Have you CYA if you make a "note" that a patient won't follow policy?

psu_213, BSN, RN · Apr 17, 2011

1) was I wrong to enforce a policy here? Or shoud I have made a note and let him carry the baby?
2) If he had fallen or dropped the baby, and I made a note, am I legally covered? Or could he sue me for not having enforced a safe policy?
3) What is your policy about UDS on babies with a mother who has a medical MJ card?

1. Now working in L&D, I'm not sure if these is a legal policy (i.e., "beyond" the hospital) or merely a hospital policy. I would think if it is a hospital policy, they may have signed something in advance about what the rules are and that the agree to abide by them. Also, is there and difference that the father wanted to take the baby out (is the father married to the mother)? Does it even matter (again, no experience in the area). What I can say--either way I would have written a note. Either "father of baby did not want us to transport infant from deliver room. Explained to father the hospital policy and rationale of policy. He then aggred to transport. Infant was transported from delivery room in basinette." If he demands to transport the infant himself (and he is alllowed to transport the baby) agian say that the policy was explained to him, he refused, etc.

2. I will use a non-L&D example (again, legality in L&D may be different). Pt A&OX3, totally mentally intact. Progressing renal failure, now requiring dialysis. Pt is told he is on a fluid restriction/dietary restrictions. Pt is told that many times and it is charted many times. Family brings in fast food breakfast for family that includes a large OJ (not the best choice for someone in CRF). Pt adivsed that it is in his best interest not to comsume the OJ (again, that is charted). Pt drinks the OJ and suffers harm from the excess fluid or the K+. At this point, since it is thouroughly charted and the pt was capable of making that decision, it would not 'fall out' on the nurse.

3. I have no idea what either of those acronyms stand for....

peeweedelivery · Apr 17, 2011

Thanks for the input.

UDS is Urine Drug Screen, and Medical MJ is Medical marijuana.

My concern is that if I did write a note, and then he did carry the baby, and fell and the baby was injured, am I covered just because I wrote a note? Or am I then in trouble because I didn't enforce policy??

I do agree that I should be covered if I wrote a note, but when dealing with a brand new baby? I don't know. Just confused.

martymoose, BSN, RN · Apr 17, 2011

I suppose you could always talk to someone in risk management at your hospital.

I most certainly have filled pages of a pts chart documenting their refusals, and the fact that theyy are aware and understand the consequences. Whether that would hold up in court, I don't know.

Your manager is a jerk and threw you under the bus, as they typically do.This guy was an ahole and bully as evidenced by the fact that the wife wanted the ama form kept quiet. And he was doing the same to you guys- being a bully- wants his own way. So of course he will cmplain to mgmt. And of course they will kiss his butt, and he will be rewarded for his nasty behavior- to which he is probably used to getting his way.

So sorry, you sound like you are a good nurse- and mgmt is going to go and ruin another one.

NPinWCH · Apr 17, 2011

Okay, well I have let a few fathers carry their babies from OR to the newborn nursery before. The first one was a lawyer and he and his wife had lost several pregnancies. This was their first and they were over the moon. He insisted and well honestly, I think the rule is stupid anyway (understand the reasons, but still they can walk with babe in arms in room, but not in private hall from OR to the nursery?!).

I didn't fight with him, just told him it was against policy and the reasoning and when he still insisted I just told him that I would chart he insisted on doing it. It wasn't a threat, I said, "Okay, as long as you know I'll be charting that you insisted on carrying the baby even after being informed of the risks." He said, "Fine by me..." After that I didn't bother arguing much with the few dads that really wanted to carry their babes, just let them and charted it.

Would it cover me? Heck no, but then if I insisted they could still sue for battery or something else I'm sure. We have no legal right to their kids at that point BUT they do have the right to refuse and take the risk. Technically, he could have signed the baby out AMA and there wouldn't be anything you could do UNLESS the baby was showing signs of illness and you got an emergency custody order. I feel that as long as the patient/parent is able to understand the risks and able to walk without assistance, well I'm willing to let them.

Remember, people CAN sue for whatever reason they feel they were slighted/hurt. People DO sue because they have bad experiences. Ticking people off can mean a bad experience....

We don't have medical MJ, so can't answer that. Also, we don't routinely test newborns, or moms. Only if there is a reason such as prior child services involvement, precipitous delivery, no prenatal care or positive tox on mom during pregnancy for a drug she has not been prescribed.

I hated being complained about for doing my job, which didn't happen often, but it goes with the territory. You won't always make everyone happy. Shake it off and just do what you feel is right next time and for what it's worth, you can never go wrong sticking with policy.

Also, when I let dads carry babes EVERY TIME I was verbally reprimanded by other nurses and my manager. So, your management wanted you to break the rules and mine wanted me to stick to them...if you let them carry you probably would have been informed you were wrong as well, but hey your patient would have been happy...

peeweedelivery · Apr 17, 2011

I sure do appreciate the input!! There is such a big patient satisfaction push right now that it feels like that is the only thing that matters. I don't like putting my neck on the chopping block, but dealing with people and a hospital I guess that goes with the territory. I do feel like I got thrown under the bus, I was shocked that she took his side. In the future, if that happens again, (I like how NpinWCH worded what she tells patients) I will write a note, and ask the carge RN to review the note and make a note that she has reviewed my note, so that I am at least covered by *someone*....

Thank you again!! I appreciate the different perspecitves.

M in OR

psu_213, BSN, RN · Apr 17, 2011

Another question...

Does the UDS get done on all babies? Is this mandated by law or is this a hospital policy? If it is law, I would doubt that parents could refuse to have it done. If the mother has a card for medical marijuana, and this test is only for marijuana, then, yes, I don't see the purpose to doing the test. If, however, the UDS tests for other drugs as well, then I would think that is should be done.

Kooky Korky, BSN, RN · Apr 17, 2011

i think you should have let him do what he wanted because how can you really stop someone, short of physicality, notified a supervisor, maybe the doctor, of his refusal to follow the rules, and made a note in the chart.

how nice of your boss to tell you now, after the fact, instead of in orientation, how to handle such a situation.

don't you love how hospital attorneys are not available to those who need them, immediately, to handle these situations?

what does your written policy manual say?

was a risk manager available?

peeweedelivery · Apr 17, 2011

A UDS is only done on babies where there is reason to suspect drug use, ie., if there is DHS involvement, or a doc suspects drug use, or we see signs (such as track marks, etc), that indicate drug use or a mother admits to drug use within the last 2 years. However, when a mom can smoke pot legally, I don't see the point in a UDS on the baby when she is up front and has it legally. It's just like having a script for percoset or antibiotics.

Kooky Korky, BSN, RN · Apr 17, 2011

Okay, well I have let a few fathers carry their babies from OR to the newborn nursery before. The first one was a lawyer and he and his wife had lost several pregnancies. This was their first and they were over the moon. He insisted and well honestly, I think the rule is stupid anyway (understand the reasons, but still they can walk with babe in arms in room, but not in private hall from OR to the nursery?!).
I didn't fight with him, just told him it was against policy and the reasoning and when he still insisted I just told him that I would chart he insisted on doing it. It wasn't a threat, I said, "Okay, as long as you know I'll be charting that you insisted on carrying the baby even after being informed of the risks." He said, "Fine by me..." After that I didn't bother arguing much with the few dads that really wanted to carry their babes, just let them and charted it.
Would it cover me? Heck no, but then if I insisted they could still sue for battery or something else I'm sure. We have no legal right to their kids at that point BUT they do have the right to refuse and take the risk. Technically, he could have signed the baby out AMA and there wouldn't be anything you could do UNLESS the baby was showing signs of illness and you got an emergency custody order. I feel that as long as the patient/parent is able to understand the risks and able to walk without assistance, well I'm willing to let them.
Remember, people CAN sue for whatever reason they feel they were slighted/hurt. People DO sue because they have bad experiences. Ticking people off can mean a bad experience....
We don't have medical MJ, so can't answer that. Also, we don't routinely test newborns, or moms. Only if there is a reason such as prior child services involvement, precipitous delivery, no prenatal care or positive tox on mom during pregnancy for a drug she has not been prescribed.
I hated being complained about for doing my job, which didn't happen often, but it goes with the territory. You won't always make everyone happy. Shake it off and just do what you feel is right next time and for what it's worth, you can never go wrong sticking with policy.
Also, when I let dads carry babes EVERY TIME I was verbally reprimanded by other nurses and my manager. So, your management wanted you to break the rules and mine wanted me to stick to them...if you let them carry you probably would have been informed you were wrong as well, but hey your patient would have been happy...

You are very foolish to break the rules and not involve a supervisor or manager or administrator in these matters. i know it's usually much ado about nothing, but you have to protect yourself legally. If lawyer dad had fallen, tripped, somehow hurt the baby, you would still be liable. His being a lawyer has nothing to do with the situation at all. just my :twocents:

peeweedelivery · Apr 17, 2011

The written policy says babies are to be transported in mothers arms in a wheelchair or in a bassinette. Nothing is written about how to handle a situation when the parents refuse. It seems there is a lot that I have learned on the floor that we were not told about in orientation, I just figured that is the nature of the beast.

Not sure if we have a risk manager.....I would be intersted in that person's perspective though.

And, this dad was a JackA**.....he gave everyone a hard time about everything. I am pretty easygoing, and I really try hard to accomodate my patients desires and give them the birth experience they want, but when I saw this as a serious safety issue, that is why I drew the line the way I did.

I will be handling this differently in the future.

I really wish my NM would have caveated what she told me with something like ...."you are a hell of a nurse and your patients love you, but....." It would have been an easier pill to swallow.

Pun intended!! LOL!!!

thank you for all the input, it's greatly appreciated.

Chin up · Apr 17, 2011

I think you handled it properly. The only other thing you could have done, was to document the father, agreeing to mother carrying the baby. But that is hindsight. I think your NM is wimping out and you should get further instruction. I just don't see you being wrong, anyway you look at it. I am going to reread your post. Please seek further council. You have rights too. The BON always goes by facility policy, and you carried it out to the T. The father was not your patient, the mother and baby were...I just don't see what you did wrong. Peace!