Cost, convenience not valid reasons to lower schools’ nursing standards

June 6, 2013

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Linda Davis-Alldritt, president, National Association of School Nurses

The California Supreme Court is considering a precedent-setting case to protect the right of schoolchildren with diabetes to receive care from licensed professionals. The court will determine whether other school employees, rather than licensed nurses, should administer insulin in schools to students with diabetes.

This case is critical to ensuring that children with diabetes and other conditions that require health care services to participate in school receive the safe and professional care promised to them by law.

For a decade, the Legislature has rejected bills to allow unlicensed school employees to administer insulin. Proponents of the bills eventually abandoned the democratic process and attempted to implement their preferred approach through a directive from the California Department of Education. In response, the American Nurses Association (ANA) went to court to enforce the law and protect school children. The ANA has contended throughout this case that students’ right to public education and to receive the health care services to which they are entitled at school must be met by the CDE, but without lowering the standard of care or violating the state’s Nursing Practice Act.

Karen Daley, president, American Nurses Association

California courts twice have agreed with the ANA, affirming in decisive rulings that state law requires licensed health care professionals to administer insulin in schools. The American Diabetes Association appealed to the California Supreme Court, claiming that California’s budget woes create obstacles to schools’ obligation to meet federal requirements to educate those with disabilities.

Overturning these court rulings will have alarming and far-reaching implications.

California’s Nursing Practice Act, designed to protect the public, prohibits unlicensed personnel from administering insulin in institutional settings. The law does allow parents, students deemed old enough for self-care, and parent designees to administer insulin.

If the law changes, already overburdened and short-staffed schools will need to find workers to administer insulin to children. Insulin is considered a high-risk medication – the wrong dose can be fatal. In hospitals and other institutional settings, another nurse must confirm an insulin dosage before it’s given to a patient.

It would be seen as outrageous if hospitals were to abandon those rules because budgets are tight. It is outrageous for California to do that in our schools. Cost or convenience is no reason to lower standards of care, particularly for young and vulnerable patients.

It is true that more nurses are needed in our schools, but that is a result of budget shortfalls and policy decisions, not because of a lack of available nurses. There is no shortage of registered nurses in California to provide health care in schools; rather, school districts have cut many school nurse positions in a quest to balance district budgets.

It is irresponsible for California to cut corners and blame it on budgets, especially when cutting corners could have a devastating impact on children.

Licensed nurses have consistent education, protocols, standards and experience. They are competent and legally qualified to manage a child’s treatment plan and initiate emergency procedures if the child’s condition requires it. Unlicensed school personnel such as school secretaries, teachers and others do not have the training and competencies to provide nursing care to students.

Several groups support the ANA’s position on this case, including the California Teachers Association, the American Federation of Teachers, and the California School Employees Association, which represents office secretaries, custodians and teachers’ assistants. These groups know that forcing already overworked educators and support staff to shoulder a new life-or-death responsibility would be devastating and dangerous. A University of Iowa survey of school nurses revealed that medication errors are three times more likely when unlicensed personnel administer medicines instead of a school nurse.

If the California Supreme Court does not uphold the lower courts’ decisions, it would be the first time in the nation that any state health care licensing law has been preempted by federal disability law. It would set a perilous precedent, and it would discriminate against children with diabetes.

We hope the State of California will do the right thing by protecting children instead of putting them in harm’s way – and allow the rule of law to prevail.


Karen A. Daley, PhD, RN, FAAN, is president of the American Nurses Association.
Linda Davis-Alldritt, MA, BSN, RN, FNASN, FASHA, is president of the National Association of School Nurses.

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