Response to the AFT's Goal of Blocking Diabetes Care Legislation
By Crystal Jackson
My 14 year old daughter, Devin, was diagnosed 13 years ago so we have been doing the diabetes shuffle for a long time. We have lived in several states and have encountered school diabetes care situations across the board. Everything from Devin's pre-school Montessori directresses in Pennsylvania who were trained to perform blood glucose monitoring, administer glucagon, and treat hypoglycemia, to the half-day, once-a-week school nurse in a California public school who thought being "low" meant insulin was needed, to the same school in CA where I couldn't leave my home 5 minutes away from school because there was no one trained to provide care for Devin on the days the nurse wasn't scheduled to be at school (4 1/2 days/week she was not there), to Devin's Virginia public elementary school where trained non-medical personnel provided for her needs (including insulin administration) without a glitch, to middle school where our school nurse is an absolute blessing, but who also is absent upon occasion and who also has a family herself thus walks out the door at 3:20, to this coming Sept. as Devin walks through the doors of high school as a freshman to be greeted by another wonderful full-time school nurse who also walks out the door at 3:20. Folks, we've seen and done it all when it comes to school diabetes care so we are far from being novices.
Now focusing upon our current Virginia school diabetes care situation. Five years ago mom extraordinaire Sandi Pope and I, along with a groundswell of grassroots support from Virginians, the D.C./Virginia diabetes medical community, and the support of the American Diabetes Association lobbied successfully for the passage of a school diabetes care bill that essentially authorizes the training of non-medical school personnel in diabetes care tasks and requires a minimum number of folks be trained in each school where a student with diabetes in enrolled. This bill was the first of its kind in the country and it has gone a long way to improve the lives of Virginia school children with diabetes. Under this law, trained non-medical personnel are authorized to provide care when the school nurse is not available. I can't tell you how proud I am to live in a state where caring for students with diabetes and other chronic illnesses is a priority to both the education and health care communities - kudos to our Virginia school nurses who recognize the value of training volunteer teachers, secretaries, administrators, janitors, cafeteria workers, bus drivers, etc. The first year the legislation went into effect, Devin's wonderful school had 24 volunteers step forward to be trained - when in fact all that was required were 3! So please don't tell me that there aren't teachers and other school personnel out there who are too overwhelmed by other classroom duties to help a child or who do not care - this is simply not true! Our teachers and others do have our children's best interest at heart and want to be in the best possible position to help our kids - whether it be with pushing a button on an insulin pump or overcoming difficulty with a math problem.
To offer some additional perspective on our school situation here in Virginia , Loudoun County, Virginia is the 2nd fastest growing county in the nation. Our present school population is 47,000 with 41 elementary schools, 10 middle schools, 8 high schools and 1 alternative school. Middle, high, and alternative schools are staffed by a full-time RN and non-medical personnel staff the elementary schools and are monitored by a rotating school resource nurse. To date, 738 school staff members, 932 bus drivers, 123 cafeteria hostesses have been trained to provide routine and emergency diabetes care. I have recently confirmed with LCPS officials that there has not been even one incident or mishap in the delivery of care to students by non-medical personnel. LCPS is definitely the model to follow and clearly demonstrates that non-medical trained school personnel can effectively deliver diabetes care to our children. The care provided by trained non-medical personnel does not replace the care provided by a school nurse, but supplements school nurse care which is absolutely critical for a child with diabetes. Like almost every other school district in this country. LCPS does not have the funding to hire a nurse for every school. And even if every school had a full-time nurse, this is not enough because nurses too get sick, most nurses I know do not attend field trips, or stay after school to provide care. Devin has always stayed after school to participate in a number of extracurricular activities and has gone on more field trips than I can count. Care during the school-sponsored extracurricular events has always been expertly provided by trained non-medical school personnel and I have always been very confident in the training provided to these folks and their ability and willingness to provide Devin with excellent care.
The bottom line is that certainly while the nurse is the preferred school staff member to provide care, the reality is that most schools do not have a school nurse and are not likely to have a school nurse in every school in the foreseeable future. We all, as parents, would welcome having a school nurse, but having a full-time school nurse simply is not enough because our kids must manage their diabetes 24/7. To reiterate, school nurses get sick with an insufficient substitute pool, school nurses must tend to children with other health issues and emergencies, school nurses usually do not stay after school to provide care during extracurricular activities, school nurses usually do not accompany students on field trips, school nurses usually do not accompany the football team on an away-game trips. Who will provide this care when a school nurse is not available?
Other trained non-medical personnel are absolutely essential to the health and safety of a student with diabetes and can be easily trained. Parents of kids with diabetes come from all socio-economic backgrounds and have all different levels of education. Prior to my child being diagnosed at the tender age of 17 months, I had a needle phobia for crimey sakes! My point is school staff members who do not have a medical license who volunteer to be trained can be trained and trained very well. Look at all of us parents, family members, and caregivers - most of us do not have RN or MD behind our names. Again, the trained non-medical school staff member supplements the care provided by a school nurse - provided there is even a school nurse to coordinate care.
Yes, we all would like to have a school nurse in our child's school. But we all want world peace too! Let's get real. What happens in between the time each school is mandated to employ a school nurse and right now when our children need care? Our kids' diabetes will not wait for a school nurse. I am personally outraged that the school nurse leadership appears to be using our children with diabetes as a platform to further their agenda - my personal opinion only. Thank goodness that Virginia has gotten it right and I applaud each and every one of our Virginia school nurses! And I know there are other states and school districts who are doing an excellent job of caring for students with diabetes so kudos to you too!
Now, from an ADA advocacy perspective: The ADA unequivocally supports putting a school nurse in every school and has said so publicly many times through various venues including an article authored by the ADA's Legal Advocacy Director Shereen Arent, JD, and published in a NASN newsletter in 2003, and also the central role of the school nurse is clearly articulated in the ADA's model school legislation. The ADA's efforts have no intent to usurp the role of the school nurse. We support the school nurse, but recognize that most schools do not have a school nurse and children with diabetes still need care. And, as I've stated above, even if every school had a full-time nurse, it is just not enough. The ADA's model legislation emphasizes the central role of the school nurse, but authorizes the training of volunteer non-medical personnel to supplement the nurse. Not replace, supplement. The ADA's goal is to make sure students with diabetes receive appropriate school care.
Most of you by now are familiar with AFT school nurse position against the ADA's model school bill on http://www.schoolrn.org/diabetes-legis.htm. In addition, what you may not know is that there is a resolution before the American Federation of Teachers membership whose annual conference is the week of July 13th in D.C. and the resolution will voted upon by AFT's delegates at that time. This resolution opposes the training of non-medical personnel in the performance of diabetes care tasks and authorizes AFT to actively lobby against the ADA's model school legislation in the states.
I wanted to make folks aware of this resolution and if you would like to provide input please contact AFT healthcare staff members Mary MacDonald, Director of Healthcare, and/or Joni Tanaciev, Assistant Director of Healthcare, American Federation of Teachers, 555 New Jersey Ave., N.W., Washington, D.C 20001, 202-879-4491 (phone) and 202-393-5672 (fax).
July 3, 2004
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