how to coordinate with students' providers outside of school

Farawyn · Mar 11, 2016

I wouldn't advise telling a mother of a kid with diagnosed medical problems that her kid needs to "persevere". That is beyond your scope, and frankly, not your business. If you have documentation from a doctor and other members of the school team are working closely with this child as you indicated, you have to let that go.

OldDude · Mar 11, 2016

Well if you a public school the kid needs to be in 504, which would get everyone at a table and make a plan. Regardless, it's ok for the child's pediatrician to discuss medical issues with the school that are relevant to school attendance. If the pedi office is reluctant to do that get mom to sign a release for the info, if you haven't already done that.

bugya90, ASN, BSN, LVN, RN · Mar 11, 2016

I'm not a school nurse, I'm a clinic nurse. I'll tell you we see these sick kiddos a lot and often the parents bring in some nasty notes wrote by the school about how their kid is missing to much school. I promise you, a majority of these cases the kid is truly sick and needs to stay home. They may be missing more days than you think is appropriate but that is between the parent and their doctor. I would not tell mom in any way shape or form that in your opinion the child is not sick enough to stay home. Again that is between the parent and the doctor. This kid may have some serious health concerns that you don't know about.

Effective communication: get a translator or go to google translate if an official translator is not available.

bay area FNP-to-be · Mar 11, 2016

Sorry, you're right about not encouraging them to stay at the wrong time. When the student is clearly ill, they go home home and if there's any doubt we let mom decide because as lay-people, there isn't much we can assess, just a basic algorithm I developed with a pediatrician. I was referring to instances where the child comes in with non-specific complaints (like saying their body hurts, but not being able to elaborate). If we call mom and she prefers they go home, I'm fine with that since I know there's nothing we can do.

I guess my question for you all, since you see more kids, is if this happens to you what routes you take to try and minimize absences. The only doctor's notes we've gotten are just confirmation of the appt. without any information of what's happening. Mom has mentioned a few things here and there, but otherwise just keeps her child home a lot.

bay area FNP-to-be · Mar 11, 2016

@Old Dude: thanks for the suggestion. I've only tried reaching out to a clinic once or twice and was quickly met with resistance regarding privacy, but I think mom would sign the release. Medical issues haven't been addressed in the 504 plan, just consults with an educational psychologist.

@bugya90: I don't send those notes because I do believe the student is sick and doubt it'd be helpful; I just want to make sure she's keeping him home when it's truly necessary, but getting support (from us and/or her child's clinics) about how to support him so he doesn't fall even further behind.

JenTheSchoolRN, BSN, RN · Mar 11, 2016

This is why every school needs a nurse. A nurse that can properly assess this child and in a plan developed with the parent and pediatrician, determine when the child can remain in school and when they cannot.

A 504 plan would also lay out what school work needs to be completed with frequent absences; a child needing to complete every classroom assignment vs. only the truly necessary so that that stress doesn't compound the already existing physical issues. If you are the one to co-ordinate a 504 plan at your school, you can communicate to the parent that doctor's documentation is needed. If not, than it my be best left for another support person for this child to handle.

NutmeggeRN, BSN · Mar 11, 2016

I'm not a school nurse, I'm a clinic nurse. I'll tell you we see these sick kiddos a lot and often the parents bring in some nasty notes wrote by the school about how their kid is missing to much school. I promise you, a majority of these cases the kid is truly sick and needs to stay home. They may be missing more days than you think is appropriate but that is between the parent and their doctor. I would not tell mom in any way shape or form that in your opinion the child is not sick enough to stay home. Again that is between the parent and the doctor. This kid may have some serious health concerns that you don't know about.
Effective communication: get a translator or go to google translate if an official translator is not available.

I have been a school nurse for 22 years now. What do you consider a "nasty" note from school? Just curious.

bay area FNP-to-be · Mar 11, 2016

This is why every school needs a nurse. A nurse that can properly assess this child and in a plan developed with the parent and pediatrician, determine when the child can remain in school and when they cannot.
A 504 plan would also lay out what school work needs to be completed with frequent absences; a child needing to complete every classroom assignment vs. only the truly necessary so that that stress doesn't compound the already existing physical issues. If you are the one to co-ordinate a 504 plan at your school, you can communicate to the parent that doctor's documentation is needed. If not, than it my be best left for another support person for this child to handle.

I'll push harder for dr. involvement since I think medical issues are underlying a lot of what's happening, not just other issues the 504 addresses. And yes, I would love for us to have a nurse. Our students would be much the better for it.

SnugglePuggle, MSN, RN · Mar 11, 2016

I'm not a school nurse, I'm a clinic nurse. I'll tell you we see these sick kiddos a lot and often the parents bring in some nasty notes wrote by the school about how their kid is missing to much school. I promise you, a majority of these cases the kid is truly sick and needs to stay home. They may be missing more days than you think is appropriate but that is between the parent and their doctor. I would not tell mom in any way shape or form that in your opinion the child is not sick enough to stay home. Again that is between the parent and the doctor. This kid may have some serious health concerns that you don't know about.
Effective communication: get a translator or go to google translate if an official translator is not available.

I am going to assume that the nasty notes you are referring to are the ones a school sends to parent when the student has a certain number of UNEXCUSED absences. In my school district, students are allotted a certain number of absences without documented excuse on file (My district allows 8 which I feel is very generous). After that number is exhausted, attendance staff begin to require documentation to consider the absence excused. Warnings are mailed when unexcused absences get excessive. What you may not realize is that public schools are required by law, at least in the State of Ohio, to report truancy. Warning letters are sent to give parents a heads up that if the pattern continues, they will be reported and end up in court.

Unfortunately, we have many parents of students with chronic health issues who fail to submit any documentation for repeated absences. Just because Johnny has a note on file from his doctor that had a difficult week controlling his asthma in September, does not automatically excuse him for the 25 subsequent absences throughout the year, unless he has a 504 in place that addresses the issue of repeated absences.

Your final comment "This kid may have some serious health concerns that you don't know about." should not even be an issue. School nurses make it their business to be aware of and to address serious health concerns of our students. It is part of our job. that being said we have no control over the parent who is not forthcoming with us regarding their child's medical issues.

bugya90, ASN, BSN, LVN, RN · Mar 11, 2016

I am going to assume that the nasty notes you are referring to are the ones a school sends to parent when the student has a certain number of UNEXCUSED absences. In my school district, students are allotted a certain number of absences without documented excuse on file (My district allows 8 which I feel is very generous). After that number is exhausted, attendance staff begin to require documentation to consider the absence excused. Warnings are mailed when unexcused absences get excessive. What you may not realize is that public schools are required by law, at least in the State of Ohio, to report truancy. Warning letters are sent to give parents a heads up that if the pattern continues, they will be reported and end up in court.
Unfortunately, we have many parents of students with chronic health issues who fail to submit any documentation for repeated absences. Just because Johnny has a note on file from his doctor that had a difficult week controlling his asthma in September, does not automatically excuse him for the 25 subsequent absences throughout the year, unless he has a 504 in place that addresses the issue of repeated absences.
Your final comment "This kid may have some serious health concerns that you don't know about." should not even be an issue. School nurses make it their business to be aware of and to address serious health concerns of our students. It is part of our job. that being said we have no control over the parent who is not forthcoming with us regarding their child's medical issues.

The OP is not a nurse so does not have a reason to know about this child's health hx. If OP was a nurse then it would be a different story.

The "nasty" notes I'm referring to are normally wrote by front office staff, not medical professionals such as school nurses. My favorite was one that said "Johnny has missed school twice this week and when he was here on Monday he didn't look very sick to me. You need to provide a doctors note with details of why he missed two days" this letter was sent home with Johnny on Thursday when he went back to school (had missed Tuesday and Wednesday). Well Johnny was recently diagnosed with leukemia and was meeting with his oncology team on Tuesday and Wednesday and was starting treatment the following Monday. Mom gave me permission to speak with the school nurse who was notified of the situation and she educated this front desk member on what she should and should not send home in a note. You would be amazed some of the things front office staff and teachers will put in notes for the parent/Doctor.

SnugglePuggle, MSN, RN · Mar 12, 2016

The OP is not a nurse so does not have a reason to know about this child's health hx. If OP was a nurse then it would be a different story.
The "nasty" notes I'm referring to are normally wrote by front office staff, not medical professionals such as school nurses. My favorite was one that said "Johnny has missed school twice this week and when he was here on Monday he didn't look very sick to me. You need to provide a doctors note with details of why he missed two days" this letter was sent home with Johnny on Thursday when he went back to school (had missed Tuesday and Wednesday). Well Johnny was recently diagnosed with leukemia and was meeting with his oncology team on Tuesday and Wednesday and was starting treatment the following Monday. Mom gave me permission to speak with the school nurse who was notified of the situation and she educated this front desk member on what she should and should not send home in a note. You would be amazed some of the things front office staff and teachers will put in notes for the parent/Doctor.

Wow. I guess I am very lucky as that is not how my office staff or teachers operate. My attendance lady and I have a very open, 2 way line of communication with regards to medical excuses. What you describe is over the top and certainly unprofessional. I certainly feel for the family placed in that situation.