should i stay on this case?

Specialties Private Duty

Published

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?

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I did not get very far into your post before I made the immediate decision that I would not work on this case.

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I'd work on the case, don't leave a child you enjoying taking care of and who needs you. Perhaps an anonymous call to child welfare???

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who should i call? i just want to make sure it doesnt come back to me. its sad that all these case managers and nurses are aware of the problem, yet nobody will speak up for this poor child.

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You realize that when you report this you will virtually be kissing your job with this agency good-bye. Is your documentation that you informed your supervisors complete and up to par? That would be your worry about your own involvement. Child Protective Services would be the place to start, I would think, in this situation. You can also make a report to the case worker for medicaid, I presume the agency paying for this.

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i have always made sure to cover myself. i always document that the family as well as the agency has been notified. and other than pack her up and take her to the dr myself, thats about all i can do, its frustrating. and yes, i know that my job would be gone. thats part of why i havent dont anything yet. but at the same time, i can find another job. im actually almost done with school to get my rn and plan on going back to the hosiptal anyway. ill try and contact cps tomorrow and see if i can talk to someone and what they think i should do. i appreciate everyones help. hopefully things will work out soon!

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I would make out a written report so that you can take your time and make sure it says what you want it to say. Either bring it with you to an appointment or mail it to the proper authority, return receipt requested, as well as a duplicate sent back to yourself. Hopefully, this will be resolved in favor of the patient.

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Specializes in ER, M/S, Hospice Home Care.

You have an obligation as a nurse to advocate for your patient, as well as report child abuse (in this case it sounds like neglect). If something goes wrong the family will blame you and so will your company. Don't ever think your company has your back; they will lie to protect themselves. Send an email to your manager/supervisor reiterating your concerns and hope that she/he responds. Also, politely express your concerns to the family. Just know that in the end when push comes to push and someone's facing charges, the management, company, and families will ALWAYS defend themselves BEFORE YOU.

Also, if you like the patient, and the case, stay with her...she needs you. You sound like you're doing a good job. Just protect yourself while advocating for the child at the same time. Also, ask yourself, am I following the company's policies and procedures. For example, If you are required to call a doctor...then you have to call the doctor. (otherwise let your manager give you something saying not to call, like an email or something in writing). Let the family know that you were advised by your company to do so. It will be the truth, and that's your greatest protection, in addition to an email. If you are going against the company's guidelines b/c the supervisors and family verbally told you not to worry, YOU WILL LOOSE.

I'm an ER nurse and home care nurse, so if a child is dying and the parents say I'm taking my child home to die, we make the final call because taking a dying child out the hospital is not the parents right b/c it's not in the best interest of the child. A dying adult can walk out the hospital, but not a child, regardless of what the parents say. Try to Think like that.

GOOD LUCK TO YOU.

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Specializes in pediatric vent/trach.

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 :)

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Heavens Heather, I am surprised you have lasted this long. Think long and hard about reporting this to CPS for the sake of both children. If you don't do something drastic like this, the status quo may remain, or things may get worse. A hot room is no place for a vent dependent child to be cooped up in all day and night any more than that hot basement is appropriate for the cats.

You also might want to consider starting to look for another case because this case will probably end for you once CPS gets involved.

What does your supervisor say about not reporting this situation to CPS?

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Specializes in pediatric vent/trach.

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!

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

All 50 states have passed some form of a mandatory child abuse and neglect reporting law in order to qualify for funding under the Child Abuse Prevention and Treatment Act.(CAPTA) All states require certain professionals and institutions to report suspected child abuse, including health care providers and facilities of all types.

Failure to report suspected child abuse can result in criminal and civil liability.

All states require the report to be made to some type of law enforcement authority or child protection agency.

Every state has a

hotline for reporting abuse and neglect.

For more information about mandatory reporting of child abuse and neglect, go to Child Welfare Information Gateway.

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