Judge Rules Only Nurses Can Administer Insulin Shots to California Schoolchildren

A Sacramento Superior Court judge has ruled that only school nurses can give insulin shots to children in public schools who have diabetes. The decision by Judge Lloyd Connelly overturned a 2007 California State Department of Education decision that allowed trained school staff, as well as nurses, to administer such injections.

Connelly’s ruling sides with arguments made by the California School Nurses Organization, the American Nurses Association, the California Nurses Association and other nursing groups that allowing non-nurses to give the shots conflicts with the state law that says only licensed professionals may give injections.

Nurses’ main concern, aside from the conflict with state law, was that improperly administered insulin could lead to extreme hypoglycemia, resulting in coma or even death.

Advocates for the ability of trained non-professionals to give insulin injections say that the ruling will result in many students with diabetes being kept out of school because of parents or guardians’ fears that there will not be a school nurse available if a child suddenly needs insulin.

There are 2,800 nurses available to the state’s estimated 9,800 public schools. Decades ago most public schools had full-time onsite nurses. But as educational expenses increased and enrollments soared, many districts began rotating nurses among schools, or in some cases did away completely with on-staff nurses.

It was the lack of full-time nurses at many schools that led a coalition of parents and diabetes advocates, including the American Diabetes Association, in 2005 to petition the state for the right to have trained non-nurses administer insulin in situations that required immediate action and where a nurse could not be made available quickly.

By law, parents are allowed to give insulin injections to their children and do not need professional certification to do so. In many cases where school districts did not have nurses available, they depended upon parents to fill the gap in emergency situations. The drawback, however, was that families with two working parents or single parents often faced hardships in suddenly having to leave work or travel great distances to administer insulin.

Advocates also argued that the lack of school nurses violated provisions of the Americans with Disabilities Act of 1973, which state that children with disabilities are entitled to a public education and that school districts must make reasonable accommodations for them. Uncertainty about the availability of nurses to give insulin injections, they said, went against the spirit of the act by leading parents and guardians to keep children out of school and created an atmosphere of fear or uncertainty among students with diabetes.

The California State Department of Education decided in 2007 to allow school personnel who had been trained to give insulin injections to substitute for nurses in situations that required quick action. The nursing organizations that later brought suit in Judge Connelly’s court vowed at that time to have the decision overturned. 

(Diabetes Health previously wrote about this topic.)