By Patrick Totty
For several years now I’ve been following the controversy surrounding a lawsuit by California parents to force public school districts to allow people who aren’t nurses or doctors to be able to give insulin shots to diabetic children. (The California Supreme Court recently ruled that non-nurses can now give such injections. You can find background information here and here.)
The official stance of the state’s nurses unions and associations was that injections by non-experts could invite possibly fatal complications. Administering insulin requires more than just superficial knowledge of how to give a shot-there’s also the question of knowing what’s the proper dosage.
The other biggest objection was simple: Injections by unlicensed people would be an incursion on the hard-won rights and privileges nurses have gained over the years. What is the point of spending years learning how to be a nurse or licensed healthcare worker if comparatively ignorant and untrained people can be allowed to execute a possibly live-saving procedure?
In an ideal world, those objections would have been enough to persuade the California Supreme Court not to OK having non-medically licensed personnel give insulin shots.
But California is not an ideal world. It’s a crowded state with public school districts that run the gamut from embarrassingly wealthy to downright impoverished. While it can mandate all it wants that only nurses can administer insulin shots, the reality is that few of the state’s school districts can afford nurses at each school, ready to give shots at any time of day. Only a few can even afford “circuit” nurses who rotate among the district’s schools and show up at each on certain days for certain hours.
The problem, of course, is that if a type 1 child needs insulin right now, and there’s no nurse onsite, the situation quickly can become dangerous.
The way around this has been for schools to appeal to the one group, aside from a child’s personal healthcare providers, that’s empowered to give insulin injections: a diabetic child’s parents.
But the availability of kids’ parents is based on a woefully outdated notion that there’s always a stay-at-home parent to call on. In the real world, it’s more likely that both parents are at work, which means that an emergency call to them is a huge inconvenience. It’s even more so for a single parent who is a family’s sole means of support. It doesn’t matter how sympathetic or lenient an employer is, repeated emergency trips to school to inject an ailing kid can begin to add up negatively in a boss’s mind.
It would be simpler to train non-nurses to inject insulin. Plunging a needle is not rocket science, and the diabetic kids themselves can have huge input into the learning process-what are typical doses for them, where they prefer to be injected, where they keep their insulin and glucagon stash (in case they aren’t coherent enough to give the location).
This isn’t to diss nurses. As healthcare becomes ever more expensive and rationed, the role of nurses as primary caregivers will become larger and more important. But there are only so many of them to go around, and there are never going to be enough of them to cover every base. In the case of children’s insulin injections, we’re talking about a commonplace, long-established procedure that rarely goes wrong.
What can make it go wrong is to allow a child to fall into acute hypoglycemia and forbid anybody to help until a nurse or parent arrives on the scene. If either of those designated responders is late-traffic jam, flat tire, accident-somebody may be forced to take action, but will open him/herself to possible censure or legal action.
All of this falls into the realm of common sense. Allowing adults at school to give injections shouldn’t cause anybody to gasp. Teachers and principals are intelligent, educated people who have already proven their ability to pick up on complex information and procedures.
Allowing and training them to become first responders in extreme situations is good for everybody all around. While it looks fine on paper for nurses to have the responsibility for emergency insulin injections, it can be a heavy burden for ones struggling with impossible demands in school districts that spread them as thinly as they can get away with.
The tempest over this will die down soon enough. As nurses get pulled in new directions, thanks to the looming nationwide shortage of doctors, the question of school insulin injections will turn out to have been a hill not worth fighting on. Our best and brightest are needed elsewhere.