‘It’s Not Rocket Science’: LAUSD Eyes Volunteers, Not Nurses For Insulin Shots

LOS ANGELES (CBS) — Nurses in the Los Angeles Unified school district voiced their opposition on Thursday to a plan to train volunteers to administer insulin to diabetic children in public schools.

Officials claim demand for volunteers is soaring due to a severe nursing shortage in the education system, but after two lower courts ruled in favor of the nurses, the case is now in the hands of the state Supreme Court.

American Diabetes Association spokesman John Griffin Jr. told KNX 1070 he believes the nurses’ argument that only licensed individuals should be allowed to give the shots isn’t medically sound.

“Three-year-olds do it, babysitters do it, parents, grandparents…it’s not rocket science,” said Griffin.

Griffin calls the debate “unfortunate”, saying that with only 1 in 20 LAUSD schools having a nurse to administer the shots, kids’ health will ultimately be at risk.

“What happens when a child is trouble at school, with terribly high blood sugars and there’s no nurse?” said Griffin. “The answer ‘Call 911’ is not an answer that I think the Supreme Court is going to accept in California.”

In addition to keeping kids healthy, Griffin also points out the economic benefits of shifting insulin duties to non-paid volunteers.

“Trained volunteers don’t cost school districts anything, oftentimes the nurses are the ones who do train them, the American Diabetes Association trains them,” said Griffin.

But LA Unified’s Director of Nursing Dee Apodaca counters that the kids aren’t really getting the proper care they need.

“The training that they may have, it is not regulated like the Board of Registered Nurses,” said Apodaca. “Who wants to take a chance with our children?”

The California Supreme Court is expected to rule on the matter before 2012.

  • Bob L.

    When there is not a valid argument SOS, Save our kids.

    “But LA Unified’s Director of Nursing Dee Apodaca counters that the kids aren’t really getting the proper care they need.”

    Need I say more.

    I wonder if any of the potential volunteers are or have been nurses?

    Calling 911 still cost us taxpayers money, but most important are not present if someone else needs them!

  • Donna

    Giving a shot is not rocket science, but that is not the only issue here. Subjective and objective data, adverse reactions, side effects and more are more important than just the physical action of sticking a needle into someone, hopefully the right placement, hopefully good clean technique after piercing a person’s main line of defense. Recognizing signs of hypoglycemia and withholding the insulin of course. School boards would rather pay for expensive buildings and decorations than nurses.

    • Sarah

      100% correct…except that 99% of general duty RNs have absolutely no clue how to manage Type 1 diabetes. Some of them are still using the “sliding scale” method circa 1972….Nurses receive little modern diabetes training, and the training they receive almost always exclusively appplies to Type 2 diabetes, the common form of the disease typically related to older age, obesity, and poor lifestyle choices. It is the parents, and Type 1 diabetic children themselves who actually manage the disease on a daily basis. THEY are the experts. If the parents provide an appropriate information sheet with carb ratios, correction factors, and site rotation,normal target BG ranges, how to treat a hypo, etc. all written out, a lay person with training can certainly follow it. As mentioned, it’s not rocket science, and I’d rather trust an intelligent trained lay person regarding diabetes than most nurses. Let’s not get hysterical. Adverse reactions? To a routine insulin injection that one takes multiple times per day everyday? That would be hypoglycemia, and it’s an expected, and treatable, part of living with Type 1 diabetes. Insulin does not replace a pancreas and lows happen. Treat them with sugar. Withholding insulin of course? Why would you do that in a Type 1 diabetic? If you withold all insulin for a Type 1 diabetic, they will develop ketones and may go into a coma. If blood glucose testing shows the level is low, feed the child, give them extra fast acting carbs right away, have them eat their meal, THEN give them their meal time insulin. Depending on what the family/child usually does for a low, this may or may not include reducing the dose for that meal. Again, this can all be written out clear as day for each child. Right placement? Good clean technique? This is a subcutaneous injection with a sterile needle. This risk of infection is almost zero, and almost all areas of fatty tissue are fair game (almost all diabetes clinics have a sheet that clearly shows injections sites). Unless you are injecting the child’s eye, you are probably OK. EVERYONE who works with the child needs to recognize hypoglycemia, and the signs are rather obvious once educated. Follow up with a fingerstick to confirm, and then treat with some glucose (regular pop, jam, glucose gel, etc.). I’m not denying nurses have their place, but unless you want to assign a specialist diabetes nurse to each and every Type 1 diabetic child each minute they are in school, caring for a T1 child requires a team effort by lay people (at home and at school), and this simply makes the most sense.

  • Leslie

    It’s not that they don’t have nurses, they don’t want to PAY for nurses. They are putting lives at risk to try and save a dime. There are thousands of new graduates every year that would take the job in a heartbeat. This will sound like a great idea until a kid dies because they were overdosed. There should be a nurse on every single campus anyways… First they will get volunteers for shots, next they will argue that teachers know CPR and can handle a cardiac arrest. WAKE UP Los Angeles! If your child has an emergency do you want a volunteer to respond or do you want a medical professional?

    • Sarah

      The question becomes, what are the *legal* implications if a child has a hypoglycemic episode at school and the insulin was given by a lay person according to standing instructions. Are nurses in the hospital sued when their patient has a low blood sugar? Are they sued or fired when their diabetic patient has a high blood sugar? Are parents charged when their Type 1 diabetic child has a low blood sugar? Would simply having a nurse give the shot prevent all lows and highs (clearly not, as you can ask any Type 1 diabetic who has even been hospitalized). I think the real issue is NOT as to if a non nurse can safely give the shots (parents, grandparents, diabetic children do it every day for their entire lives, etc.), it’s do we have the resources to allow Type 1 diabetics to be cared for at school in ANY capacity. Non nurses are the only soution, unless you want to pay for a specialist diabetes nurse for each diabetic child each minute of the school day. RNs in general have little to no working knowledge of Type 1 diabetes. Your average school nurse is not going to have any additional benefit. Lastly, you don’t need a nurse, respiratory therapist, or doctor to manage a cardiac arrest outside of the hospital setting. CPR was designed to save lives outside of the hospital. Anyone can be trained in CPR and how to use an AED to manage a cardiac arrest until the paramedics arrive. What more could a school nurse do that a lay person could not? Nurses usually aren’t trained in intubation, and I doubt most school nurses carry advanced critical care life saving skills and equipment. Nurses are great for some things, but I am sick of nurses trying to convince the public of things they are not to suit their own agenda. Yes, it would be nice to have nurses for each child, or even school for that matter, but since that can’t happen, stop putting kids lives at actual risk by stating that only nurses can do the job. The truth is anything but.

  • Bob L.

    I see SOS is at it again.

    “But LA Unified’s Director of Nursing Dee Apodaca counters that the kids aren’t really getting the proper care they need.

    “The training that they may have, it is not regulated like the Board of Registered Nurses,” said Apodaca. “Who wants to take a chance with our children?”

    Could not DIRECTOR DEE APODACA help set up such a standard for training and work with the schools. Who gives the shot when the kid is not in school?

    We have volunteers working with Law Enforcement that gets proper training. Ms. Apodaca, would your time be better spent preparing such training for volunteers than try to build an empire.

    Leslie, the kids are not getting educated now, lets fire more teachers and have a nurse in every classroom, just in case.

  • Sheri

    @ Bob L….

    Well, certainly we could devise a program to train volunteers to administer insulin correctly, interpret subjective and objective signs and symptoms. Ms. Apodaca would likely agree to that.

    It’s called NURSING SCHOOL

    • Sarah

      Stop trying to make a simple subcutaneous insulin injection sound like brain surgery. Stop trying to make things over-complicated. Do they teach this airy fairy illogical nonsense in nursing school? This is not a new experimental drug the child is getting. A child who has been taking insulin every day for their entire life is highly unlikely to have a sudden anaphylactic allergic reaction one day out of the blue and drop dead. So we can cross that out. And low blood sugar doesn’t happen immediately after an injection. ALL staff need to know how to spot a low or high blood sugar, unless the nurse wants to follow the child around all day after giving said injection. So back to reality….how many parents of Type 1 diabetic children and diabetics themselves decide to become nurses? Probably not many. Oddly enough, they perform the task of managing their blood glucose levels, and insulin injections, every single day, in any situation imaginable. The real risk is of hypoglycemia, or low blood sugar, and this can and does happen to a Type 1 diabetic regardless of who is giving the injection. Anyone can learn how to treat this. LIke any nurse trained after 1970, you will know that blood glucose can immediately be tested for with a handheld almost instant monitor called a glucometer. Before you give the insulin, test the child’s blood glucose. Give the insulin as instructed according to the parent’s instructions on correction factors, carb ratios, BG levels, etc. No one in their right mind would try to sit around and try and guess a child’s glucose level based on “signs and symptoms”. This is not an ER triage. That’s what we have glucose meters for. I’m all for nurses in general, but this is a ridiculous argument, and an even more ridiculous post. As long as the “volunteers” are willing, reasonably intelligent, reliable, and properly trained, this really shouldn’t be an issue.

  • Bob L.

    There are so many variables, I have not seen a valid argument yet, other than LAUSD Nurses Union and Director trying to build an empire. What happens now if a student gets an insulin shot just before going to school with some type of reaction?

    I don’t know how many refresher courses I had in First Aid and CPR for such emergencies in the workplace.

    Would a nurse take on other duties instead of sitting most of the time reading the latest check stand tabloid? We all know the answer, “That’s not my job.”

    None of us can make a valid judgement. What is the maximum this happens in a school year at any one school? What percent of schools is there this type of medical problem.

    I have no problem creating a program and requiring a license, like EMT and Paramedics requires a license, and refresher training.

    If the money was there, lets put both a nurse and doctor at each and every school in California. Have an ambulance park in the driveway, just in case it is needed, but the money is not there. Our politicians are getting elected by cutting services and laying off teachers that will have dire consequences in the future. In my lifetime, the US went from having the best School Systems in the world, now we are number 12, and as we continue our path of self-destruction we will be last within the next generation.

  • Bob L.


    Since some people like simple things, here goes…

    The bottom line is what the California’s Supreme Court rules. If they don’t reverse what the lower courts have ruled, more kids will be injured by their decision than if we let volunteers give shots. I’m not saying Nurses would not be nice in every school, but we just cannot afford them, plain and simple. Do we want nurses at every school by having our kids less educated because we have to fire more teachers?

    What would be better for the kids, schools with no nurses, or schools with volunteers?

  • T

    I know this article is old – but look what i just found …..guess we arent the only ones with questions….http://www.wwnytv.com/news/local/Physicians-130439088.html

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