Speak Out When Schools Eliminate Full-Time Nurses!

The following is a speech Cynthia Heintz made to her local school board regarding the impact of eliminating her children’s full-time school nurse. She starts with a possible scenario of a student with diabetes not getting the attention she needs in the classroom because the nurse is no longer there and the teacher has her hands full. Chilling, isn’t it?

Minute 1: Child doesn't feel well
Minutes 2-3: Child decides to tell teacher, but teacher says "just a minute"
Minute 4: Child returns to seat feeling confused
Minutes 5-6: Child begins to feel worse and cannot express thoughts clearly
Minutes 7-8: Another student notices child with head on desk, tells teacher
Minutes 9-10: Teacher asks child if she is OK
Minute 11: Child cannot communicate
Minutes 12-13: Child passes out, may begin to have seizures
Minute 14-15: Teacher calls the office to call "911"
Minutes 16-17: Teacher tries to move all other students out of classroom
Minutes 18-20: Child's brain function decreases as the sirens are heard in the distance

Having only a part-time nurse at schools saves money, but what is the hidden cost?

| Sep 4, 2008

This is a worst case scenario.
This is the untrained trying to do the unknown.
This is 20 minutes of hell.

[Editor's note: I have left some explanations in this article that are usually assumed known to our readers. This is in case you wish to adapt this speech for use in front of your own school board.]

I am here tonight to voice my concern about the elimination of the full-time nurse position in our schools. Not only is the nurse invaluable for routine support at our campus, but she also trains the staff in the use of glucagon.

Glucagon is an injection given intramuscularly to a diabetic in the event of stupor or unconsciousness. It takes three to five minutes for an ambulance to arrive at a school, locate a hypoglycemic child, and begin life-saving procedures. Using glucagon buys valuable time between the observation of severe hypoglycemia and the treatment necessary to reverse that process.

Our nurse has done an amazing job of training the school staff to use glucagon.  Imagine how many people come into contact with one of my three children with diabetes in the course of a school day.  Now try to imagine training all of those people in the vital use of glucagon.  That is not something that can be accomplished on a one-day-a-week basis.

The job of school nurse has been proven time and time again to be vital in maintaining the safety of our children.
Our nurse has been a lifeline for us. I know that I can trust her observations of my children. Because she is a full-time nurse, she knows what looks "normal," and she is able to detect the signs of a dangerous situation and the subtle nuances that precede a severe hypoglycemic state. Familiarity combined with acquired individual knowledge cannot be dismissed as having little or no impact.

In addition, there are state-mandated responsibilities of a school nurse. These cannot possibly be complied with on a one-day-a-week basis.

Federal laws protecting children with diabetes include Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Education Act of 1991, and the Americans with Disabilities Act. Under these laws, diabetes is considered a disability. It is illegal for schools and/or day care centers to discriminate against children with disabilities. In addition, any school that receives federal funding or any facility considered open to the public must reasonably accommodate the special needs of children with diabetes.

To facilitate the appropriate care of the student with diabetes, school and day care personnel must have an understanding of diabetes and must be trained in its management and in the treatment of diabetes emergencies. Knowledgeable trained personnel are essential if the student is to avoid the immediate health risks of low blood glucose and to achieve the metabolic control required to decrease the risk of diabetes complications.

Studies have shown that most school personnel have an inadequate understanding of diabetes. Much of what is known by our staff about diabetes has been taught by our nurse. Nurse Kate Cowsky is an invaluable resource when it comes to educating the teachers. Her style of teaching is one that invites questions and clarifications regarding the daily management of the child with diabetes and includes physical demonstrations, including positioning an unconscious child to avoid aspiration and the practice of giving an injection (to an orange!).

Knowledge is power. Knowing what to do when a child with diabetes is having a medical situation makes all the difference in the world, not just for the child (although obviously that is the most important), but also for the teacher, who feels empowered and not helpless.  The parents, too, can breathe a little easier and go about their jobs.  The teacher knows what steps to take, the other children in the classroom know exactly what to do (and there have been drills to make certain of this), and the parents know that while they are racing to the school, every step has been taken to ensure the safety of their child.  This is the kind of training you receive from a full-time school nurse.

We will settle for nothing less.

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Categories: 504 Plan in School, Blood Glucose, Diabetes, Diabetes, Government & Policy, Kids & Teens, Low Blood Sugar

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Posted by Joan Hoover on 5 September 2008

When a school lacks a nurse or a well trained staff member a window is opened for trouble by the well-meaning misinformed. For example, these three vignettes from my personal experience:
1.) The insulin reaction, promptly treated with Diet Coke, as the teacher knew diabetics shouldn't have sugar.
2.) The insulin reaction treated with a CUP of Karo Syrup, as the assistant knew that a reaction meant not enough sugar.
3.) The child, in reaction, sent home sick from school mid-day, without communication, and found wandering, lost and disoriented, in the neighborhood an hour later.
For the diabetic child in school, a little knowledge is indeed a "dangerous thing". Realizing how easily small problems can become large ones may help School Boards to give health care a higher priority.

Posted by Anonymous on 5 September 2008

No offense, but in New England (Massachusetts, Connecticut, Rhode Island), an area of the country which has one of the highest rates of college enrollment, yet school nurses are practically non-existent because school systems are paid for at the individual town level, and most towns deem school nurses an unnecessary luxury. One need not have a paid school nurse to have appropriate staff training.

Posted by Anonymous on 5 September 2008

WOW! Great story!! America needs to mobilize to create public policy to mandate that every school have a school nurse (minimum ration 1 nurse to 750 Students Healthy People 2010 guidelines. Act today!!!

Posted by Anonymous on 5 September 2008

To the Anonymous person states that most towns deem School Nurses as an unnecessary luxury let's give you a little education. It seems that the only people who "deem" nurses unnecessary are those fortunate many who have children who rarely require any acute or chronic interventions. Personally, I cannot imagine that you can train general "staff" to recognize a sickle cell crisis or intervene, a diabetic crisis and what steps to take between the time that 911 is called and an actual medical professional arrives (it only takes about 2-3 minutes for brain damage to occur and no type of CPR will help a diabetic with a blood glucose level of 14)....I could go on. It is not that the general staff is not capable to do so, but they did not get into education to play health care professional. I guess it all depends upon what the community of the school wants for their children. I have an advanced degree in nursing, I teach students how to recognize symptoms and how to self-manage their own care. I teach dental health; screen for vision, hearing, BMI's, immunizations, I provide education to the community. We do not need yet another generation of adults that think that the only way to get better is to just pop a pill. Many of our society members misuse medical services out of a lack of understanding. The costs of health care are making health care a luxury that is certainly not unnecessary. The biggest hinderance to the thought process that nurses are a unnecessary luxury are those that have no idea what a professional nurse actually does.

Posted by Anonymous on 5 September 2008

This article rightly points out the necessity of having a full time school nurse in every school. The nursing judgments that come from education and experience cannot be delegated to non health care professionals. All staff needs to know how to recognize a problem and when to seek assistance and provide emergency care. However, no matter how well inserviced, teachers and aides cannot replace professional school nurses.

Posted by BusinessPrincess on 5 September 2008

The possible scenario you showed is reason enough that unless a qualified trained professional knows the signs/symptoms of diabetes or other illness the outcomes can be deadly.
I have over 24 yrs of nursing experience and can tell you first hand that nurses make splint second decisions.

With people you are dealing with lives and especially children you really need to know what you are doing.

A nurse must be available full time. Children need medication to be given during school hours and dosages must be accurate.


Posted by Anonymous on 8 September 2008

I would not feel safe for my grandchild if there was no nurse onboard! With a diabetic child, things happen to quickly, and you must know what to do in a given situation. All who come into contact with the child should know what to do. My grandchild was found one day in the hallway at elementary school, when she complained of feeling low, and the teacher let her go alone to the nurse. Another teacher saw her in the hall, and knew who she was, carried her to the nurse's office. People do not understand how very serious this disease is, and what can happen to the diabetic.

Posted by Anonymous on 9 September 2008

As a school nurse I have had a teacher have a stroke and a heart attack in my office. Her doctor told her she would have died or had serious brain damage without the asprin that I gave her when she asked for Tums. I had a student suffer with headaches and I found that his blood pressure was VERY high. He now takes medication. I have referred children to doctors for showing signs of diabetes that now take insulin. A school nurse is often how these children with life threatening conditions find out they have them. In my district the nurse's are paid far less than the teachers and are far less valued. If our children are not healthy or can't see well thay are not going to learn.

Posted by Anonymous on 9 September 2008

A child with diabetes should never be sent to the "nurse" or the "office" UNESCORTED! The worse case senario is the hypoglycemic child gets confused, goes into a restroom or other secluded space (enclosed staircase, etc.)and loses consciousness. Death anyone?

To avoid this awful possibility, all of the child's teachers should read this scenario and know to send another child for help. Or call for security to escort the child to the appropriate place. Or just plain call for help.

Are not students allowed: To check their blood sugar in class? To have emergency glucose supplies on hand in their desk or back pack? I can hear my uneducated teacher colleagues now: "Testing BG in the classroom is too disruptive! What if another child catches diabetes from the blood? What if someone gets stuck (with a lancet) by mistake?" or "I allow no candy or gum in my classroom, how can I allow a diabetic kid to have emergency sugar? He/she will just want to eat it in front the other students who can't have any!" Obviously this teacher is grossly uneducated and has never tasted glucose tabs or glucose gel.

I taught high school & junior high school for 26 years. I have had type I diabetes for 49 years. I always told my students about my diabetes. I always showed them how I checked my BG. I always showed them my insulin pump and how to disconnect it if they thought I was hypoglycemic or acting weird. I always taught them where I kept my emergency glucose (everywhere!) and how to administer it.

I always felt very safe at my school with my kids. To me the health clerk was a worthless superfluity. All she did was give diabetic kids cookies whenever they told her that they felt low.

The only bad experience I had was in elementary school with a school nurse turned PE teacher. She insisted that I must meet President Kennedy's fitness goals and that I must keep running. I was staggering and becoming more incoherent thank God for my classmate who ran for out regular teacher. I hit my face on ground running and still have the scars on my face from that episode.

Posted by Anonymous on 10 September 2008

I have to wholeheartedly disagree with the comment about lack of school nurses in New England. I'm not positive about the rest of the NE states, but Massachusetts has one of the highest rates of school nurses in the country. I went through a master's program in MA with school nurses from across the country, and there is no doubt that MA provides actual RN's in the schools (DOE certified) much more than many other states such as California, which typically has one RN for an entire district with non-licensed "health assistants" in each school. I always tell parents- make sure your school nurse is actually a nurse! I am always shocked that teachers' unions put up with lack of nursing staff. In MA that would NEVER fly. Concerned parents should also talk to their Teacher's union reps about these situations. Present to PTO's as well to gain support for nursing staff. Sometimes there is what appears to be apathy from parents-but it may be due to ignorance and assumptions about who, if anyone is sitting in the Nurse's office.

Posted by Anonymous on 16 September 2008

My son developed diabetes when he was 7, so it was a long haul for him to stay in neighborhood schools until graduation - they kept wanting him to go to a school across town where they had a full time nurse. It was more important for him to be with classmates who knew how to recognize symptoms and at a school where he was allowed to and reminded to test his blood sugar regularly. A local diabetes group did trainings but the district did not want anyone trained in glucagon emergency injections. All his teachers wanted the training and I would use his expired kits to let them get practice.

School nurses should be at every school for more reasons than diabetes. Children with emotional problems often have medical symptoms that take them to the nurse, so they can be treated before they are completely overwhelmed. I always breathed easier when the 'shared nurse' was at my son's school. But like a previous message poster, I had to tell every teacher and school volunteer that when my son had symptoms of low blood sugar, the last thing that should happen would be to send him off somewhere on his own! In elementary school his main symptoms of low blood sugar would be eerily similar to typical age appropriate misbehavior and only his classmates could remind overworked playground aides that he had diabetes and should not be sent to the principal's office on his own for 'discipline' - I was shocked at how often grown ups just forgot about the diabetes. And some staff, no matter how much training they had, seemed never to get over that he would 'get away' with misbehavior 'just because' he had low blood sugar. It takes all kinds I guess.

Speaking of which, at a school where there was a full time nurse, my son was told he could not keep his insulin in the nurse's refrigerator, because some teachers kept their lunches in there and they did not want to 'catch' anything from his open vial of insulin.

And I'm sorry to say that during a low blood sugar even early on, the nurse on duty at his elementary school came back from the staff lounge without a soda or juice because the machine did not have his preferred flavor of soda or juice - and she had already taken up time asking if I had change for the machine, because it wasn't right to use the staff 'spare change' in case a teacher wanted to make change there later on. Argh!

All other nurses in the district were appalled when they heard this - but even some emergency room doctors and staff are not as well-informed about type one diabetes as they need to be.

School nurses must be more important today as we plan for overnight emergencies due to natural disasters or attacks, lock downs, flu pandemic and generally worse strains of childhood illnesses.

Families of children with diabetes are doing their communities a favor by advocating for full time school nurses.

And I am very thankful for the dedicated and adventurous teachers who felt it was quite within their realm to learn basic diabetes care just so they'd be competent caregivers while my son was in their classrooms.

If I was making a presentation before my school board, I would speak more to the support of neighborhood kids who remember that their friend has diabetes, can help them avoid emergencies, and can tell the difference between misbehavior and symptoms of dangerous lows when they happen. Also, staying in neighborhood schools gives children with chronic health conditions a supportive community of adults and other students who recognize that diabetes is just a small part of who he or she is or will be. We want all our children to reach their full academic potential in neighborhood schools with the small supports and accommodations each of them needs to show us what they can do.

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