School Nursing

The Relentless School Nurse: Social Determinants Are Not Just Words

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Eighteen years as a school nurse in Camden, New Jersey has given me plenty of opportunities to meet families from many countries.  There is one mother and son that stand out in my recent experience that speaks to the power of respecting our families’ cultural perspectives.

There is a part of Guatemala where the commonly spoken language is Mam, a Mayan Indian dialect that is not commonly found in Camden.  One of my parents and her preschool-age son found themselves resettled in Camden from this region.  Spanish was this mother’s second language, and extremely limited at that, so communication, even with a Spanish-speaking translator was very difficult.

The mother sought out my help after a medical leave from work. She was returning to her factory job following emergency surgery when her boss refused to accept her medical excuse note, claiming it was fraudulent.  The mother, fearing she was sure to lose her assembly line job, for which she had no sick time, had turned in the release note without understanding that there were several red flags on the note itself.  Her employer immediately saw that the note was not dated, it was hand-written and the header of the prescription pad had a new label with the provider information, but the phone number was not working.

The gruff employer pointed out all of these deficiencies when I called him in an attempt to secure the mother’s job.  I wanted to reassure him that the note was not fraudulent and that this employee had a valid reason for being out of work for two weeks.  The supervisor was convinced that the note was fraudulent and my reassurance was not changing his mind.

After multiple calls to the health care provider, I obtained a revised note, causing the reluctant employer to reverse his termination decision.  It turns out that there was a new nurse practitioner covering for an ill colleague in the clinic so the office manager had printed temporary labels to use on the prescription pads.  Hundreds of labels had been printed with an incorrect phone number.  Imagine how many other work notes had been written with this glaring error.

Relentless School Nursing calls us to take extraordinary measures on behalf of our students and families. Upstream thinking is what was required in this scenario.  Imagine the chain of events that would have occurred had the mother not asked for help, or if there had not been a Relentless School Nurse? She would have certainly lost her assembly line job and that would have impacted her and her child’s health and their tenuous financial stability.  Social determinants are not just words!

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