ANA's Position on Diabetes Care in Schools
April 4, 2005

Schools are required by law to provide an environment that allows for the management and safe delivery of care for children with diabetes during the school day. Obstacles to effective diabetic care still exist in many schools and are of mutual concern to health care providers, parents, and educators. Legislative and regulatory initiatives are being promoted at the state level to address these barriers to care. ANA has been working with representatives from ANA's Constituent Memeber Associations (CMAs), the National Association of School Nurses, and the American Federation of Teachers to address this issue.

Background
ANA has also been involved in discussions with the American Diabetes Association (ADA), which represents individuals with diabetes and their families. ADA is promoting model legislation at the state level that emphasizes the central role of the school nurse, but authorizes the training of volunteer, non-medical personnel in the performance of diabetes care tasks and emergency care. ADA has developed a guide to support diabetic children in schools which is being enacted through school policy, regulations and legislation. ADA believes that in order to facilitate appropriate care of the diabetic student, school personnel must have an understanding of diabetes and be trained in its management and emergency treatments for students.

In October, 2004, ANA staff met with ADA representatives to discuss their model legislation, as well as concerns related to the delegation of nursing services. ANA agrees with the concept of providing broad support for diabetic students, but is concerned about details of the ADA plan related to delegation of nursing services and the training of non-medical school employees to address the health care needs of diabetic students. These plans include student assessments and the administration of Insulin and Glucagon. The lines of communication remain open between ADA and ANA. ADA continues to seek ANA support for their model legislation and to look for areas of agreement on the issue.

CMAs, particularly those in states targeted for legislative action in 2005, now find themselves needing to address issues related to safe, effective care for diabetic children in the school setting while also protecting their state's nurse practice act. During November 2004, ANA convened a conference call with representatives from the CMAs and the National Association of School Nurses (NASN) for a discussion about the components essential for inclusion in a policy statement on care of students with diabetes. ANA has also been working with the American Federation of Teachers (AFT) on this issue. Both NASN and AFT have developed positions that reflect the general principles identified by the CMAs as essential for safe diabetic care in the school setting.

ANA Board of Directors Action
At their March meeting, the ANA Board of Directors adopted policy to promote the management and safe delivery of diabetes care in schools and to facilitate advocacy on this issue. The policy includes the following:

*     ANA supports delegation of routine management tasks for the care of students with diabetes only if state law permits delegation of nursing services and only when the registered nurse determines who will be trained and what aspects of the care shall be delegated. In addition, the registered nurse will conduct the training, oversight, and evaluation of all care delivered by the nonmedical personnel; and

*     ANA does not support delegation of those registered professional nursing services that require assessment and/or emergency care; and

*     ANA advocates that, if a registered nurse is not available to attend to an emergency situation involving a child with diabetes, emergency services should be activated immediately by dialing 911 or the appropriate local emergency number for assessment and treatment by a qualified health care professional; and

*     ANA will work collaboratively with the CMAs, the National School Nurses Association and the American Federation of Teachers to advocate for policy, legislation and/or regulation related to the safe delivery of care in schools for children with diabetes that protect both the children and the registered nurses in these settings; and

*     ANA will continue to advocate for public policy and funding that provides for at least one full time licensed registered nurse in every school building.