[Hannahrn]

I posted this under the legal nursing board, then I thought to post here as well, thinking this has probably happened to other NICU nurses ...curious to know your experience/advice...
Hope someone can help answer this ?...I am an RN in the Neonatal ICU. THere are times when parents of our former patients ask us to help with the care of their baby in thier home in exchange for money. THis is "under the table" and not arranged through the hospital in which we work at all. Specifically, a parent of former preemie twins recently asked if anyone would be willing to come to their home and do the overnight care/feedings for the twins because they were so desperate for sleep. They said they would make it "worth our while" in terms of money. One of the twins is still on O2. It seems as though the parents just need a babysitter or nanny, not necessarily a nurse, but since they are so comfortable with us after caring for their babies for 3+ months, they are asking for our help & money is not an issue with them. What are the legal implications of this? Would we be performing under our nursing license if we accepted this under-the-table job, even though it is more like a babysitting job...just to feed the kids overnight. What if something went wrong? After all, one of them is still requiring O2! What is the appropriate way to go about this? Thanks for any info..

[Gompers]

A couple of my coworkers have done this...I refuse to, because you never know what might happen. I definitely wouldn't do it without having personal malpractice insurance. Either that, or have some kind of legal document drawn up. I just worry too much, I think, since people tend to be so sue-happy these days.

[prmenrs]

I have done this, but thru an agency. The agency paid me. It was a much sicker baby, tho.

I think if something happened, you would be held under a higher standard than the average babysitter. Do you have your own liability insurance?

[BittyBabyGrower]

I'd have to decline...if something happened to that baby while it was in your care, those parents could come back and say you should have know better, etc. The good samaritian law wouldn't back you up. If you have your own insurance I would call them to see if they would cover this, but I don't think that they will.

[Nurse Ratched]

Originally Posted by Hannahrn

What is the appropriate way to go about this? Thanks for any info

The only appropriate way is to thank them and advise them that you are unable to accept their kind offer.

Even if it weren't under the table (which is illegal on its face), I am certain your facility has a policy against this. Refer them to a social worker who can provide a list of agencies that offer trained workers in this area.

(BTW - I used to run into this at the adult day care where I worked - same response.)

[BabyNurse513]

I posted the same question several months ago. Here is a link to that thread so you can see the responses I got.

http://allnurses.com/forums/showthread.php?t=93325

[dawngloves]

This is interesting. How about if you were watching, say a neighbor kid and there was an accident that perhapes turned tragic. (Let's say a near drowning).
I wonder if you could be sued for malpractice?
This person is not being asked to provide medical care, just to mind the children.

[Jolie]

Originally Posted by dawngloves

This is interesting. How about if you were watching, say a neighbor kid and there was an accident that perhapes turned tragic. (Let's say a near drowning).
I wonder if you could be sued for malpractice?
This person is not being asked to provide medical care, just to mind the children.

Dawn,

On the surface, I agree with you, but looking a little deeper, I think it would be unwise to accept this type of arrangement.

First of all, the OP has an established relationship as a professional nurse for these babies and their parents. If she were to be employed in their home, I don't think she could make the legal distinction that she is now acting solely as a babysitter and not a professional nurse, especially since she is being paid, and one of the twins has a continued dependence on medical technology (which is probably why the parents aren't comfortable with a run-of-the-mill babysitter.)

Secondly, and I know this issue could be debated to death, but I believe she could face potentially liability if something untoward occured on her watch, say a choking spell or apneic episode that left the baby harmed. Is she willing to carry personal liability insurance, and if so, would it cover her in this situation that involves an "informal" employment agreement.

I would certainly be flattered that the parents have such confidence in me, but I would politely decline this arrangement for the reasons stated above. If the parents are truly in need of home-care assistance, they need to approach their pediatrician and insurance company and get it approved. Then, as employees of the home care agency, any of the NICU nurses could go into the home and provide care with their scope of practice, payment and liability issues clearly defined.

If the parents are simply over-tired (and what parents of twins aren't?), then they need to ask Grandma and neighbors for help and not impose on the NICU staff.

I think the issue of watching a neighbor's kid is very different, as you would not likely be paid for such a favor, nor do you have an established nurse-patient relationship with the neighbor or her child. I believe that if a tragic accident were to occur in that circumstance, you would be held to the standard of "What a prudent person would have done" rather than "What a prudent nurse would have done."

I don't believe that the Good Samaritan Act would offer protection the nurse babysitting for the NICU graduate either, as there is payment involved.

[pediatriclpn]

If one of the babies is still O2 dependent that is considered skilled nursing care in some states and insurance companies will pay for in home nursing. That is the route the parents need to take. We had a young boy with CF who spent over a year in the hospital come home to home care. Alot of his hospital nurses joined our agency so that they could still care for him, but still keep the nurse/patient relationship, not the babysitter type of relationship. And the nurses had backup thru the agency. But it is still an independent decision for you to make. Good Luck!

[Gompers]

Originally Posted by Jolie

I think the issue of watching a neighbor's kid is very different, as you would not likely be paid for such a favor, nor do you have an established nurse-patient relationship with the neighbor or her child.

I think that is the most important difference here between regular baby-sitting and a post-discharge childcare arrangement.