Does this sound wrong to you?

[CloudySue]

I was at an overnight case where the parents have 6 children, one is my client. I've only been there a few times, and since everyone's sleeping all night, I am not familiar with who is who. Around 6am, an hour before my shift is up, both parents are getting ready to leave the house. Usually one stays at home at least until my shift is over. Mom goes to sign my form, and I said, "Is there anyone here for the other kids?" and she said very assuredly, "My oldest daughter is in charge of the others." I wanted to ask the age of the daughter but I just figured she was probably 16 or 17, to take on that role. I didn't ask and felt like a chicken for letting it go.

I was glad I didn't push it because a few minutes later she came back to me and complained, "I actually take offense that you would think I'd leave you alone with the other kids. I take pride in the way I care for my children." Well, I was completely taken aback by this, I told her I meant no offense, I just really need to understand what the situation is going to be in the household w all the children, for my own liability. She softened after that, realizing that I didn't know the family situation like all the other nurses they have do. So things were kind of smoothed over. She said that she could not imagine anyone taking advantage of a nurse like that. I told her it was well-known amongst home health nurses that there have been incidents where families have left other children with nurses and it was more common than one would think. I told her I was between a rock and a hard place, and I had to ask, because I don't know them and I had to be sure. So she saw my point of view and dropped her annoyance w me. I figure everything is kosher. The two leave.

Kids remain asleep upstairs. I'm still downstairs w my sleeping client. When the kids wake up about 6:20 and come down to eat, etc. they are very friendly and well-behaved. However no older daughter is there to watch them. To their credit, they take care of themselves very well and I don't have to do a thing for them. The kids are friendly and chatty, and started talking about the family, birthdays, who's who, names, ages, etc. and they mention the older sister upstairs is... 14.

So I was placed in a situation where I was the only adult in a household with 6 children, only one of whom I was responsible for. The parents trusted their 14 year old to be in charge of the other 4, ranging from 3-12. Nothing happened, and everything was fine. She's probably a well-behaved, smart, responsible girl. However, I'm extremely bothered by being placed in a situation where if something terrible would have happened that a 14 year old couldn't handle, as the only adult in the home all 6 children would look to me. What if a fire broke out? I'm supposed to grab my client and evacuate the house with her, but what about the other 5 sleeping kids? Of course I'd run up the stairs and do what I can to round everyone up. What if a kid got seriously ill or injured? Started choking? Of course as a nurse and as mom and as a human being I'd jump in and do whatever it takes to help those sweet kids. But... I shouldn't be placed into a situation where I have that sort of moral responsibility. That's not why her child receives nursing services, to have that extra babysitting perk. And for the mom to make me feel like my concerns were offensive? I'm offended that she'd assume I'm totally ok with being alone in the house with her 6 CHILDREN.

What do you think?

[poppycat, ADN, BSN]

I found myself in the same situation one time. I reported it to my supervisor who seemed very surprised the mom would do that. However, it was later learned that all the other nurses on the case allowed mom to get away with doing it so she thought that was part of our job. When she found out this wouldn't be allowed any longer, she chose to change agencies!

It's completely wrong for her to do that to you. Your license is on the line when you're left in charge of children who are not your patients. If anything happened to one of them you can bet that mom would haul you into court.

[nursel56]

I think that is most likely a matter of your state labor laws. They probably don't have two law sets based on whether or not a babysitter is related to the children they are babysitting.

The strict letter of the law vs the reality of what could happen should there be an emergency in the home is another matter altogether, though. I'd be very uncomfortable in that position, too. The fact that the other nurses are willing to accept the risk makes it unlikely anything will change. I would definitely make your agency supervisor aware of the situation.

[HisTreasure, BSN, RN]

I've had this conversation with the nurses in my home, and with other "special needs" moms. The consensus seems to be that the moms feel the nurse is there for the one client. The rest of the home is none of the nurse's business and therefore, they should be able to operate as they choose. Most special needs parents realize they have to give up some privacy and control to the nurse and that alone is difficult. Many feel judged for every parenting move they make and feel under the microscope every minute of their lives. I've felt like that with some of the sub nurses that have come through here for my foster daughter (who I miss dearly ).

Very few states have statutory ages when children can legally be left home alone, it's usually left to parental discretion, and so these moms ascertain that had a nurse NOT been in the home it wouldn't be an issue. I raised the point of liability on the nurse's part, should something happen while she's in the home, and the moms state they wouldn't hold the nurse liable. Yeah right. They would. Aaaannnndddd... the agency wouldn't back the nurse up. We ALL know that.

So, I told the nurses in my home that I would NEVER expect them to watch or care for any of my children. In fact, I even signed a personal affidavit to that affect for their comfort. Then again, I don't leave my children home alone, either. Perhaps a liability disclaimer would be something worth discussing with your supervisor if you feel comfortable? You don't want to get caught in a situation where your license and livelihood is in jeopardy because the 14 year-old failed to act appropriately with a choking child or, any other thing a hormonal teenager with tons of freedom may be tempted to do. Who knows?

[Adele_Michal7, ASN, RN]

I second everything the others said. How often do you work in this home, it sounded like you're new on the case or were subbing. Maybe you can call your agency and inform them!

[SDALPN]

This happens all the time. 14 year olds can babysit and it's quite common as well in my state. I would be more concerned leaving a 14 year old alone with a special needs child. Some agencies require the nurses to leave the child with one of the primary caregivers, which must be 18. If you feel like the kids are in danger, contact social services. Otherwise, you can notify your supervisor and the supervisor will speak with the family. When the family figures out it is you, they may not want you back. If the family lets you go, their behavior will continue and you will be without work. The agency only cares about money and not losing the case. The agency will make sure the family gets what they want. Sad, but true.