Small complication in my pedi rotation

  1. Yesterday in my pediatric clinical rotation my patient's parents felt that I was their child's keeper. They would send him out into the hall to find me. He wanted to go everywhere I went including the nurses station and the med room. How was I supposed to make it clear to the parents that yes he was my responsibility for nursing but not my babysitting responsibility. At the end of my day they came to find me to see if I would sit with him while they went to get lunch. If I were not a student then I would have more than one patient and would not be able to devote all of my time to one patient. How should I have handled this family?
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  2. 22 Comments

  3. by   BeachNurse
    Hi, there..I would simply explain to the parents that you are there to learn pediatric nursing and that you are more than willing to meet any and all nursing needs within your scope of practice. Hoever, you will need to draw the line tactifully and let them know that their child cannot be running the halls, and that parents have the primary responsibility of looking after their children on this unit. You are there to learn. When you are not giving nursing care to their child, you will obviously be busy looking up meds, following other nurses, etc.

    Tell them that you have other responsibilities while you are there. I see no problem with telling the child and the parents, "I really have some other things I need to be doing here." Also, I see no problem with telling them that you have other patients to see, even if it is not true. YOU are the professional (or will be very soon), and you need to stand your ground and set the rules so they dont walk all over you.

    If this kid is running around it sounds like he's not all that sick! I could understand the parents needing a break if the child was quite ill and they hardly ever left the room. In that case, I would volunteer to keep an eye on the kid while they got some lunch or something.

    Good Luck!
  4. by   nurs4kids
    Welcome to pediatrics! lol...There's always the kid who is well enough to run around (there for abx tx, aereosols, and other simple things). These same kids usually have pathetic parents that because they refuse or can't seem to learn to do the treatments at home, must stay at the hospital. Same families are usually on government assistance; hence cost taxpayers more because the family is pathetic. Same parents don't want to be bothered with caring for kids at home, or in the hospital.

    Be up front with them..tell them what you ARE there for..if this doesn't work, tell them what you are NOT there for...childcare courses generally take a lot less time than nursing ;D

    good luck!
  5. by   prmenrs
    What do you do if the parents are not there?

    When my son was about 3, he had an overnight stay p/op. He had had a laser excision of a subglotal cyst, tonsillectomy, and maybe eartubes, I forget. He was supposed to have cool mist air tent. There was no air outlet in the room, only O2, but he didn't need that, so they put an air compressor in the room. He was in a crib, supposedly sitting up. He sleeps prone. The nurse would roll the HOB straight up, and he'd slide down til his face was against the plastic, so I'd put the bed down considerably, he'd sleep til the nurse came in and we'd start all over again.

    We had come in early, and my mother came for a while. I went to eat about 3pm, and then my mother went home. They gave me a broken banana lounger to sleep on, and I tried to sleep on that thing with the air compressor next to my head.

    Next morning, I tried to feed him breakfast, but he wasn't having any. It's now about 9am, I've seen the nurse once. I can't leave him in that crib, he'll climb out and kill himself (he's a bit retarded, so I can't expect him to stay there for long), not to mention the IV's still in, I'm exhausted, and HUNGRY, and did I mention crabby? I dash down to the nurses' station, and ask for someone to watch him so I can get something to eat and wash my face and hands?

    You'd have thought I'd asked for world peace. Finally, they said they would and came and got him. He still has not had anything to drink, doesn't even want a popsicle, and the fact that his IV is sort of bent sideways doesn't seem to worry them too much.

    I got back in less than 20 minutes, he was in one of those tables w/a hole and seat in the middle of it, try to get out, all by himself in a staff room behind the nurses station, with a HUGE open glass of orange juice in front of him! He just had his tonsils out the day before!!!! Actually, by that time, it was not in front of him, it was all over him.

    My point being--well, I'm not sure I have one, except that parents can get taken advantage of, too! There's got to be a happy medium here somewhere.
  6. by   kids
    A couple of years ago my then 13 year old son sustained a TBI in an accident. After being life flighted 15 miles to a "local (Portland, OR) trauma center he spent 6 days in Peds ICU then was transfered to the general Peds ward. I arrived the morning after his first night on the unit and was told they had found him still very unsteady on his feet, wandering in rooms and urinating in inapprporiate places. He was in a room next door to an unlocked stairway door (3 flights down, 1 up)...I pointed out that his bed had an alarm on it and that I wanted it on AT ALLTIMES. On morning #3 I came in to find him sitting in bed with wet hair. He said he had taken a shower. A short time later he wanted to go to the bathroom, didn't want to use a urinal, I was getting him out of bed with a gait belt and a walker when I found the dried urine rings. Needless to say, after he went to the bathroom I got him into a chair, calmly went to the nurses station and went ballistic on the staff. Seems not only had his bedding not been checked during the night, the day nurse had given him towels and told him he could take a shower on his own. He was transfered to the community hospital 10 minutes from home by lunch time.
  7. by   nurs4kids
    Kids..that's pathetic. I would have hit the roof!

    Prmenrs,
    Admittedly the OJ thing is a bit off, but to not understand the position of the nursing staff? What do we do if there is no parent?? We send them to ICU where there is a 1:2 ratio max. Our ratio on post op is 5:1, and I hear our ratio is quite low compared to others, so you figure if I'm watching your child while you go eat, it's 9am which is the busy time on a surgical floor (meds, preoping for surgery, doing d/c's and the other little things we don't "plan" for)..I'm watching your child 1:1, who's caring for my other 4 patients?? Also, it's not unusual for a parent to say "I'll just be gone 15mins.." and be gone an hour. So, to give a parent permission to leave the floor is insane. I've had them leave and not come back for hours. The nursing supervisor's reply.. "who's the idiot who gave them permission to leave??". Was there no sink in the room to wash your face? Was there no way you could prepay and have a tray delivered to the room for you also? Why didn't you just take him with you? When a three year old is left with a stranger, a stranger who he relates to pain, he's a nightmare to "watch"(if you had problems with him IN the crib, what did you expect the staff to encounter?). I'm not familiar with the table with the hole cut in it, that does sound a bit barbaric. I've had patients at the nurses station with me before, usually in a wagon or stroller, and been called away to another room, asked someone else to watch them, they get called away...I come back to a patient alone at the nurses station. All post op patients are not T&A, BMT's..many are much more serious and require more nursing time. Step back on the other side of the picture, and they may not look so awful
  8. by   prmenrs
    I wasn't offered a tray, or the option to pay for one. I didn't have trouble with him in bed except for when the nurse rolled it up to a 90 degree angle which was not compatable with the way he slept. He couldn't suck his thumb, and I couldn't hold him b/o needing the mist tent.

    Have YOU ever tried to sleep on a banana lounger? It was broken and kept falling down. With an air compressor next to your head? My ears were buzzing for a couple of days. I couldn't leave the room to go to the bathroom if he was awake. I was frazzled. I may be a nurse, but mothering comes first. I got NO sleep, and nothing to eat or drink (unless you count tap water, which in San Diego, we do not) for 18 hours. I propably should have planned ahead with fresh undies, deodorant, oral hygeine, snacks, etc., but I didn't know I'd be camping out.

    His IV was bent, and I offered to help retape it--he was a very difficult stick b/o his 3 1/2 month premie stay, and he still wasn't eating or drinking. The nurse who had him didn't think that was important. There was 1 other kid in the room, but our nurse's assignment was all over the ward--the other kid had a different nurse. I don't know how many kids she had assigned to her. I don't work on a peds floor, I work in NICU; therefore, I DON'T know what the staffing ratio is, and I shouldn't need to know. As a mother, that should not be MY concern.

    There is a happy medium here--I did as much for him as I could--diapers, repositioning, comforting, hands and face, etc. All I expected from them was a rollaway, some breakfast, and nurses that were just a little tiny bit interested in their patient. I really don't think that's too much. And 20 minutes of "babysitting" in a 30hour hospital stay isn't too much either.
  9. by   nurs4kids
    Okay, perhaps the setting was a little different than I'm accustomed. We don't have semi-privates and we have coffee and drinks available for parents. Yes, I've slept on a banana lounger, they're very uncomfortable. Did you ask for one that wasn't broken? Was he not positioned at 90 degrees to benefit breathing? Why did you not climb in the tent with him? (I remember that as a child, the fear of that tent..my Mom got in the tent with me) As for retaping the IV: If it's working properly, bent or not, it's my experience to leave it alone instead of risking losing it trying to retape. Because of the size of kids, we often have to secure them bent, in order to have an area big enough to tape. Do you not do this with premie's (sincere question, not sarcasm)? As for the twenty minute break: If I have five patients and each parent requests to leave for twenty minutes..that's a whole hour out of my shift spent babysitting. A whole hour taken away from caring for my patients. I'm sorry, I'm a parent first just like you, but sometimes the responsiblity falls on family, not the hospital. Did you not have a family member visit in that 30 hours that could have relieved you for 20minutes or brought you food? Your complaints with the staff are for what they didn't do for you, not for what they didn't do for your child, the patient.
  10. by   prmenrs
    I'm very sorry about your grandmother, but that story about your 2-year-old was priceless!! What a memory!

    How about that air compressor? Do you know how loud that thing was--added to the ambiance in a big way.

    Actually, I don't remember seeing the nursing staff very much--I handled the IVAC pump alarm, buzzed for a new bag when needed, They did do @ least one set of vitals per shift, brought me a set of linen for the aforementioned banana lounger [I asked for sleeping accomodations @ about 4pm, that was all that was left], brought in popsicles from time to time. I confess--I ate some of them, he sure wouldn't.

    The IV wasn't bent till when I checked it in the morning; we don't ever tape an IV bent--once it's bent, it usually doesn't work out too well--leaks.

    If he had been in a bed, I would've crawled in w/him, but he was in a crib--I weighed about 240, so it really didn't occur to me. Probably would have exceed the recommended weight limit anyway! I did try to keep him on his back part of the time by playing w/him sitting up, but he was REALLY sleepy, and he sleeps prone, he just fussed when I tried to have him sleep on his back. It didn't seem to make a difference in his breathing, in fact he was more comfortable on his stomach (this was in the pre-back-to-sleep days).

    As for family, I'm a single adoptive parent. I met my son in the NICU and fell in love w/some big brown eyes and fabulous eyelashes. He had gr 3-4 bleeds and has a shunt, and he was and is "intellectually challenged". I was reluctant to leave him because of that, plus those cribs are SO high.

    My mother is supportive in some ways, but she doesn't drive--hasn't for years. A friend brought her over the surgery day, but they had to leave after my 3:00 break.

    I still remember this whole thing after all these years w/much bitterness; IMHO, they didn't "do" much for him, and they were less than helpful to me.

    Anyway, it's ancient history; we've been in for surgery a few more times since then, once more at that facility, didn't go as badly. 3 more times at my hospital--as he gets older, he's a little more self-sufficient, and a very big flirt. (He has a stated preference for blonde nurses!!). The last time in January was an absolute breeze!!
  11. by   bergren
    In child health the goal is to provide family centered care. The parent cannot support the child if their needs - food, sleep, stress, information - are not being met. We care for the whole family.

    Parents are not obligated to stay with their children while they are hospitalized. Yes, it is ideal, for the child's emotional well-being and for the most optimum, timely care. But not all parents are able to stay for many many reasons.

    The hospital and those caring for kids need to make sure they are safe and cared for. If that means requesting the hospital pay a 1:1 sitter, usually an aide, for a child, then that is what needs to happen. Our hospital has a very active Child Life Department that provides both in-room diversions and playroom activities for the children. We also have volunteers who can sit and play games with children and rock babies. Student nurses are ideal for children who need some social stimulation. With only one patient, they can provide all of the play therapy and the diversions that can make the hospitalization a less traumatic experience. You are wondering why the family keeps sending the child to find you? Perhaps as a student you could do an indepth interview of this parent or parents and find out what the hospitalization experience has been like for them. Identify the nursing diagnoses that address the parenting or coping strain this is puting on the family, not to mention financial strain. Holistic nursing care is not limited to the procedures and tasks in the Kardex or the documentation. What was your instructor's response to the child's seeking you out?

    Being a parent, or for that matter, any family member of someone hospitalized, means riding a very fine line between advocating for your loved one and risking alienating the staff.

    And to the nurse who is admonishing the mother/RN for speaking if her needs, are you not speaking of your needs? Be a part of a team that goes to administration with data supporting the fact that you need volunteers on your unit to provide for children who are without parents. Get feedback from the parents who have visited your unit who need some respite. Keep a one month record of how oten you are faced with this dilemma.
  12. by   nurs4kids
    Ok, prme, I owe you an apology. I ASSUMED. I assumed you were married or divorced and had supportive family and friends. Very wrong of me to assume. As for the crib..lol..I've seen very large parent's climb into the crib with the child, not a pretty sight. If I have a patient with the same problem you described, I will offer a regular bed for the patient, if they're 2 1/2 or older, so the parent can sleep with them. The hospital doesn't advocate this, but as the LARGE mother of two todders, I do
    I can't imagine a hospital not having air, just O2, this may explain your accomodations, or lack thereof. Do they give their areosols with O2?? I think you and I are interchanging the word bent and I'm you're thinking what we actually call "kinked". A kinked one will leak every time. I'm very curious, though, if you're actually saying all your IV's are taped straight. Do ya'll use a T-Connector? I just don't see how you could always keep an IV straight on a premie. What do you do for the IV's in the thumbs or very distal sites??

    As bergen stated, we too, have a wonderful child life services department and we have a volunteer dept. Both of these will usually stay with a patient while the parent takes a break or child life will take them to the playroom, BUT both of these departments are 8-5. I was speaking as a night shift nurse. Our hospital will NOT pay for a private sitter, as Bergen, suggests. As a taxpayer, I hope they never will. That cost would be written off somewhere and I don't imagine insurance would cover it. Insurance will normally cover ICU. The big problem I see with the sitter thing is..back to the leech issue...once it was done for one parent, that leech would tell another leech and soforth and so-on. Eventually we're paying private duty for people because they don't WANT to stay with their kids, not because they can't.

    Preme, I can't say enough how much I admire you. I didn't realize you'd adopted your son. How sweet and unselfish. I'm sure he's rewarded you a thousand times over.

    Sorry I jumped the gun on you, I'm a victim of the system. A big percent of our patient population is on "the system", and many of them enter the doors trying to take advantage of our sustem, so I stay on the defensive. Wrong of me, but true.

    Did you ever think of calling Patient Rep??

    LOL..my daughter, I'm still red-faced! Thanks for your condolences.
  13. by   bergren
    "Our hospital will NOT pay for a private sitter, as Bergren, suggests."

    The hospital MUST provide a safe environment for the client. That would be the case whether a developmentally impaired adult or child. Otherwise they are inviting liability should harm come to the child that a prudent nurse could have anticipated. The description of the teen with TBI is such a case where a sitter would be one solution. If your administration denys such requests, then the child cannot be left alone. We have rooms as such in the hospital I am in. If the nurse leaves the room, another must step in. We need to be the advocate for the child and family and build a case for such services. Ask for the hospital attorney's opinion.

    Please, please don't refer to parents as leeches. I am the moderator for this forum and I ask respectlfully that we not use such terms for clients and their families. I understand that you feel they are working the system, but please lets stay away from derogatory labels. Thanks.
  14. by   prmenrs
    Apology accepted with my Thanks. Given the theme of this thread, I wonder if the nurses at that hospital were thinking of me as the "l" word, because @ that point in time, he was still a foster child, and I didn't have him on my insurance yet, he was on MediCal (Calif's version of "Caid")? Hmm, never thought of that angle.

    The 2nd time we had to be admitted to this facility, he was 9, and it was his 1st shunt revision; they were much nicer to me! But he was easier, too. I didn't stay overnight, left about 11:30pm after getting there @ 6:30am, cried all the way home~20mi.

    We were admitted on Saturday, didn't go home til Tuesday--took him a while to get used to a shunt that worked. He was a little too self-suficient this time, disconnected his own IV so he could get up and go to the bathroom!!

    iv's and premies
    We have IV boards as small as a large Bandaid--abt 1"x3", the smallest kids get those. I personally like to put the board so that the baby will grasp it, which often leaves some of the IV apparatus hanging out over the edge, but you can build up that end w/cotton. We use t-connecters, not the screw-on type, the slip connector that is @ right angles to the IV catheter. We usually try to thread as much catheter in the vein as possible, but we always tape them straight--we use an op-site/tegaderm to secure it and provide something sterile over the site, then 1/4" micropore tape "chevroned" over the hub; after that it's every nurse for her self! Personally, I'd staple 'em in IF I thought it'd work and that I could get away w/it! Kidding, I'm just kidding!

    We have 2 other size boards, about 1 1/2" x 4" and 2"x 5"; We have to cut the Tegaderm to fit, which is a royal pain!
    Last edit by prmenrs on Oct 14, '01

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Small complication in my pedi rotation