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April 16, 2007

Comments

Gretchen

Yes, it would be ideal to have school nurses in every school, but we don't and won't for the foreseeable future. So we must deal with this reality by allowing non-nurses to care for students, like my daughter, who have type 1 diabetes and attend schools without nurses. And this works just fine, as recently demonstrated in a study from Virginia described by the American Diabetes Association on its website. In the same way we manage my daughter's diabetes at home without a trained professional nurse on hand 24/7, it can be safely managed at school by properly trained staff. Indeed people all over the country manage their chronic diseases, whether diabetes or asthma or some other condition, in this way. It is unfortunate that in their quest to increase the numbers of school nurses, the nurses have taken positions that would endanger the safety of children who suffer from chronic diseases. Here in Illinois, nurses oppose legislation (HB 146) that would allow for this sort of training. For more information see www.thecareact.com, which includes information on the legislation, and some posts from nurses who oppose the legislation.

Linda Gibbons

I am responding regarding the IASN position on HB 146.

It is our position that all children with diabetes deserve the care of a licensed healthcare professional while in our schools. There is no reason for them to receive lesser quality care. Diabetes is a continually changing condition that requires judgments to be made on a day-to-day basis or even more frequently. Insulin is on the highly dangerous drug list and in a hospital setting, the dose is required to be checked by 2 RN's after it is drawn up. Is it safe to delegate this task to an unlicensed person?

The Illinois Nursing Practice Act forbids that nurses delegate any task that requires nursing judgment to an unlicensed person. HB146 as written would have school nurses violating the Nurse Practice Act and jeopardizing their license to practice nursing.

In addition, nurses are licensed to take medication and other medical orders only from professionals who are granted prescribing authority by their practice acts. This would include physicians, podiatrists, and advanced practice nurses. This does not include parents. HB146 does not require a provider signature on the diabetes medical management plan. The statement of confirmation of the diagnosis and the name and route of medication administration does not fulfill the requirements for a medication order. It would need to include dose of medication and schedule for administration.

We firmly believe that all school children in Illinois deserve the care of a certified school nurse so that they can benefit from their education and appropriate accommodations can be made for any medical needs they may have. We see no reason for Illinois to have less stringent requirements for health and nursing services than those provided for in federal legislation, such as Section 504 laws and IDEA.

As school nurses, we do train all school staff in how to recognize diabetic signs and symptoms and when to call for professional assistance.

Linda Gibbons, RN, MSN, IL/NCSN.
Chair, Government Relations Committee
Illinois Association of School Nurses
Director, School Nurse Certification Program
National Louis University
1000 Capitol Drive
Wheeling, IL 60090

Gretchen

A better position for your organization would be to advocate for bills that would put more school nurses in schools, not to oppose bills that protect children with chronic health issues. Sadly, you sound more interested in protecting the jobs of school nurses than the health of children who manage their disease with more dignity than those who do not understand their disease. Your suggestion that "unlicensed persons" cannot and should not manage chronic conditions is absurd on its face. If this were the case, all children with diabetes would be hospitalized for life, or I would have a registered nurse living in my home around the clock. Fortunately, neither is the case. And equally fortunately, your position, contrary to that of the American Diabetes Association, is not likely to prevail, as more and more states are embracing the idea that the school must be a safe place for all children, including those suffering from chronic conditions. I look forward to the passage of HB 146 in Illinois.

Suzanne

Contrary to Ms. Gibbons’ claims, what children and their families deserve is the truth. It is both an insult and a lie to imply that children who do not receive care from a certificated school nurse are somehow being short-changed. That’s funny moral budgeting of the worst sort.

In a deliciously ironic way, Ms. Gibbons has actually demonstrated the need for HB146 and its hallmark provision—education and training. So, Ms. Gibbons, to start, let’s all take a breath and start by actually reading the bill instead of just reacting with our own short-sighted self interest, shall we?

HB146 does not violate the "delegation" regulation of Title 68 because the supervision of volunteers is not assigned to nurses. Trained volunteers serve under the supervision of the principal. Thus, the delegation claim is folly.

As for insulin being a dangerous drug? That entirely depends. In the context of a hospital, the proper administration of insulin can be problematic. Why? A well-known fact that Ms. Gibbons has conveniently left out of her allusion: More medication errors occur with insulin in hospitals than any other prescribed drug because of---not despite---nurses. Without recent and relevant training in the standards of diabetes care---something no Illinois nursing association mandates of its members---many nurses are not familiar with the newer analogs or the relative dosing matrices appropriate to type 1 and type 2 diabetes.

Ms. Gibbons continues on to imply that federal law somehow privileges nurses. This too is false. No federal law requires students with diabetes be cared for exclusively by nurses. In fact, the only time anyone with diabetes is routinely care for by a nurse is in acute care settings, most often at diagnosis and even then the aim of nursing is to teach patients to replicate the care nurses provide. At all other times, diabetes is managed by regular people---parents, spouses, friends, teachers, even teenage babysitters---all of whom receive some sort of training, either formally or informally.

The misinformation perpetuated by this organization is ongoing, unfortunate and plainly self-interested. To appropriate this issue and contort it to advance the interests of a select few nurses over the basic---and yes, easily accommodated---needs of children is unconscionable. If the nursing associations really wanted to do something productive to advance the health and safety of students with diabetes at school, surely, they could have come up with something more substantial than opposition built upon such easily refutable arguments.

Mark Bishop

I’d like to remind people reading this that we all have the same goal – protecting children’s health – so let’s try to avoid making personal attacks.

There was a comment about needing to actually “read the bill.” I agree. We all need to have the best information possible to comment and discuss the actual issues. You can take a look at the bill’s actual language online at the Illinois General Assembly website: http://www.ilga.gov.

We also need to read one another’s comments carefully and not make assumptions or extrapolations from singular statements.

I do believe that the Illinois Association of School Nurses is interested in protecting nursing jobs in schools, but there’s a good reason for that – school nurses support better student care at school. (This is not to take away from the care that parents provide for their children at home.) I think we all can agree that student health would benefit if we had greater student access to school nurses.

The Healthy Schools Campaign respects the efforts that the ADA has made in improving diabetes care and we do believe there is a great need for better care of all chronic disease in our schools, including diabetes.

However, when respected and knowledgeable organizations raise serious concerns, those concerns should be discussed and addressed in a constructive way, rather than dismissed by implying they are liars or that their positions are merely self-serving.

There will be many school health battles in the future and I hope that we, as a community of children’s health advocates, will be able to address them together without burning any bridges today that we may need tomorrow.

Suzanne

Alas, I'm afraid my criticism sliced too close to bone to be read properly.

Beverly

Before I became a school nurse, I worked in hospital pediatrics for 16 years. I have followed this issue since it began with another bill almost 4 years ago. The IL Assoc. of School Nurses opposes the The Care of Students with Diabetes Act and I think the nature of their opposition deserves the strongest criticism. If healthy children and schools are the goals then healthy, honest debate is a good place to start.

Gretchen

Readers of comments on the issue of diabetes in school will be interested in this Chicago Tribune article on the subject:

http://www.chicagotribune.com/news/local/chi-diabetes-08-dec08,0,6388020.story?page=1

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