Are Children with Diabetes safe in School? Educating the Educators

Beth McNamara Health Guide
  • We've made great inroads to ensuring that children who are managing Type 1 diabetes have not only a medically safe environment but also an equal learning environment at school. The American Diabetes Association's Safe at School program, championed by Crystal Jackson, has helped to pave the way for this in states across the U.S.

    Yet, should we be concerned that these inroads are reaching a roadblock, specifically a lack of qualified school nurses who are available to ensure medical safety for children. According to a November 2009 article in USA Today:  "30% of schools have a part-time nurse, and 25% have no nurse," as reported by the 2007 National Center for Education Statistics.

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    The level of care and your child's access to a school nurse depends on where you live in the U.S. According to statistics reported in a January 21, 2009 article in Education World, "In Vermont, there is one school nurse for every 298 students; in Utah, the ratio is 1 to almost 6,000 students. The average caseload per school nurse in the U.S. is 1,150 children. Only 45 percent of U.S. schools have a full-time nurse and 25 percent have none."

    As is fairly well known, the number of kids with diabetes, both Type 1 or Type 2, is growing. According to the ADA, 186,300 people under 20 have type 1 or type 2 diabetes... About one in every 440 children and adolescents has diabetes.

    More kids diagnosed with Diabetes results in more kids in the schools needing trained medical care. But fewer nurses mean that kids may not always have access to the care they need. This is of particular concern for younger children who have great difficulty monitoring their condition, particularly dangerous BG lows.

    Diabetes is not the only chronic and demanding health issues that these nurses are responsible for. They are stretched thin caring for children with severe allergies, asthma, epilepsy, physical disabilities, among others. These kids are fortunate, through legislation, to have the same educational opportunities afforded them that they may not have had years ago, but the lack of medical staff may put them at risk.

    The reductions in school nurses are adding to that pressure, says nurse Karen Johnson, a diabetes educator and wellness coach for diabetes website

    The school nursing shortage in the U.S. has evolved from a scheduling problem to a
    serious health and liability risk as Amy Garcia, a registered nurse and executive director of the National Association of School Nurses (NASN) told Education World.

    The Good News ... And The Sobering News
    Fortunately, the future is not altogether gloomy. According to the January 2009 Education World article, 40% of states improved their nurse to student ratio in the last year. In addition, NASN and its state-level affiliate chapters have proposed legislation in Congress that would require "all school districts to have at least one registered nurse per 750 students in the general population -- that is, children without chronic medical conditions. The ratio for students with serious chronic conditions -- such as those requiring ventilators -- should be 1 to 1."

  • Yet, the tough economic times are impacting public school systems. In an effort to make large budgetary shortfalls, districts are cutting where they can, including within the ranks of their school nurses, which in turn increase the caseloads for nurses. To add proverbial fuel to the fire, nurses are in high demand, so fewer are available to fill positions that may be open.

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    "That whole model that any medical need a child has is handled by the nurse is no longer in place in most schools," Ed Kraus told USA Today. Kraus is an attorney and associate professor at the Chicago Kent Law school who also does work with the ADA.

    Some districts are turning instead to training non-medical staff to manage chronic care conditions, like injecting insulin or administering feeding tubes. As Brenda Green, director of school health programs for the National School Boards Association says, "[Non-medical] people can learn to do things in a safe way. But you have to have people who are willing to take on the commitment and be thoroughly trained." 

    This solution is not true in every state in regards to diabetes. Consider California. In November 2008, a Sacramento, California, Superior Court judge in Sacramento California overturned a 2007 rule that allowed trained, non-medical school staff to give insulin injections to children with diabetes. This ruling was prompted by nursing associations who sued, noting that California's Nurse Practice Act states that only licensed nurses can administer insulin.

    One of the goals of these nursing associations was to get more school nurses, which is understandable, because California schools have one of the highest nurse to child ratio in the country: 1 for every 2,129 students. These nursing associations indicated that the new 2008 ruling would allow parents with diabetic children to have peace of mind because a medical professional would be managing the child's condition and administering the insulin.

    These parents would have peace of mind, certainly, if there was a nurse available to administer the insulin. Reviewing the numbers above, if there is only 1 nurse for every roughly 2,200 students, then most nurses are covering at least 2 - or more - schools. If a nurse is not available when a child needs a corrective dose of insulin, and trained non-medical staff no longer allowed to administer it, then who does? If the child is unable to self-administer insulin, then it is the parent who must rush to the school to do so.

    One Action To Consider Taking
    If you're not happy with the school nursing situation, talk to your representative. The U.S. Department of Health and Human Services has created national health objectives called Healthy People 2010. Included in these objectives is the goal that there is 1 school nurse for every 750 students. If your state doesn't meet this standard, ask your representative to do something about it.

Published On: January 14, 2010