The debate in the California Supreme Court this week about whether schools must provide a licensed school nurse to administer insulin to diabetic schoolchildren comes as the school nursing profession is reeling from job cuts as well as position replacements by part-time licensed vocational nurses and health aides.
“Before Proposition 13, it used to be that just about every school in California had a full-time school nurse,” said Linda Davis-Alldritt, president of the National Association of School Nurses who served as the state school nurse consultant for the California Department of Education from 1996-2012. “Now there are very few.” It is common practice now for a nurse to serve four or five different schools in a district, she said.
“The jobs are there, but the hiring that’s going on is for licensed vocational nurses, health aides, and sometimes credentialed school nurses,” said Katy Waugh, president of the California School Nurses Organization. Vocational nurses must work under the supervision of a doctor or nurse, while health aides have a high school education and pass a test to work in school district, Waugh said. “Some districts have decided they can do without the school nurse,” she said.
The California Nurses Association has argued that state law requires licensed nurses to provide insulin injections and other medicines to students, and two lower courts have agreed, the Los Angeles Times reported. The American Diabetes Association appealed, arguing that state law should be interpreted to permit a trained, unlicensed and designated school employee to administer insulin shots with parental consent. During a hearing on Wednesday, some justices on the state high court appeared skeptical of the nurses’ arguments, the Times reported.
In California, nine counties had either no school nurse or one school nurse in 2011-12: Alpine, Amador, Del Norte, Inyo, Kings, Modoc, Sierra, Tuolumne and Yuba, according to the California Department of Education. California schools employed 2,361 full-time-equivalent school nurse positions in 2011-12, the latest data available. The most recent high employment mark for school nurses in California was 2,901 full-time-equivalent school nurse positions in 2008-09.
Davis-Alldritt noted that when she began working as a school nurse in the Elk Grove Unified School District in 1978, students with diabetes received insulin shots from their parents at home in the morning and afternoon. “Now we have kids getting diagnosed with diabetes over the weekend and coming to school on Monday with the expectation that the school is going to give blood glucose checks, as well as insulin shots, all throughout the school day,” she said. “That points to the need for a school nurse.”