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Nurses unhappy with diabetic ruling

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Posted: Wednesday, August 14, 2013 12:00 am

Local school nurses are not happy with the California Supreme Court’s ruling Monday to allow trained but unlicensed employees to administer insulin to diabetic students if a nurse is unavailable, claiming it will be a disservice to fragile students.

“We agree it compromises student safety,” said Sheri Coburn, San Joaquin County Office of Education’s director of Comprehensive Health Programs. She oversees school nurses in districts across the county, including Lodi Unified.

The administering issue arose in 2006, when two Bay Area school districts were not providing services for diabetic students protected under the state disability act. The American Diabetes Association sued the districts because parents were having to miss work to administer insulin to their students. The case ended up before the state’s Supreme Court.

Although recent statewide budget cuts to education have decreased the number of school nurses in some local districts, Coburn said most have kept up the level of nurses needed to care for diabetic students.

“We’ve really tried to provide that level of care,” she said.

To do so, some districts have employed licensed vocational nurses — who are overseen by registered nurses — to administer insulin and monitor diabetic students.

Lodi Unified has not reduced its nursing services. In fact, four years ago there was an increase in full-time LVNs from three to five, according to Bill Saunders, administrative director of student services.

By using creative budgeting such as federal funding from Medi-Cal, the district currently employs enough nurses to give injections, so the ruling will not likely affect Lodi Unified students, he said.

Nurses hope that the district will maintain nurse coverage, as they feel there is more to their job than just administration of doctor’s orders and providing injections, Saunders said in an email.

“Proper assessment of a student’s needs involve signs and symptoms, looking at the whole child. It is a big responsibility,” he said.

In Lodi Unified, he said, some students in sixth grade and higher self-administer medication in the school office, and some do not come into the office but school nurses check on them periodically.

Coburn points to a recent incident in San Joaquin County where a kindergartner with diabetes came to the office complaining that he didn’t feel well. Office staff told him to go lay down on a cot. Shortly thereafter, they heard a splat.

Not knowing he was hypoglycemic, the student had fallen onto the floor and was unconscious. His blood sugar level was 47; the average is between 100 and 120.

“The office is busy, it has a lot of demands. When you are harried and not used to it, you can make mistakes,” Coburn said. A school nurse would have first tested his blood sugar, she added.

Another concern, she said, is knowing the correct dosage.

“Insulin can kill people,” Coburn said. “In the hospital, it takes two nurses to dose it.”

Local school districts have policies that currently limit who can dose medication.

Galt Joint Union Elementary School District nurses, for example, have already trained health assistants and other school personnel to support monitoring diabetic students, according to Superintendent Karen Schauer.

She, like other district superintendents, will seek direction from the California School Boards Association before changing current policies.

Saunders said any changes in Lodi Unified will happen only after receiving input from parents, students and staff and approval by the school board.

There are also legality concerns as the Nurse Practice Act prohibits nurses from training non-licensed personnel to give insulin injections, he added.

Meanwhile, Coburn encourages schools to continue hiring licensed professionals.

“I worry about the liability issues. It’s not that other people can’t do it, but parents and caregivers know their children,” she said. “I just hope the best for students.”

Contact reporter Jennifer Bonnett at jenniferb@lodinews.com.

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