Children spend a great deal of time in the school setting for both academic and extracurricular activities. As such, it is important that they be safe at school. In a recent article in the Philadelphia Inquirer (February 8, 2012) by Linda Siminerio of the American Diabetes Association and Alan L. Yatvin, "School health care goes beyond nurses," the authors address the delicate issue of medical care in the school setting. As every parent of a child with a chronic health condition such as diabetes knows, allowing another individual to care for your child is extremely difficult. It is even more stressful when the child requires complex care such as blood glucose monitoring, insulin injections, and treatment of hypoglycemia during school hours. As such, all parents should feel confident that their children would receive appropriate care in the public school setting as defined by the Americans with Disabilities Act (Federal law).
According to the authors, Philadelphia has had a "long-standing national trend of cutting and overextending school nurses," which came to a crisis at the end of 2011. Apparently, "47 nurses were laid off in an effort to reduce a budget shortfall." The Philadelphia Federation of Teachers however complained to the State Department of Health that school employees who are not nurses should not be giving medication to children.
The Philadelphia public schools are not the only ones affected by this issue. Indeed, other cities, including Washington, DC, are in the same precarious position: not enough school nurses to be present in all public schools to care for children with chronic illness. If a child has a medical problem and no nurse is available to respond, non-medical personnel are unable to assist and outside support is called in for assistance.
Nurses, of course, are essential in the care of children in public (and private) schools. However, it is absolutely erroneous to assume that they are the only individuals who can safely check blood sugars, administer insulin via injection/pump, or treat with rapid-acting carbohydrate. Clearly, millions of non-medical professionals such as patient family members, childcare providers, and friends provide care to children with diabetes on a daily basis. Indeed, many of our children with diabetes can perform these complex tasks by themselves.
According to Siminerio, other states have demonstrated that trained non-medical school employees can provide diabetes care appropriately and safely.
The United States Department of Education and Justice, Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), along with the American Diabetes Association (ADA) are all in agreement that that trained non-medical personnel are the most appropriate individuals to keep children safe in the school setting when no nurse is available.
The key in this situation is training. At Children's National Medical Center, parents and caregivers attend "survival skills" training when their children are first diagnosed. These caregivers then train others to assist in the care of their children. As such, if nurses cannot always be available in the school setting, it appears most appropriate, indeed medically necessary, they must be given permission to teach other responsible individuals to serve as "back up" staff. This is absolutely essential if there is a nursing shortage. In my opinion, it is absolutely inappropriate to force a parent to physically leave their job and go to their child's school to attend to routine diabetes related needs (check blood sugars, give insulin, etc.) The exception would be if the child experienced a seizure due to hypoglycemia or was ill secondary to ketones. However, in this case, even if a nurse were physically in attendance, the parent would most likely be called to take the child for medical treatment.
It is essential that we advocate for trained non-medical school personnel to help children with diabetes-related tasks when a school nurse is not available. We are fortunate to have trained advocates, such as Crystal Jackson of the American Diabetes Association, to provide assistance in these particular situations. Please alert your healthcare providers if your child is affected by nursing shortages for them to advocate on your behalf.