Notice: Social Workers Issuing Sick Notes

Legislation

Pursuant to section 5(2) of the Medical Certificates for Employee Absence Act, social workers in Nova Scotia are permitted to issue sick notes. This reform is part of Nova Scotia’s new rules for sick notes, which were implemented to allow doctors more time to care for their patients.

As per the new rules effective from July 1, employers in Nova Scotia can no longer request a sick note unless an employee is absent for more than five working days or has already had two absences of five or fewer working days within the previous 12-month period.

Moreover, when employees do require a sick note, healthcare professionals other than doctors are now authorized to provide it. These healthcare providers include nurses, dentists, pharmacists, physiotherapists, and social workers, as long as they are providing care within their regulated scope of practice.

Scope of practice considerations

In the context of social work, a social worker can issue a sick note based on a social work assessment of a client. However, they cannot issue a sick note for illnesses or diagnoses outside their scope of practice, such as COVID-19. The issuance of sick notes by social workers should be based on social work assessments and should support the care being provided by the social worker.

For example, many social work assessments involve using the bio-psycho-social model that considers biological, psychological, and social factors in understanding health and illness. Social workers often utilize this model to assess the overall well-being of their clients.

An example of a bio-psycho-social issue for which a social worker could issue a sick note might involve chronic stress:

• Biological: Chronic stress can lead to physical symptoms such as headaches, stomach issues, high blood pressure, chest pain, and problems with sleep.
• Psychological: The individual may also be experiencing symptoms of anxiety or depression as a result of the chronic stress. They might have difficulty concentrating, feel constantly worried, or experience feelings of worthlessness or hopelessness.
• Social: The individual’s chronic stress might also be influenced by social factors. For instance, they may be dealing with financial difficulties, job loss, divorce, or caring for an ill family member. These social stressors can exacerbate both the physical and psychological symptoms.

In this case, a social worker could issue a sick note if the client’s bio-psycho-social assessment revealed that their chronic stress was significantly impacting their ability to function in their daily life, including their ability to work.

Standards for consideration

2.2.8. A Social Worker shall provide a professional opinion about a client only when it is based on sufficient and substantial information about the client which may include documented interaction, assessment, observation and consultation.

10.1.2. Social Workers shall identify and explain their education, training, experience, professional affiliation, professional registration and nature of service in an honest and accurate manner.

10.1.3. Social Workers shall not claim formal social work education in an area of expertise or training solely by attending a single lecture, demonstration, conference, workshop or similar teaching presentation

6.1.1. Social Workers shall advocate for social change in the best interest of the client and for the overall benefit of society, the environment, and the global community.

6.1.2. Social Workers shall promote fair and equitable access to services by engaging in efforts that seek to ensure that all persons have fair access to the resources, services and opportunities they require to meet their basic human needs.

6.1.3. Social Workers shall advocate for equitable social, economic, political and cultural policy and legislation.

NSCSW Standards of Practice, 2022

Ethical considerations

Before a social worker can issue a sick note, they must first critically assess their qualifications. They should provide an honest and accurate description of their education, training, experience, professional affiliations, licensure, and the specific services they render.

Moreover, it’s essential for social workers to have an in-depth and informed comprehension of their client’s situation prior to giving a professional opinion. This understanding can be garnered through comprehensive interactions, assessments, observations, and consultations with the client. Such an approach ensures that the advice given is rooted in a complete understanding of the client’s circumstances, thus reducing the risk of potential errors or inaccuracies that could negatively impact the client.

In addition to individual client care, social workers also bear responsibilities on a larger scale. They are expected to advocate actively for societal changes that not only benefit their clients but also society as a whole. This involves promoting fair and equitable access to services and resources and advocating for policies and legislation that advance social, economic, political, and cultural equality.

The practice of employers requiring sick notes is an example of a situation that calls these principles into action. Viewed from critical theory, social justice, and ethical stances, this practice is problematic as it imposes unnecessary burdens on employees to produce a sick note, potentially worsening their health issues and creating barriers to necessary rest and medical care. Although new legislation may somewhat alleviate this burden, it does not address the issue fully.

In summary, the role of a social worker goes beyond providing individual care—it also includes advocating for broader societal and policy changes. Striking a balance between these roles is vital in effectively fulfilling their duties, ensuring their clients’ well-being, and nurturing a more equitable society. We encourage all social workers to engage in acts of social justice advocacy to address the larger systemic issues, even as they work to support the individuals who seek their help.