Actions for the School Nurse
Please print and distribute to the School Nurse
When a school nurse is assigned to the school (or school district), he or she is the key school staff member who leads and coordinates the provision of health care services for a student with diabetes at school and at school-related activities. The school nurse, in collaboration with the principal, takes the lead in identifying, training, and providing ongoing supervision of trained diabetes personnel.
Diabetes technology, therapies, and evidence-based practice all are changing rapidly. The school nurse, who provides care to students with diabetes and facilitates diabetes management training for school personnel, has the professional responsibility to acquire and maintain current knowledge and competency related to diabetes management on a regular and ongoing basis. (See Train School Personnel)
The school nurse is responsible for the following actions and should review them when notified that a student with diabetes is enrolled in the school, annually, or more often as necessary.
- Understand your role in ensuring compliance with Federal and State laws that may apply to students with diabetes, including Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act. Understand the procedures for implementing these laws. (See School Responsibilities Under Federal Laws)
- Understand State laws regarding delegation/assignment of nursing tasks and other laws relating to the provision of health care in schools.
- Obtain and review the student’s current Diabetes Medical Management Plan (DMMP) (PDF, 218 KB) and other pertinent information from the student’s parents/guardians.
- Using the medical orders in the DMMP and information obtained from a thorough nursing assessment, develop an Individualized Health Care Plan (IHP) (PDF, 96 KB) . Promote and encourage independence and self-care consistent with the student’s ability, skill, maturity, and development as indicated in the DMMP. After reviewing the IHP with the parents/guardians and student, implement, review, and update the plan throughout the school year as needed. (See Tools for Effective Diabetes Management)
- Prepare the student’s Emergency Care Plans for Hypoglycemia (PDF, 96 KB) and Hyperglycemia (PDF, 97 KB) based on the medical orders in the DMMP. Provide copies of the emergency plans to all school personnel who have responsibility for the student with diabetes throughout the school day and during school-sponsored extracurricular activities and field trips (e.g., teachers, coach, physical education teacher, lunchroom staff, bus driver).
- Facilitate the initial school health team meeting to discuss implementing the student’s DMMP and IHP. Participate as a health expert on the teams that develop and implement the student’s Section 504 Plan, other education plan, or individualized education program. Monitor compliance with these health care and education plans and facilitate follow-up meetings of the school health team to discuss concerns, receive updates, and evaluate the need for changes to the student’s plans, as appropriate.
- Plan and implement diabetes management training for the trained diabetes personnel and all staff members who have responsibility for the student with diabetes. Use the three levels of training described in this guide to design the diabetes management training, and consider using standardized training materials that are available for training school personnel. (See Train School Personnel) Determine that all personnel mentioned in the health care and education plans know their roles in carrying out these plans, are trained in how to carry out their roles, and know how their roles relate to each other, when and where to get help, where routine and emergency supplies are kept, and the procedures for handling emergencies.
- Make parents/guardians and the student aware of which school personnel will be informed about the student's diagnosis and who will be trained to provide care.
- Obtain materials and medical supplies necessary for performing diabetes care tasks from the parents/guardians. Arrange a system for notifying the student or the parents/guardians when supplies have expired or need to be replenished.
- Obtain materials for the emergency supply kit from the parents/guardians and designate a storage location for emergency use. The kit should contain enough supplies for at least 72 hours. Notify all school personnel of its location.
- Perform or assist the student with routine and emergency diabetes care tasks, including blood glucose monitoring, urine or blood ketone testing, insulin and other medication administration, carbohydrate counting, and glucagon administration. Be aware of the school’s policy on activating Emergency Medical Services in case of a diabetes emergency.
- Maintain accurate documentation of all diabetes care provided at school. Document communications with the student, the parents/guardians, and the student’s personal diabetes health care team, and document communications related to the training and supervision of trained diabetes personnel.
- Provide ongoing education and training as the school year progresses for staff and new staff, as needed, and when the student’s DMMP changes.
- Assess competence and provide ongoing supervision of trained diabetes personnel in carrying out the health care tasks outlined in the student’s health care and education plans.
- Conduct ongoing, periodic assessments of the student with diabetes and update the IHP. Assessments should include self-care abilities, adherence to diabetes care tasks, successes/barriers to meeting blood glucose target ranges, social-emotional concerns, and readiness for transitions (e.g., high school, college, adulthood). Watch for signs of eating disorders, such as unexplained weight loss, particularly in female students
- Foster a supportive learning environment and treat the student with diabetes the same as other students, except when necessary to respond to their medical needs and any resulting educational needs. Be alert for teasing and bullying of the student with diabetes due to peers’ curiosity and lack of information about injections, blood glucose monitoring, or why the student with diabetes gets to eat snacks in the classroom.
- Distribute the Diabetes Overview in this guide to all school personnel who have responsibility for students with diabetes, and determine that they understand the basic elements of effective diabetes management and know how to recognize and respond to a diabetes emergency.
- Provide education and act as a resource on managing diabetes at school to the student, family, and school staff.
- Act as an advocate for students to help them meet their diabetes health care needs.
- Assist the classroom teacher(s) with developing a plan for substitute teachers.
- Assist the physical education teacher with managing the student’s physical activity program at school.
- Visit the classroom teachers routinely to provide support and counseling and to address concerns regarding the impact of diabetes on the student in the classroom.
- Collaborate with coworkers and outside agencies (e.g., school district registered dietitian nutritionist, food service manager, and food service personnel) to obtain nutrition information for the parents/guardians and the student.
- Communicate with the student’s parents/guardians—and with their permission—communicate with the student’s personal diabetes health care team about progress as well as any concerns about the student’s diabetes management or health status, such as hypoglycemia episodes, hyperglycemia, general attitude, emotional issues, and self-management.
- Respect the student’s confidentiality and right to privacy.