I work as a nursery nurse in Texas. Here, the erythromycin eye ointment after birth is mandated by state law.
Twice in the last month, we have had parents refuse it. The second time, risk management told us to stand right there and give it even if the parents were adamantly refusing. The comment was also made that if a nurse was unwilling to give it under such circumstances, then she didn't need to be working there.
I'm sorry, but I have a problem with this. I would rather err on the side of not committing an act of battery.
I am an employee of the hospital, true, but I feel it is the state's place to enforce it's laws, not mine. (ex. We can't stop them when babies leave without a car seat, and that is also law here.) I have no problem calling CPS (child protective services) about the refusal of eye ointment and letting them deal with it (- not vindictively, of course - just to follow procedure, which is what the procedure has been in the past).
As a side note, CPS came in this case, interviewed the parents and did nothing.
I feel that forcing medical treatment --especially that which is not critical, i.e. not life-saving-- on people is a very slippery slope.
Would I be committing an act of battery if I gave the 'eyes' in spite of parent refusal?
PS - Before you go off on parents like this, keep in mind that I am one. I gave birth at home to all my children, and -- although we did give the eye ointment, which wasn't necessary for our monogamous marriage, if you get my drift -- we refused vitamin K for the ones who didn't have risk factors indicating need. I also don't vaccinate, and I believe strongly in a patient's / parent's right to refuse medical treatment.
I delivered in a hospital (once by c-section and then once lady partslly in the elevator!) and I refused Vit K, eye ointment and the Hep B vaccine after my c-section. It was not any big deal with the staff or hospital. I was set to refuse it again on my second baby but I went from 4cm to delivering in 7 mins and my daughter was born with massive bruising--I don't know how she could have looked worse! It was a different hospital but they didn't give me any hassle either. I did change my mind and allow the Vit K for her, but not the Hep B or eye ointment. The Hep B series was started later when it should be given.
Parents have the right to refuse non life theatening care for their children. Review your hospital policy, as well as the state statute, to be sure your policy is correct. Personally, I would not deliver or even work at a facility that forced care on families. You might even file a complaint with the state agency that oversees hospitals that pt. are not being given the right to refuse non life threatening care.
No, that's not why. All newborns have a "vitamin K deficiency" (although I question if it's truly a "deficiency" if every single mammal is born that way). They don't start producing endogenous Vitamin K until they're around a week old (that's about how long it takes for e. coli to colonize in their GI tract - e. coli is what is responsible for Vitamin K synthesis).
thanks for that info, that is different then what i've been taught in school. i appreciate getting other sources :)
RE: Why do they even bother coming to the hospital... The parents in question didn't plan to come to our facility. She precip'd before they could get to the FS birthing center.
My side comments on homebirth and vaccines were made simply to elaborate on the point that I believe in parental right to choose and to encourage people not to 'go off' on such parents as these in the OP. I never meant to start a debate on those issues. Sorry.
Bottom line - is giving the eye ointment with parents refusing, in a state where it is law, an act of battery?
Specializes in ICU, Home Health, Camp, Travel, L&D.
Giving *ANY* treatment parents refuse, with the exception of life-saving treatment in some circumstances, is battery, and is *illegal* and *unethical*.
It seems to me, from many of these posts, that paternalism in medicine/nursing isn't discussed much in nursing school anymore, or isn't necessarily seen as a bad thing.
How is it that, for some healthcare professionals, that the role of service provider has shifted to health dictator? I'm a college educated professional, not a waitress, but I am a servant/steward/educator of those who come to me as patients for help. I am not the decision maker for these families, nor should I be.
IMO, the paternalism is one part holdover from the days when the doctors (and by extension, their "handmaidens") knew best, one part genuine concern for the patient's well-being, and one part by-product of the nanny state that presumes to have the final word on what every citizen should or should not be doing.
I'm amazed that Risk Management is forcing the issue. Usually they are the squeamish ones trying to avoid anything that even smells like a confrontation, even in those situations where they need to step up.
Perhaps anyone who is concerned about this kind of mandate should actually take a look at their state laws governing the situation to see if there are opt-out provisions. If there are and Risk Management refuses to allow people to exercise those choices, they could be placing the entire facility/organization in harm's way.
I would encourage anyone whose hospital endorses forcing Vit K and erythromycin on babies against their parents' wishes to be sure they have an up-to-date professional liability policy in place.
At my hospital if a parent refuses either vit k or eye ointment a doctor is called to the bedside to discuss risks and benefits. Then the Dr writes up a note (sort of like a consent note) detailing the conversation. It is not a nursing responsibility other than getting the Dr or NNP. I don't know of anyone refusing the vit k after the risks were explained. Of course I work mostly nicu so when the Dr explains that their baby is at higher risk it changes things. The only nicu parent I know that refused eye ointment also tried to refuse surfactant on his 26 weeker But I don't think you should ever give any med without consent in a nonemergency situation. If the doctor wants it given he or she can give it.
Bottom line - is giving the eye ointment with parents refusing, in a state where it is law, an act of battery?
Without a doubt. The law is clear; there is no (rational/ethical) debate. Parents have the right to refuse, and it is the duty of the nurse to empower them to make informed decisions and support their choice. Circumventing the choice such as described in the OP, is an illegal and immoral act. Any physician, nurse or hospital administrator flagrantly disregarding the law and the rights of the patient/parents deserves professional censure and both civil and legal penalties.
But I don't think you should ever give any med without consent in a nonemergency situation. If the doctor wants it given he or she can give it.
linearthinker, DNP, RN
1,688 Posts
I agree w/ Klone and CEG. Yes, it's battery. I'd press charges and/or sue any person and facility in such an instance.
RNOTODAY, I find your your stated position to be diametrically opposed to the ethos of nursing.