach you to follow a sliding scale, you need to get your money back.

[X_Digger]

232. Perhaps you're not reading my post..

If the doctor's order is sliding scale based on bs level and the level changes due to illness, then so does the amount of insulin needed.

as to what discretionary fast-acting dosage changes a nurse makes, based on something other than glucose level.

Do you not see that those statements are the same? Illness affects blood glucose, but it's the same meter reading used whether or not one is ill. The only discretion (real-time) in dosing fast-acting is when you know you're not going to eat because you're too ill.

There's no magic knowledge in dosing pre-meal insulin, no 'if X then +Y' complications to be decided at dosage time, other than glucose level.

[uppityperson]

235. "that's the long acting, not the fast acting"

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=2939424

Now you say it is the fast acting. Now you agree that fast acting insulin dosages may change, which has been my point through this subthread.

[X_Digger]

237. Apparently you AREN'T reading

The only one schools would have to deal with is the fast-acting- and only if glucose levels are above a certain point.

no 'confounding medical problems' (that affect dosage of fast-acting insulin).

You don't change the dose of fast-acting insulin based on illness- it's *always* by scale, assuming you're still eating. Illness may affect blood glucose, but it's always the same scale. Should I use smaller words?

You can change your long-acting while ill, based on a preset amount in consultation with a physician. Long-acting is not typically given throughout the day, when school nurses would be caring for kids.

[uppityperson]

239. "illness may affect blood glucose" and hence insulin is what I have been saying

Looks like you are saying now that you agree since that is your quote.

[X_Digger]

240. Are you intentionally being obtuse?

The scale is the scale. The scale doesn't change with illness- the result may change, but not the scale.

A person with a sixth grade math education can determine the proper amount of insulin to dose.

[uppityperson]

241. "the result may change" is what I have been saying. I guess you agree with me but not sure why you

continue to insult me. Odd.

[HiPointDem]

233. says the person who originally said there were only two kinds of insulin. and then said there were

3.

wrong and wrong.

[MattBaggins]

174. It's simple when it you or just one child in your family

It is easy when you know your own body. When you know your own eating schedule. When you know your own food likes and dislikes. When you only have one or two types of insulin to give.

You have 30 kids to watch and three need insulin before eating. You have to calculate how much each will get. What happens when Mary does not like her PBJ sandwich and throws it away with out you knowing? She now leaves the lunch room and goes to gym class to work up a sweat... oooooops.

Please let the Nurses do their jobs.

[X_Digger]

201. Then Mary gets a glucotab, and a stern look for not eating her PBJ while you wait for mom.

Or a sub-lingual strip of the same while you wait for the ambulance to arrive, holding her in the rescue position, if unconscious or post-seizure.

What, you think a nurse is going to magically sense that Mary didn't eat her PBJ?

All educators should know what to do in case of hypoglycemia, how to use an epi-pen, how to do CPR, how to do the heimlich, first aid for punctures and cuts, the signs of anaphylaxis, and how to deal with epilepsy-- hell, I'd go so far to say that *every* adult needs to know these things.

[Lars39]

222. Type II versus Type I in a growing child

Treatment can be very didfferent at times.

[elleng]

54. 'except in emergencies'

suits these situations, imo.

[RandySF]

55. WTF??

I would not let my kid near a non-medical professional with a hypodermic.

[patrice]

60. Are CNAs or CMAs "non-medical"?

[HiPointDem]

66. They practice under supervision. And yes, from my experience, they're pretty non-medical.

[patrice]

75. I have heard from some in the field that the whole profession has declined, STARTING with

the schools of nursing, over the last 15 years. I suppose that could be expected with the rise of diploma mills and other types of one-size-fits all education, e.g. online education, that we have seen across ALL career fields.

[HiPointDem]

76. Neoliberal economic policy & concentration of wealth & power are the root causes.

Profit-driven health care is the symptom, and it 'trickles down' in lots of ways.

[patrice]

81. I agree. If there ever was a field RIPE for worker owned co-operatives, you'd think this would be it

[HiPointDem]

94. there are such, starting with doctors' practices. but the drivers of cost, wage cuts &

deskilling are outside the control of labor, so coops arent' going to help the situation.

Much of health care is paid by the feds; the rules are set by the feds, and in the interests of the people who pay them, in order to increase profits to the various industries involved.

[MattBaggins]

178. I know dozens of Nurses

with Masters and above who believe in Homeopathy and crap like Reike, so they and the system that doesn't teach them basic Science are as much to blame.

[HiPointDem]

188. The system does teach them basic science. You're just mistaken on that point.

[nadinbrzezinski]

142. Would you let your kid near your wife?

This is coming from a mother that needs to care for diabetic child

[patrice]

58. Doesn't "if no nurses are available" imply that if nurses ARE available the Obama administration sup

ports that they should give the shots?

It seems that the problem here is the definition of "available", so we need more information about differences between the two sides in how they see that word applies to this set of circumstances.

[uppityperson]

63. From the OP article....why a "shortage"

Cones, the nurses association's lawyer, said no U.S. court has ever ruled that federal disability laws override a state's authority over medical care and licensing. She said the main reason California schools don't have enough nurses is that they're reluctant to spend the money to hire them.

[HiPointDem]

67. no, it doesn't. nurses are always available if you care to make it happen. the admin is just

encouraging the latest lowest-common-denominator attack on the population.

[patrice]

70. - or - they'd like to see the level of professionalism amongst med techs and such increased, which

could be helpful to the pressures upon nurses, especially in a nursing-shortage environment.

.....................

"attack on the population" . . . really? It is possible that you could have a hard time being taken seriously with wild-ass accusations like that. People actually do have reasons for things that you may not perceive and if you wish to make a serious case for "attack" you do need to, at least by the process of elimination, account for those other reasons.

[uppityperson]

71. There is NO nursing shortage. There are PLENTY of nurses. The only shortage is nurses who do not

want to work understaffed for crap wages. There are also tons of nurses who can not find jobs.

[HiPointDem]

74. There is no fucking nursing shortage. A 'med tech' works in a lab. It would be medical assistants

and CNAs in the schools, they're paid shit.

"Increasing the level of professionalism" = driving down wages, cutting jobs, attacking unions and driving down standards of care.

[patrice]

79. Over-worked nurses with too many patients seem like issues that CNA/CMAs coud help ameliorate if

nurses had more power to define their working conditions, especially scheduling, relative to the medical corporations that they work for. Too bad this hostility between the fields mitigates against that kind of power and, in fact, enslaves both levels even more and more.

[HiPointDem]

80. Nurses aren't overworked because of a CNA shortage, they're overworked because of budget

& position cuts in the name of better returns to shareholders and deliberate austerity policy generally.

'this hostility between fields' = neolib apologetics

it's the slavemasters creating the 'hostility'; attacking people's livelihoods and pitting people against each other tends to do that, as the slavemasters know full well.

it's a result they desire.

[patrice]

86. I didn't intend to imply that. I have stood with nurses' local here & I have administered programs

that delivered their continuing education units for re-licensure, programs in which I read volumes of their written feedback, every week, for 3+ years (and also that of CNAs/CMAs, Medical Social Workers, Administrators, and Dieticians). I have some idea of what their problems are.

Yes, nursing shortages are not caused by CN/MA shortages; the respective shortages most immediate causes are different. The causes in nursing we have mentioned. The shortage causes for CN/MAs are about very low wages, poor scheduling, high patient to staff ratios, expensive benefits, no child care, lack of professional respect and the fact that "shit" just naturally rolls down-hill so whatever goes wrong becomes the fault of the person at the bottom of the power structure.

CN/MAs have more responsibility than they have power to deal with their problems. Though somewhat different proximate causes, the shortages in the respective fields are concurrent, because they are result of the same thing: mid- and higher- level management that have nearly nothing to do with direct care and yet make the lion's share of decisions about how direct care is done.

[HiPointDem]

93. There's no shortage of nurses *or* cnas. You are arguing for driving down wages & skill levels,

whatever you think you're doing.

Medical continuing education is, frankly, crap, at least in my field. The same capitalist mindset that's designing high-stakes testing, run by the same companies. It doesn't foster deep well-integrated knowledge.

That's my opinion based on my personal experience with it. Nothing personal towards you, it's one of my pet peeves.

[patrice]

105. Yes, "driving down" as long as the respective labor organizations are fighting each other instead

of collaborating to increase the professional status, and hence the wages and working conditions, of the poorer workers and to protect the professional status and increase the power to control their work environments of the better paid workers.

And you know nearly 0 about the specific nature of our learning opportunities.

[HiPointDem]

205. nurses have the professional status to administer insulin. CNAs don't. When they do, they will

be nurses.

I know something about continuing ed for medical personnel though. It sucks. It's a for-profit business and it sucks bigtime.

superficial crap, run on the same model they're trying to impose on education generally. online, junky multiple-choice tests, international reach.

[DevonRex]

131. BULLSHIT. The article says budget cuts forced schools to let nurses go.

"State law says no, but in the midst of recent budget cuts, not all schools could afford a nurse. In some districts that actually have school nurses, the ratio is 6,000 students to 1 nurse. Consequently in 2007, the without Legislative approval the Department of Education allowed other school employees to give the shots. The President of the National Association of School Nurses, Linda Davis-Alldritt, says that move jeopardizes student safety.

"Insulin as a medication can be fatal if given wrong. It's a hormone. Too much insulin can cause fatality and can cause it fairly quickly," said Davis-Alldritt.

Critics of the nurses' unions, including the American Diabetes Association, say they're just trying to boost jobs and that insulin shots can be administered safely by other people."

[uppityperson]

61. Telling quotes from OP article and CORRECT LINK

http://www.sfgate.com/default/article/Obama-administration-steps-into-insulin-shot-fight-2369896.php

On the other side is the American Nurses Association, which argues that allowing non-nurses to give shots could harm children and discourage schools from hiring more nurses.

If the court agrees with the Obama administration, said Maureen Cones, the nursing group's lawyer, "students with disabilities will lose their right to receive health care from the licensed professionals who are best qualified to provide it."
(clip)
The diabetes association argues that the lower courts misread state law and that schools can designate employees to "assist the child with medication," said Dennis Maio, a lawyer for the association.
(clip)
Cones, the nurses association's lawyer, said no U.S. court has ever ruled that federal disability laws override a state's authority over medical care and licensing. She said the main reason California schools don't have enough nurses is that they're reluctant to spend the money to hire them.

[Hayabusa]

69. I know that the mom likely knows how to give the shots

but having her do them at the school with no medical supervision opens up a huge liability against the district in my opinion. What if this is the one in a million chance that she gets it wrong?

[Yo_Mama]

130. There is no liability issue because it's not the school doing it

But parents shouldn't have to go to school to give their kids insulin shots.

[madrchsod]

72. i've had a lot of needles in me for the last few years.

i have had nurses that can find my vein without any problem and no pain. i've also had nurses that could`t find a vein if it was yelling at her. letting a untrained non professional give shots is really stupid especially dealing with children. there`s more than one thing that could go wrong and i doubt a non professional could handle an emergency situation.

[Bay Boy]

102. A nurse having a problem finding your vein...

...(most likely) means they were trying to start an IV on you. Poking someone with a shot of insulin is many times easier to do.

[Yo_Mama]

120. Insulin is not administered into a vein

It's a tiny little needle that goes under the skin.

Nowadays, a lot of people use pen types, which are really easy.

[nadinbrzezinski]

140. Insulin is not going into a vein

So that's not an issue. An issue is using the same spot too often, leading to the formation of fat deposits

[madrchsod]

183. thanks.... i did`t know that.

[nadinbrzezinski]

185. You want to laugh? I used

Insulin syringes decades ago when my cockatiel needed shots...for Tuky it was a full fledged syringe. It's a matter of scale

[patrice]

73. Wondering here how the old hates between the AFL-CIO and SEIU, the main organizer for "lower"

medical professions, are getting on.

[Omaha Steve]

153. On the local and state level everything is fine

My local Federation of Labor is AFL-CIO. The SEIU and Teamsters are both in it.

[limpyhobbler]

84. Every school should have a nurse in the fist place. This seems nuts to me, to be

taking nurses out of the schools.

[Yooperman]

104. As a Husband & Father to type one diabetics...

My Wife was 10 years old when diagnosed and our Daughter was diagnosed when she was 9 years old. Who by the way was giving herself shots the day after she was admitted to the hospital and diagnosed with diabetes. It does help to have been raised with a diabetic Mother... but children adapt much better than most adults do.

It is not rocket science giving the correct dose of insulin. I personally feel ALL teachers should be trained and have a good understanding of how to administer insulin to those that need it.

At least have a couple staff members with the proper training.

I am as pro union as you can get. But this issue for me is a no brainer as to require union nurses at every school just to administer insulin is not necessary or cost effective.

My humble opinion...

YM

[uppityperson]

107. Do you think school nurses "just..administer insulin"?

[Yooperman]

109. Of course not...

But you don't need a school nurse to administer insulin.

If a school can afford a nurse fine...but most have only one nurse for several schools.

YM

[MattBaggins]

179. Yes you do

because diabetes management is a whole lot more than just sticking a needle into your belly.

Insulin dosage become easy because you know your own needs.

[Yooperman]

224. Did you read my first post...

I have been with a type one diabetic for over 30 years. My daughter is also type one...

Yes there are concerns but it's not like you have to be a nurse to understand how to handle it.

Teachers or a few staff members can get some training and handle the needs of the children quite easily.

A nursing degree is not needed. Training yes.... but this is a very specific need.

[likesmountains 52]

114. By some of the responses here it appears that anyone who can read a book,

could replace a college educated teacher. This makes me very sad and worried about professional jobs being filled by cheaper, less qualified people.

[uppityperson]

115. Or anyone can replace a college educated nurse.

[Yo_Mama]

124. Well, the thing is that 8 and 9 year olds are often taught to administer insulin

As are average parents, and older siblings. So it's not an operation that requires trained medical personnel NORMALLY.

Where you want a nurse is when something goes wrong with a diabetic kid. THAT can become a medical emergency quickly enough.

[uppityperson]

127. I agree. You need a licensed nurse NOT for boring meh stuff but to prevent things from going wrong &

dealing with them when they do. As they do.

[Yo_Mama]

129. Yeah! Little kids = problems

It's not the regular insulin shots that are a problem. It's managing their levels and knowing what to do when they get off. Even if you are going to call the parents, the parents aren't necessarily going to get there that quickly.

Diabetes in growing kids is difficult to manage anyway. Then they get a bit sick, and whammo, major problem.

[theaocp]

117. No problem.

Just be ready for ENDLESS lawsuits. Y'all okay with that? If so, whatever. If not, STFU and pay your goddamn taxes to fund educational medical necessities. Fucking Christ.

[uppityperson]

123. +10000

[Aerows]

264. The state will pay one way or another

Option 1 is to hire a nurse. Option 2 is to pay for lawsuits after the fact when something goes wrong.

[IDemo]

121. I've had over 50,000 insulin shots

I'm approaching the 50 year mark with Type 1 diabetes. When I was diagnosed at age 7, I only took just one injection in the morning before school. Shortly afterwards, a second shot was prescribed for the dinner hour. I've been on 4 injections daily for most of my life: three rapid-acting doses before each meal and a long-acting insulin in the evening. Not infrequently, a correction dose is called for when the BG gets too high.

The photo at the link shows a vial and syringe, which is what I still prefer. The latest technology is the 'Flex Pen', which allows you to dial the dosage and push a button to deliver the dose. It's just my guess, but I'd assume that almost all patients new to the disease are using either that or an insulin pump. Most who have even a bit of manual dexterity can administer an injection with little difficulty.

My question would be - how capable are most youngsters of determining a correct dosage when a pre-lunch BG test indicates an adjustment is called for in either insulin dose or mealtime carb intake? It's nice to imagine that patients maintain tight control of blood glucose levels by following a strict regimen, but it's not always that easy to "stay between the lines". Varying diets, activity levels, illness and other factors can wreak havoc with the best diabetes treatment blueprints. It's this aspect that makes me think that having a school nurse available to look at the glucose reading, how many carbs are on the menu, and what the child's glucose correction factor is, is advisable.

That, and it would be comforting to me to know that someone at my child's school knew enough about hypoglycemia (dangerously low blood glucose levels) not to assume it's treated with...an insulin shot, which is exactly the wrong thing. I couldn't count the number of people in my life who have assumed that was how to deal with me if I got into a low sugar state.

One vote for the nurses for the above two factors at least.

[nadinbrzezinski]

139. Dad was prescribed one of those, flex pens

Let me tell you, with poor vision you might want to use that in years to come. As a medic I used syringes, so that would not have been an issue.

I am type two, one of my meds can cause hypoglycemia...I carry dextrose. Need to change my tube actually.

[IDemo]

150. I gave the pens a 90 day trial last year

and couldn't wait to get back on the syringe. The pens seemed unusually bulky and difficult to maneuver into many of my injection sites while still being able to get a finger or thumb onto the injector button. I've been using the syringes since they were made of glass and required boiling each time to sterilize them, along with a stainless steel needle.

The eyes have gotten a bit tired with age, but the ophthalmologist told me he hadn't seen a diabetic with virtually no evidence of retinopathy as I have in his lengthy career, so hopefully the vision will last as long as I do.

[nadinbrzezinski]

156. Dad's vision was a real issue. He started insulin five years before he passed.

So it was my mom chiefly, or me, who did the routine. They are bulky indeed. So it never occurred to me it would be an issue for self injection. So thanks for that.

Yup, insulin is in my future, even as type two...sooner or later the pills stop working.



I think part of it is attitude...and truth be told, every type one kid I have ever met prefers the jab...to the yuky sick feeling. It's the adults that have a heck of a time getting over the...you need to do what?

I took a kid to the hospital, you know this, he got really sick with a cold, well guess where his sugars were? He absolutely loved it when they got them back down at the ER, he was all smiles. I will never forget that.

You stay healthy.

[IDemo]

176. It's still difficult convincing myself that I need as much or more insulin when sick

Even when not eating, or very little. Thankfully, I don't get sick very often. My HbA1c's are pretty much in the non-diabetic zone - mid 4's to low 5's.

With all the talk of upcoming treatments and cures (a cure has been "5 years away" since I was about 20), it's easy to think we were born too soon. But I could have really been born too soon by just a few decades and missed out on insulin.

I hope you are able to manage the Type 2 well and are able to delay the need for insulin.

[nadinbrzezinski]

186. Did the only metmorfin dance

For ten years with six months of Avandia, up I go in weight. Side effects really hit me.

I keep mine in the 6...but you can tell when I gey sick, or meds stop working

[MattBaggins]

182. Do keep in mind that those pens click for each dose

they can be used by blind people

[X_Digger]

212. I'd think a blind person would have more trouble with the disposable needles.

My wife went back to regular syringes for that reason.

[DevonRex]

132. The American Diabetes Association agrees with the Obama Administration.

From the same article:

"State law says no, but in the midst of recent budget cuts, not all schools could afford a nurse. In some districts that actually have school nurses, the ratio is 6,000 students to 1 nurse. Consequently in 2007, the without Legislative approval the Department of Education allowed other school employees to give the shots. The President of the National Association of School Nurses, Linda Davis-Alldritt, says that move jeopardizes student safety.

"Insulin as a medication can be fatal if given wrong. It's a hormone. Too much insulin can cause fatality and can cause it fairly quickly," said Davis-Alldritt.

Critics of the nurses' unions, including the American Diabetes Association, say they're just trying to boost jobs and that insulin shots can be administered safely by other people."

[IDemo]

134. Then the ADA is wrong,

See post #121. It's not just about giving shots, which almost any 3rd grader could do with little difficulty.

[DevonRex]

136. The schools can't afford nurses. Period. So now diabetic children can't be educated?

The DOJ has to enforce ADA.

[IDemo]

162. 'Children' represents a large group

While the arithmetic involved in determining a blood glucose factor correction of insulin dosage and/or carbohydrate intake at mealtime is generally manageable, getting it right each time may take a bit more discipline than most (not all!) third graders have.

And the corrective action needed when blood glucose dips too low becomes increasingly inaccessible, eventually reaching a danger point and often too rapidly to react. Type 1 diabetics should always carry glucotabs, juice or another form of rapid-acting glucose. The activity levels of grade schoolers along with their BG levels can fluctuate wildly from one day to the next, and recognizing the symptoms and knowing how to handle the situation quickly is critical.

[Aerows]

266. Can they afford lawsuits?

Because that is destined to happen.

[DevonRex]

268. Agreed. I think this is maneuvering by DOJ to get CA

to come up with the money for these districts somehow. I know nothing about budgeting but there has to be a way for the state, which is financially healthy now, to chip in.

ETA: My preference is obviously for more nurses to have jobs, for the children to get their shots safely and, above all, to get an education without endangering their lives. So if CA can come up with the cash, everybody's happy. If not, there will have to be a safe compromise that let's these children go to school.

[likesmountains 52]

133. I was recently on a flight, about 30 minutes in, when the flight attendant asked over the speaker

if any "medical people" were on board. I was trying to sleep, and ignored them for a minute (I'm a NICU nurse and doubted that there was someone about to deliver a premature baby!) They called again so I got up and found a woman pretty passed out in the aisle. I was able to quickly determine that she was probably diabetic, hadn't had a chance to eat before she got through check in, security and boarding. We got her some sugar and juice, her family members came to the back of the plane and confirmed that she was diabetic. This was a 50+ year old woman that let things get away from her.....what about a kid? Sorry, this discussion just touches a nerve with me.

[newmember]

141. How many diabetic children are there in grade school ?

Are we talking about a dozen kids in a school of lets say 1000 children

[nadinbrzezinski]

144. Technical, but that is part of your answer

http://www.diabetesandenvironment.org/home/incidence

[newmember]

146. Forgive my ignorance but the woman who wrote the book claims

about 600 children a year in the U.S develop type 1 diabetes

That seems like an extremely low number to have nurses in every school.
We could be talking about 1 child in a school of 1000

[nadinbrzezinski]

147. It's not diabetes we have nurses for

It's all kinds of things. ADHD, asthma, kids scrapes, vaccines...sniffles... At one time kids took their Tylenol to school, but these days they need to ask the nurse.

Me...well, really, schools truly can't afford them...but that is a whole different discussion.

Nurses can also be used to monitor kids for things like whether they are growing ok, in other countries they are also used for things like national vaccination campaigns.

The CNA is choosing the wrong battle to say we need nurses, and in cash strapped districts...it's the nurse, or the biology teacher.

[newmember]

151. It's a long time ago but I remember when I went to grade school we had a school nurse.

I don't know if she was an RN or an LPN but that's what we as kid would use her for.
It was for band-aids from cuts on the playground or when you felt sick she would call
your parents to come and take you home.

How much can it cost to have an LPN come to the school at least just to give a few shots
during the course of a day. It doesn't seem like the cost would be that much for a school.

[nadinbrzezinski]

158. That is most of what a school nurse does

They rarely get real emergencies...

And have to administer some prescribed meds.

Back during the polio mass vaccination in the 1950s school nurses did it. You try that these days.

But in some inner city schools nurses are the primary health provider for kids...

[likesmountains 52]

172. In some schools the school nurse is the child's only

health care provider....Schools should not have to choose between a biology teacher and a nurse.

[nadinbrzezinski]

173. I made that point somewhere else

In an ideal world they should not, but they have to.

This is what tells me the real value we place on education.

[HiPointDem]

149. about 19/100,000 children have type 1, and about 8/100,000 have type 2. both types can require

insulin.

nurses take care of *all* medical problems in schools, not just diabetes. and there are lots of medical problems in schools.

[newmember]

155. So what am I missing here ? maybe I need to read the article again

California wants to take out all nurses out of schools?

[HiPointDem]

191. They have been taking nurses out of schools.

In some states, the money needed to pay school nurses has been redirected to classrooms to make up for cuts to education budgets. In California, that has been happening since Proposition 13 was passed in 1978.

"The way that schools were funded was drastically changed," Spradling said. As school districts saw their budgets shrink, "nurses were one of the very first things cut."

California, once a leader in student healthcare, now ranks among the 10 worst states in the country, averaging one nurse for every 2,187 students in 2009, according to NASN.

To cope, some school districts are training secretaries and teachers to give medications to students. That solution doesn't sit well with the nursing community. Allowing unlicensed, non-medical school staffers to administer drugs like insulin is too dangerous, some say.

http://articles.latimes.com/2011/jan/16/health/la-he-school-nurses-20110116

[newmember]

210. That sounds crazy to me

"To cope, some school districts are training secretaries and teachers to give medications to students"

[uppityperson]

197. Data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011)

http://www.diabetes.org/diabetes-basics/diabetes-statistics/

Under 20 years of age

215,000, or 0.26% of all people in this age group have diabetes
About 1 in every 400 children and adolescents has diabetes

Of course it isn't evenly divided out, some places have more, some less.

[midnight]

143. Time to look at this as a way to employ more nurses and not to the fact that there are not enough

nurses.. That argument has been used for over a decade to bring in visa workers for cheap... All the time keeping nurses salaries low...

[dsc]

154. A teacher's take on this

First, in NC we are already forced to give shots to kids who need them. I haven't had to but have had to train to. I teach high school so those kids usually take care of themselves. But this is a very slippery slope. At my school we have a boy who is prone to seizures. If he has a seizure, he needs to have a drug administered rectally. He was in the teacher my neighbor's room. I have to say as an openly gay male teacher I would be immensely uncomfortable with having to do this. I feel that this kid should have a nurse doing this. That is what the nurse goes to school to learn how to do, that is what the nurse practices doing, and that is what the nurse is paid to do. I am not a nurse, I didn't go to school to be a nurse, and I don't do things like that. This is what happens when we given in on rules.

[arely staircase]

171. from this texas teacher

thank you for putting this in perspective

[Ilsa]

195. Diastat! Yep. And where are these drugs to be kept?

In the trained-non-licensed-personnel's desk drawer? What happens if a kid accidentally infests or takes someone else's medicine? Or if they destroy it and it isn't available when the child needs it?

I bet nurse's salaries are almost recovered by money received for higher attendance rates.

[Ilsa]

177. At some hospitals, it has been policy that TWO

nurses verify insulin dosages, including getting the right kind of insulin.

Managing diabetes at school with children in elementary school is a very serious issue. It requires a team approach with parents, doctors, teachers, PE coaches, and the student and parents. I can't imagine a non-nurse volunteering for this, no matter how the school assures her or him that they can't be sued.

[likesmountains 52]

184. Agree. At my hospital insulin must be checked by 2 RNS

[NoodleyAppendage]

211. Yet another example of downward wage pressure effects in healthcare

I guess we can add "interested pseudo-medical person" to the list of ever growing medical para-professionals and physician extenders...<sigh>

[abelenkpe]

214. Every election we vote to give more money for education

And schools. And every year school districts cut back further, less money for teachers, art, music, PE, counselors, nurses, supplies, etc etc etc. Which is why every year every school holds even more fundraisers for their underfunded, understaffed schools.

We have unemployment problems. Hey, how about this: Hire more nurses, more teachers, more counselors. Get the money Californians desperately want given to schools to the schools. Staff them properly.

Unlicensed non medical workers giving our kids shots? Oh yay. What could possibly go wrong? I personally feel all warm and fuzzy knowing the school my kids attend cant even afford a nurse.

Hey look! A problem that requires additional funding to solve properly. Only the life and well being of our kids are at stake. What's that worth? Apparently not much. But hey, if a bank came hat in hand saying its health was at risk would anyone think twice about shoveling money at that problem faster than it could be printed? How about millions of dollars for military equipment our military says it doesn't need or want? We seem to have plenty of money for that. But not enough for public schools. Todays US is one truly messed up society.

O well it's not like they'll be public schools for much longer. Soon they'll all be privatized. With Dem approval no less. Our taxpayer dollars will still fund them, but in return students and families will receive even less.

[Starry Messenger]

216. There is plenty of money in CA, we're one of the top 10 economies in the world .

85 billionaires make their home here and high profit corporations have their flagship offices here. There is money. People need to stop believing that we are broke and help build political will to get some more of that money back via taxes. You think CEOs in CA let volunteers administer to their kids' medical needs?

[Omaha Steve]

218. We used to give our dog Luka allergy shots

Not so critical in comparison to insulin for youths.

[Riftaxe]

229. Demonstrates the priority of the Nurses Union...

About the only way you can screw up an insulin shot is failing to take it. This is especially true with the new flexpens for delivery, if the adults are incapable of giving injections have the students show them how.

[HiPointDem]

234. it's not just about giving the shot. the priorities of the state are clear too.

[Riftaxe]

242. There is that as well, but many adults

Have passed EMT courses. I would be shocked if no adult at any school has not successfully passed one. I doubt certification has changed all that much over the years.

To a diabetic, insulin is not only about health but quality of life, this action is the last thing in the world that will bring any credence to the nurses union, it could and should be seen as children being denied medicine.

[HiPointDem]

246. I disagree, and I don't think you grasp all the issues involved. Physically giving a shot of

insulin is very easy, certainly. You don't have to find a vein, just jab the stomach.

That's the least of it.

1. School nurses do more than administer insulin.

2. This suit opens the door to using non-medical personnel to administer all medical services in schools. You may have read the post about the teachers being tasked with changing catheters. These are the kinds of things going on these days. We can make the same argument: anyone can be trained to change a catheter, people do it at home for themselves, their spouses and kids, etc. But it's also a procedure with a potentially serious risk picture. What parent would want anyone besides an experienced medical professional doing it for their child?

3. While it is easy to give a shot of insulin, it is much less easy to give multiple kids multiple shots of different kinds of insulin at different doses on different schedules, as well as dispense other meds to other kids, as well as deal with other medical issues (like catheters), as well as understanding how each kid's medical issues, sensitivities, reactivities may affect their response, as well as recognize emergency situations that arise in the course of such duties and know how to handle them *automatically,* not to mention record-keeping, contacts with other medical providers, parents and staff.

The kind of global, integrated knowledge that a nurse has through training and experience can't be replicated by training teachers or medical assistants in narrow subroutines, like robots.

4. It is not fair or wise to task teachers with providing medical care in addition to their other duties; nor is it fair or wise to have unsupervised medical assistants making $8-$15/hours tasked with duties that may potentially kill or harm children. The liability & potential harm alone is above their pay grade. You may have read the post about the untrained person who injected the wrong meds, a situation that could have ended in death. These things *will* happen, but they are less likely to happen the more highly trained and experienced the person in charge is, and that person is better equipped to deal with emergencies when they arise as well.

It's not the case, as one poster claimed, that there are only two kinds of insulin & you just need to give x units of insulin for every x units of blood sugar over normal, or that every kid will get a shot on the schedule he claimed. Does an MA know what to do if the kid is diabetic and pregnant, or is a brittle diabetic, or what to do besides call 911 if a kid starts seizing?

5. There are liability issues for schools. Posters seem to think these don't matter, but in fact they can potentially bankrupt districts. An outcome that perhaps this admin would like, since they are doing their best to destroy public education, but it's not an outcome the public should like, since they will pay the bill and the piper.

6. The major impact of such measures, if allowed to become policy, will fall, as always, on low-income schools and districts, because upper-middle class schools and districts *will* have school nurses. The cut-rate options are always especially for the poor, who 'can't afford' best practices.

5. The nurses are upholding professional standards. That is what they *should* be doing. Any suggestion that this reflects badly on them is hogwash.

[Riftaxe]

247. Well, to take a differ nt opinion

and being from New Hampshire where schools are funded through property taxes, I will damn well take that risk just to let a child get his medication.

Now to others, I take insulin myself and have probably longer then you been around.


1) Of course they do, who could argue that?

2) It does not, even the worst barrister would argue need.

3) This is why we invented a written version of the language. Most adults can read, and most kids sure as snot know when they have received an injection. In dispute, perhaps refer to the written language thing in case just.

4) let the janitor do it if you think administering 3-4 shots per 500 students is that disruptive or the teachers not give a shit (which would be woefully wrong)

5) This is the only serious issue you raise, but only speaking for myself, and being a funder of my schools, frivolous law suits are discouraged by the courts, the public, and sure as hell the politicians who want to remain such. You go find 12 people to find a district in fault just because a kid got a rash. Feel free to campaign for the candidate of "I made damn sure those children did not get their insulin".

6) Penalize kids because the future might lead to...., nope we are here to prevent that.

7) If they refuse to do it, or refuse to let anyone else do it, they are not nurses they have violated the spirit of the oath (i know they not need to take it) but they have no business in health care.

[HiPointDem]

248. the kid will get his medication if there's a nurse. if you're so concerned about children getting

their meds, fund an actual medical professional instead of a cut-rate know-nothing scab, or piling extra duties on teachers.

if you're not willing to pay for proper services, i don't buy your 'concern'.

[Riftaxe]

249. I would prefer he does get his medication from a nurse

what is your malfunction?

Ahhh, perhaps literacy is just not your thing then?

[HiPointDem]

251. i have no idea what you're talking about. i'm literate in a couple of languages. perhaps i just

don't speak cheap laborese.

& you have no idea how old i am, either. or what i do for a living. nor does your own experience administering your own meds mean you're qualified to administer meds to schoolchildren.

[Riftaxe]

253. Perhaps concentrate on English

then.

I edit to one up your edit, and just to be sure

[HiPointDem]

255. ah, yes, english -- mr 'writing things done'. perhaps you'd better concentrate on your own,

mine is just fine, thanks.

[Riftaxe]

256. you got me, i made a typo, i will now commit seppuku

Consider this, we have gone from at least in my priority that children should get their medication, to who should be able to administer that medication to apparently squabbling about typos.

I know this IS DU, so i will state these 3 things:

1) Children should get their medications
2) I not care a wit who administers it, or the subsequent lawsuits, let them sue, it will either be laughed out of court, or i pay more.
3) I suspect you are stressed so I will wish you a good night, and a better day tomorrow


Remember no one wins the internet!
*If you truly care, I made a grammatical mistake in the post....Lord help you if you do (and I am agnostic).

[HiPointDem]

257. you called me illiterate, now you act like my pointing out your 'typo' in response is some kind

of below the belt hit?

i'm not stressed in the least, & i had a fine day.

'children should get their meds and i not care (sic) a wit (sic) who administers it (sic)' is a stupid statement.

that's two grammatical mistakes and one spelling mistake.

you have a fine night too.

[HiPointDem]

258. what are you talking about? my edits weren't to correct grammar or spelling mistakes.

Original version with no edits.
248. the kid will get his medication if there's a nurse. if you're so concerned about children getting
their meds, fund an actual medical professional instead of a cut-rate know-nothing scab, or piling extra duties on teachers.
Tue Jun 4, 2013, 11:17 PM - Unexplained edit. (Hide)

Unexplained edit.
248. the kid will get his medication if there's a nurse. if you're so concerned about children getting
their meds, fund an actual medical professional instead of a cut-rate know-nothing scab, or piling extra duties on teachers.

if you're not willing to pay for proper services, i don't buy your 'concern'.

[uppityperson]

238. Most people are physically capable of giving a shot. However, there is a whole lot more

To it than simply poking someone. If you give the incorrect type or amount or the kid didn't eat or is sick or stressed or etc, it can be very bad. Secretaries are different from nurses in training and experience. And both are differentbfrom some kid's parent.

Most of us are capable of writing a prescription yet pharmacies won't fill them unless we prove we have prescriptive authority gained by education, testing and licensure. Same with nurses and situations like this.

[Riftaxe]

243. flexipens regulate the amount well enough

and all but a few states have regulate the prescription size of syringes. I recently had to go out of country just to find a reusable syringe. The dosage is not really a problem, I would assume if you can work at a functional level you can count to 300.

If you need more then 300u of insulin, you are already hospitalized, and your physician is in jail or at least pending that.


on edit: had to order a glass syringe from a foreign country, rest was typed quickly but i will let it stand.

[Jennicut]

244. I'm a type 1 diabetic. Giving shots is easy with an insulin pen. I give myself 5 shots a day.

All teachers should know how with a diabetic kid in their class. Should know how to do a glucagon shot too. Waiting for a nurse on a lunch break is too late on the glucagon shot. If you have low blood sugar you can go into a coma and die. Same with high blood sugar. Hyper/hypoglycemia is nothing to mess around with. And it is not hard to do. Just measure the amount needed on the pen and give the shot.
Always, always watch the person with diabetes for highs and lows and make sure they eat directly after taking the humalog (short term insulin). It acts fast. I have some stories of 50 mg/dl blood sugar where I nearly passed out not eating quickly enough.

[HiPointDem]

250. you know your own body and your own meds. suggesting that teachers should be

giving insulin and glucagon shots & be trying to figure out 'the amount needed' in emergency situations with 30 other kids in the room is worse than idiotic.

If you give the wrong amount the patient can also 'go into a coma and die'. The presence of a nurse on staff = less chance of running into such emergency situations because they are almost always caused by misadministration of meds, illness, dehydration, etc -- things which a nurse, unlike a teacher, is trained to spot & head off early, and things which a nurse can actually focus on, unlike a teacher, who's focused on trying to teach and manage her classroom.

[Riftaxe]

252. This is why we have physicians

Who write things done.

My Physician is a pure harridan and it makes me appreciate her all the more dearly.

[HiPointDem]

254. 'writing things done' (sic) does not = carrying them out properly and safely.

[Jennicut]

260. I do think there should be nurses on staff. But in areas the school district won't pay for them

and the parents are waiting for the school districts to do something, type 1 kids still need to go to school. And what if the nurse is absent that day, in the bathroom, etc. You would need someone to give an instant glucagon shot. Hyperglycemia is more unusual but can happen too so a kid may need that insulin shot. I can also understand a teacher's reluctance. I do it every day for the last 8 years. It's just second nature. Diabetics have to pretty much take care of themselves. Most kids by 3rd grade could probably do the shots themselves and know how to calculate the carbs and short term insulin needed for that meal. Most have pumps to help with highs and lows. But the younger ones need help.

[HiPointDem]

269. no, you don't.

[Aerows]

267. If a school district can't afford a nurse

how are they going to afford the inevitable lawsuits that result when a child becomes seriously ill or dies at school because the teacher gives the child the wrong dosage, or an unqualified person gives a rectal suppository or replaces a catheter?

It's absolutely ridiculous to expect a teacher to take on duties and liabilities like that. My sister is a teacher, and parents freak out about everything. I could only imagine what their reaction would be to something going wrong with their children's medical care.