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Do you know if I am at risk for teaching nonmedical staff how to administer insulin?

Monday February 27, 2012
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Dear Donna,

I am currently working as a health specialist RN for an organization that provides Head Start services to approximately 600 preschool children at 11 different centers. We have one child who was recently diagnosed with diabetes and needs insulin and glucose readings every four hours. Since I cannot be at this particular center every day, I am unable to administer the insulin. However, my supervisor wants me to teach the nonmedical staff, who are teachers, how to provide these services. I am concerned that if something were to happen, such as the insulin being administered in the wrong amount or at the wrong time, that I would be the one liable. Do you know if I am at risk for teaching nonmedical staff how to administer insulin? If so, what would be your suggestion as to how to handle this?


Dear Donna replies:

Dear Tiffany,

To answer this question I consulted Nancy Brent, a nurse attorney. The following is her response.

“There is no easy answer to the issue surrounding the delegation of insulin administration to unlicensed personnel in the school setting. As you know, there are many federal and state laws impacting this issue, including the state nurse practice act, Section 504 of the Rehabilitation Act, and the Individuals with Disabilities Act.

“There is no question about the position that professional associations such as the American Association of School Nurses and the American Nurses Association take on this issue. They clearly state it is only the school nurse who is capable of providing for the health needs of the diabetic student in the school, including the administration of insulin. Reviewing the statement of the AASN, "School Nurse Role in the Care and Management of the Child with Diabetes in the School Setting" (revised 2006) it’s position is very clear.

“The ANA has been a strong voice in supporting the school nurse's role in administering insulin to students in the school setting. In their lawsuit filed in California, ANA versus O'Connell, the Appellate Court, Third District, upheld a lower court ruling that the administration of insulin to students by unlicensed assistive “trained” school personnel violated the California Nurse Practice Act and other laws. The case was appealed to the California Supreme Court in 2011, and to date no ruling has been made.

“Because every licensed nurse is accountable and responsible for his or her own actions, any delegation in any situation that is contrary to the state nurse practice act and rules, can be very problematic for the nurse. Moreover, the school nurse also may be violating other state and federal laws. If there is a requirement that a school nurse delegate insulin administration to others in the school setting, then that, as a minimum, is contrary to the state nurse practice act. Seeking legal advice from a nurse attorney or attorney in that state is essential for guidance in handling this requirement.

“There are several resources available on the ANA and National Association of School Nurses websites and on the Internet generally, that may be helpful in dealing with this issue. In addition, the textbook by Schwab and Gelfman, "Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, School Nurses," (New York, Authors Choice Press, 2005), could be helpful as well.”

Also check with your state chapter of the National School Nurses Association (www.nasn.org), even if you are not a member, for additional advice and information on this issue and to see how other school nurses in your area have handled this issue.

Best wishes,

Donna Cardillo, RN, MA, well-known career guru, is Nursing Spectrum/NurseWeek’s “Dear Donna” and author of “Your First Year as a Nurse: Making the Transition from Total Novice to Successful Professional” and “The ULTIMATE Career Guide for Nurses: Practical Advice for Thriving at Every Stage of Your Career.” Information about the books is available at www.Nurse.com/CE/7010 and www.Nurse.com/CE/7250, respectively. To ask Donna your question, go to www.Nurse.com/asktheexperts/deardonna. Find a “Dear Donna” seminar near you: Call 800-866-0919 or visit http://events.nursingspectrum.com/Seminar.