Make the call to CPS

[zombieghoast]

This is my second year as a school nurse and I had this student last year who broke his toe and mom only ever took him to the ER and never the follow up appointments as instructed because "it cost too much". The social worker helped me with the case because she has had issues with mom. She had to threaten to call CPS on mom because we never received any documents that he was healed. So now he broke his jaw during summer and came to school with a wired jaw. Grandma now has custody of him and grandma said he can go to gym. Principal said that we need a doctor's note and all of the paper work to verify this. Two weeks ago he got the wire removed and I got nothing... Called grandma multiple times and she never called me back. Then I saw her last week in the office and I told her I need the papers from the doctor and she can call the office to have it faxed to me. A week has gone by and I talked to the social worker and she told me she is no longer going to deal with that student's behavior (the really bad misbehaving kids have to see her) and for me to call CPS. I have never done this so I don't know how to approach this.

[Wave Watcher]

I don't have anything to add. Everyone gave great advice. :-)

The only thing I thought at first was, "Did you have wire cutters in case the kid choked?" lol I worked on an ortho unit and we had a lot of jaw procedures sent to us and many were wired shut. Made me nervous. lol

Just be an advocate for the kid. That's all you can do and calling CPS is one of the ways we can do that. Hang in there.

[Windchaser22]

I'm wondering why the social worker didn't make the call. In NJ they, and teachers as well, are also mandated reporters.

[jdub6]

I will say up-front that my peds experience has been acute and not school, and most of my fair amount of experience with what is dcf (department of children and family services-supposed to sound less threatening and more service or advocacy based) has not been in my rn capacity. (As an aside, when I did deal with it as a nurse, both in cases of child and elder/"vulnerable adult" issues, we actually always collaborated with sw who in my experience always took the lead. You are a mandated reported, but as others have said so is the sw, and unless she is also principal I don't understand why she is ordering you around instead of collaborating with you, so if you both have concerns you can make the call as efficient, with as much info, as possible, together or at least in cooperation. I also wonder why she is just putting this on you instead of calling, or at least giving you more reason to call than "he has exhausted my patience.")

Looks like I am in the minority but I agree with the last person who said this sounds like a bad reason to call, and possibly the sw bullying a difficult family instead of being professional by trying to connect them with resources to solve the problem (now, maybe she really has given it just as much of a try as she would with anyone else, and the family's lack of cooperation has made it for naught, but she still should not now decide to just throw the system against them without a valid reason, and his misbehaviour alone is not one). If you would normally call for a family that does not return the proper paperwork in this situation within x amount of time, then call and give them all the facts relevant to the situation. If you have reason, besides "I don't like them and they seem sketchy", real evidence, to believe the jaw fracture was a result of abuse or neglect, call. You are required to. BUT. From what I have gathered, missing md documentation for a variety of things is a common problem for you folks. Truthfully, one could make the case legally that a parent's failure to make sure jr gets appropriate meds/treatment by returning md orders is guilty of neglect and should ALL be reported. But, it seems like common practice is to cut slack, for some even to try to gather documents yourself. And it also sounds like it is common enough that if all cases were called in the state could not possibly even begin to investigate all. So the question is why call for this family? Is the student at increased medical/educational risk due to grandma's failure to comply? Is there anything else the school can do to help (maybe grandma is elderly, sick, can't drive, whatever...maybe as another said she actually doesn't have legal custody, the state does and she is tired of chasing down the caseworker). Is it your job? Not after a point. But you likely have more resources to offer, more quickly, than the state.

This is getting lengthy. I guess my big concern is a LOT of the posts here are about missing paperwork. Some are vents, some are brainstorming, but I cannot recall anyone mentioning calling the state for it. So what makes this case different, at this juncture? If it is just overall frustration with the family then this may be unethical, will definitely not increase cooperation from them in the long run and is unlikely to cause any big action from the state. If you are now realizing you have real, medical, more than usual concern for the student and have not called that is a different matter. But I would limit my call to that rather than "the sw also told me he is really annoying" and tell her you will be calling for medical concerns and suggest she call regarding any psychosocial concerns.

Many have mentioned advocating for the student, doing what is best. Sounds like the kid has already been through a lot. If this was a meek quiet little rich white girl with a sweet little rich white granny in the same medical situation, would you consider it in her best interest to get the state involved? Remember, involving strangers, courts, and officials in a child's life is a stressor for them. In some cases it is worth it and that is why cps is there. In many cases, even some where there was life-threatening stuff going on, it adds to long term emotional and behavior problems in the child, and further alienates an already high risk parent from the system often leading to long term incarceration, addiction, etc. What is really in his best interest? And what is your own established standard in other cases of missing paperwork like this? Should you involve admin like others have mentioned? If so, perhaps seek some guidance BEFORE calling. Do you have a way to return the student to class without this documentation? Someone said a wired jaw is an obvious physical reason to exclude...at some point are you allowed to use the obvious reasoning idea to let him back in?

Please know I am not suggesting you ignore your professional assessment of medical risk nor your legal requirement to report. As someone with close family members adopted from the state, foster parents and former foster children, who is very much aware of some of the awful things that can happen to a child AND the scars left by the whole situation, I am suggesting that you re-balance this case against others and just ask first whether you are acting more out of frustration/anger or out of objective professional assessment of what you would typically consider to be the appropriate action in the student's best interest. If you decide not to call and the sw has concerns she is obligated to report them. CYA is a valid point, if you have told the sw you feel there is medical neglect etc going on. I would not feel the need to call to cya based on only the interaction you described. In fact I would wonder if it would draw attention to you NOT calling in other similar cases.

[jdub6]

Yikes that was long. I get carried away sometimes, especially as devils advocate. I forget no one will finish it. Anyway, I finished The Great American Novel, I saw your title again with the question mark. Remember, you are a nurse, not a cps worker. Your job, and legal obligation, is to use your best nursing judgement, report legit concerns, and let them decide what to do. I would encourage you to make sure you don't single out any family due to prejudice, but at the end of the day you are responsible for doing your job and telling them if you have concerns because of it, no more no less. (So is the sw.) While it is possible that you could be prosecuted or disciplined for not reporting something, honestly the state cannot even handle their caseload of immediate threats to life and are very unlikely to go digging into your professional life more than they have to. And truthfully if you do call it is unlikely they will do a whole lot. Either way, while anything is possible (our job is high-stakes, no matter what) it is called a hotline because it is designed for people without professional knowledge in that area to call with concerns and get HELP with it. In your case that help is their judgement whether to do anything, and if so what to do. If still in doubt after assessing the situation, call, say what you know and no more, and let them do their job.

[OldDude]

jdub6

"If this was a meek quiet little rich white girl with a sweet little rich white granny in the same medical situation, would you consider it in her best interest to get the state involved? "

Could you elaborate or further explain the point you are trying to make with sentence and how it relates to the OP?

[jdub6]

OldDude: From the OP, the prompts to call the hotline came from SW due to "being sick of the kids behavior" and there were several comments about the mother and grandmother's lack of cooperation in general and occasional disrespectful remarks from the family. It also mentioned the excuse of "broken down car" for months which I took to mean they likely aren't rich, at least in their eyes. I did not mean to imply racism but was just trying to stretch out the example to the fullest...I realise the op didn't mention race. Perhaps I should have left it out entirely. In any case, the point was that it sounds like the SW is done trying due to the boy's behavior, and that the other factors (broken down car, lack of "team spirit" from family etc) have contributed to the frustration of the staff. These are fine reasons to vent with each other and the internet. By themselves, they are not good reasons to call cps.

I was asking what differentiates this poorly verify behaved child and family's case, from a nursing perspective, as abuse/neglect in the context of an injury during summer with no return of paperwork now (something that seems to waste lots of school nurse time, from lots of families.)

I was not trying to criticize the OP in any way and I apologize if it sounded that way. The OP asked for suggestions/advice. I was merely trying to give another way of thinking about it. It sounds like the whole staff has already dealt with a lot of difficulty from this family and student and it's so easy to let yourself just decide to throw them to the system-sounds like the sw may be at that point. But this has real consequences for the student and should be done based on objective review of the situation, not influenced by ANY prejudice (even if your prejudice of the whole family as obnoxious or difficult is entirely warranted!).

[SnowyJ, RN]

Yes, I would call, regardless of the socio-economic status of the family.

I think we need to keep in mind, calling CPS is not PUNATIVE, it's for the protection of the child. if you are looking at it as punishment toward the parent or guardian, you aren't getting the point.

Last year I hotlined a situation where I was worried about neglect of a child. Turns out, the family was in a dire situation, and CPS actually helped them navigate through it. They provided the proper contacts at social services to get their heat turned back on, etc. We had tried reaching out to the parents, to no avail.

CPS should be seen as an ally, not a punishment.

[huffmannurse]

Yes, I would call, regardless of the socio-economic status of the family.

I think we need to keep in mind, calling CPS is not PUNATIVE, it's for the protection of the child. if you are looking at it as punishment toward the parent or guardian, you aren't getting the point.

Last year I hotlined a situation where I was worried about neglect of a child. Turns out, the family was in a dire situation, and CPS actually helped them navigate through it. They provided the proper contacts at social services to get their heat turned back on, etc. We had tried reaching out to the parents, to no avail.

CPS should be seen as an ally, not a punishment.

I love this. You took the words right out of my mouth!!

[OldDude]

OldDude: From the OP, the prompts to call the hotline came from SW due to "being sick of the kids behavior" and there were several comments about the mother and grandmother's lack of cooperation in general and occasional disrespectful remarks from the family. It also mentioned the excuse of "broken down car" for months which I took to mean they likely aren't rich, at least in their eyes. I did not mean to imply racism but was just trying to stretch out the example to the fullest...I realise the op didn't mention race. Perhaps I should have left it out entirely. In any case, the point was that it sounds like the SW is done trying due to the boy's behavior, and that the other factors (broken down car, lack of "team spirit" from family etc) have contributed to the frustration of the staff. These are fine reasons to vent with each other and the internet. By themselves, they are not good reasons to call cps.

I was asking what differentiates this poorly verify behaved child and family's case, from a nursing perspective, as abuse/neglect in the context of an injury during summer with no return of paperwork now (something that seems to waste lots of school nurse time, from lots of families.)

I was not trying to criticize the OP in any way and I apologize if it sounded that way. The OP asked for suggestions/advice. I was merely trying to give another way of thinking about it. It sounds like the whole staff has already dealt with a lot of difficulty from this family and student and it's so easy to let yourself just decide to throw them to the system-sounds like the sw may be at that point. But this has real consequences for the student and should be done based on objective review of the situation, not influenced by ANY prejudice (even if your prejudice of the whole family as obnoxious or difficult is entirely warranted!).

Thank you for the explanation