should i stay on this case?

[sdlpn]

i have been doing private duty for a 3 year old girl on a vent for a little while now. the home i work in is very nice, and on paper this family looks wonderful..but they arent. they are foster parents for now, but will be adopting her soon. the husband is retired from the medical field, and they have even adopted a child 6 yrs ago that was on a vent. so on paper this place is great. they know how to work with these kids. but...ive been there a few months and they never i mean never come in the room and see the kid. its so sad. he just lays there in the crib. i have been working with him, and we have come a long way. now i can sit her up and she can actually hold her head up without falling back. it makes me mad because the only reason this girl is so far behind is because nobody works with her. but thats not the only problem. the family doesnt want nurses calling the dr, they will always call. they dont want us telling the company we work for anything either. when something does go wrong, for example her picc line being swollen, they make excuses to not go to the dr. she also cant regulate her temp very well, so we give tylenol pretty often. i cant even count how many times we have run out, and the family is aware, and a week or 2 goes by before they get more. there are other meds as well as her breathing treatments that run out, and the family always has an excuse why we cant get more..pharmacy is out(wouldnt u call another one?) or the dr is on vacation and cant write a refill..im sorry but if it was my child, i would find a way to get it. u cant just got for 2 weeks without meds! they have pressured the nurses to do things out of our lpn scope of practice as well such as trach changes and picc flushes. the only reason i have stayed so far is for the girl. i have grown so attached to her, so i want to do whats best for her. i have spoken to my company, and they are aware and agree that the family neglects her, but nobody does anything about it! the case manager has known about them forever and she overlooks everything too! what should i do? i worry that i risking my nursing license there sometimes. but at the same time, this kid needs someone that cares about her and does the right thing..so should i stay?

[caliotter3]

Well, everything your supervisor told you is true. It is difficult to substantiate a case, and you will more than likely suffer the consequences more than the parents, but that does not change the fact that you have a duty to report if you suspect. It is not your job to prove the case, only to report your suspicions. And yes, as most of us find out, most agencies choose to look in the other direction and expect their employees to do the same if they want to remain employees. This is one of the bad sides to hh. Good luck with your decision.

[sdlpn]

its hard being in this situation, especially when you care about the child so much. thats the only reason i have stayed on my case so far. things have gotten a little better in the home, but it does seem like they are showing the girl attention now just so i see that. but coming in the room for 5 min 2 days in a row doesnt make things all better. but i guess its better than nothing. my company has turned their back on me, they will not speak up, even though they all agree the child has been neglected. its very frustrating. im not sure how all these people sleep at night knowing this poor child is just laying there all the time all alone. hopefully things will continue to get better. in the mean time i have contacted cps about the issue. i have a meeting with them next week. hopefully all goes well.

[Up2nogood RN, RN]

Well, thats just it...my supervisor gives me no insight on what I should do, and she has actually asked me if I was "prepared to deal with opening such a huge can of worms?" which I couldn't help but to take as a threat. They have told me that abuse is hard to prove, and neglect is even harder to prove...I have done home care long enough to know that unless its blatant physical abuse or neglect, the agency will do nothing, especially when the client is bringing them 20-24 hrs a day. I have been doing this for a long time and have had some really difficult cases, and as a rule, I usually like the hard cases, the ones that no other nurse will go to...I love a good challenge :) But this one is just breaking my heart...there is so much more to the story...inappropriate things happen on a daily basis. I have been with this client since he came home from the NICU (he was born at 24 weeks gestation) and I am only here because of the little guy and his brother...I tell my husband everyday that I am going to quit, but I just cant! My client has been sprinting and is on target to be decanned by the end of summer...we will no longer be needed once this happens...I am so worried about what will happen when he no longer has nursing....I am soooo conflicted on what to do. Any suggestions would be greatly appreciated!

As previous posts have mentioned, it's your duty to report, especially since there won't be nurses there much longer. I know it's a difficult situation but I would never stay with a company that swept possible child abuse under the rug.

[nursel56]

Wow- sd and heather- both of you are in such difficult situations! It drives me insane when you do bring these things to the attention of those who's job it is to protect children, and they don't care/do anything. I took care of a little 5yr old girl in the hospital for 2nd and 3rd deg burns from the waist down from being dunked in a scalding bath. You could clearly see where the waterline had been. The parents claimed it was an accident,but she was exhibiting other very age-inappropriate behaviors. In the end they gave her back to the parents and they immediately moved to Texas. It haunts me to this day.

Heather, have you considered getting Humane Society for the animals? Caging a large dog to the point that she cannot walk is clear abuse. That home sounds really bad, and what I ask myself is, "what will happen when I'm gone". As close as we get to these children, the reality is we have so little control over their ultimate future and must rely on our judgement as nurses as well as obey reporting laws.

Wish both of you the best. . .it's very tough. You do have a chance to make a difference in their lives, though. ((hugs))

[Kyasi]

The problem here is that as a Nursing Professional, once you are aware of what you consider child abuse or neglect, you are legally bound to report it. If you don't, you can be held liable when/if it ever comes to light. However, proving mental abuse is very difficult.

It's interesting to see that other vent kids are in this same situation. I took care of a child who was sequestered to her room also. The nurses were the only ones to get her outside. There was no real abuse and to the outside world, everyone thought they were the cat's meow for adopting a 'medically fragile' child. I long suspected that they did so for the stipend that they used to help build her new home. They provided a nice home for her, and her needs were met physically... it was the emotional needs that aren't being met and it would be hard to prove neglect there. After I left the case, they were investigated for child abuse on 2 other kids they fostered and those kids were removed from the home although no charges were filed.

I was involved in a marital dispute over a foster child once. The parents were fostering a handicapped child and they were involved in an ugly divorce. The foster mother was going to get custody of the child when clearly the foster father was the better choice. I called my boss and she said I couldn't get involved. Later, after thinking about it, she gave me permission based on the fact that if I was aware that this child would be going into an unsafe situation, I was legally bound to speak. I sent a letter to the Judge, the Social Worker, and the lawyer prior to the hearing and it caused a major upheaval. They all realized that because I had been in the home for many years on a daily basis, I was probably the most knowledgeable about what was really going on in the home. ( something I pointed out to them in the beginning of my letter and questioned why none of them had thought to ask a Nursing professional who had been in the home for hundreds of hours what her opinion was) Of course, the S.Worker didn't want to lose her job so she changed her tune from, "this is a marital dispute, I'll leave it up to the judge and let the chips fall where they might", to "what is the best thing for this child?" DAH! The father got the child.

So you can have an effect in the outcome of a child if you can prove abuse. Document, document, document! My letter changed the entire outcome of this case in less than 24 hours.

Kyasi

[Magsulfate, BSN, RN]

You could lose your license if you don't report this to child protective services. Probably have criminal charges filed against you if you continue to let these children be abused. Like someone posted earlier, as a licensed nurse, you are legally bound to report abuse and neglect to the proper authorities. I can't sugar coat it because there's no sugar here.

Once you've reported, you've done all that you can do. It is then legally the responsibility of the child protective agency. If the child is harmed or dies, it will be on their shoulders, not yours.

Since your manager and the company won't do anything, I cannot fathom any reason why you have not reported this to CPS already.

I am in the same dilemma. I care for an 18 month trach/vent client. The parents will not allow this child to come out of his room, which is very tiny and cramped with equipment, the child is VERY active and has no place to move and play, plus it is at least 90 degrees in that tiny room. Mom and dad do not come up to the childs room EVER and dont interact with him. They also have a 8yr old who is not allowed out of his room either, except for school and meals. Mom and dad dont work and lock themselves down stairs behind closed doors all day and us nurses have to get "permission" to use the bathroom. This family is living off of the SSI they receive for the baby. The home is filthy! They have 2 dogs and 2 cats...the larger of the 2 dogs was kept in a very small cage that she couldnt even stand up in, and on the rare occasion that they let the poor thing out, she could hardly walk d/t being kept in this tiny cage. The family was supposed to buy a bigger cage...but instead mom and dad went to Vegas! The cats I havent seen for a year as they were banished to the basement a year ago and have not been seen since, however you can smell them which is the reason they dont use the A/C...it fills the whole home with cat urine smell.

I seriously think that the parents have some mental problems and I know for a fact that they get drunk every night...I have reported this and so have all the other nurses that work this case...and my supervisor does nothing...I report things to her on a weekly basis...and nothing is ever done. I have had the same problem with mom and dad not picking up meds, mom has taken it upon herself to change orders on our MAR without telling us or having orders to do so, she is ALWAYS changing the vent alarms so they dont have to hear him alarming during the hour between shifts. I am so frustrated but I love my little client and stay here for him. I seriously have thought about calling CPS, not so much for my client, as for his brother since I am certain he is autistic and malnourished and he is emaciated, he has told me he was hungry but mom and dad dont have any food in the house, and he is now no longer allowed to talk to us nurses because his crazy mother does not want him "forming relationships" with us. I leave angry every day...why have kids/animals if you wont take care of them???....and they have informed me that they are trying for another baby! I am sorry for the rant, I am new on here and I really needed to vent! thank you :)

[GoNightingale, BSN, RN]

I woulld anonymously call child welfare.

[BerryHappy]

Call CPS (Child Protective Services) and get the HECK OUT! You could LOOSE your license very easily over this type of case. I am sure you feel bad for the child, that is why you will call CPS. They can do much more than you are able. Feeling bad for the child is compassionate, but think about how you will feed YOUR child or pay your bills if you loose your nursing license.

[CrunchRN, ADN, RN]

Geez! CALL CPS. It is your duty. You are not helping these children by staying with them, but not reporting the situatioon to the proper authorities.

I know your hearts are in the right place, but as a nurse you are required to report this, and as a person who cares these children need more intervention than your assistance.

[GoNightingale, BSN, RN]

Good answer berryhappy!