I need some answers here. (sparing all the detalis....) I had a patient who's husband gave me a hard time (not the only thing he didn't agree with) about the hospital policy on transport of a newborn. In our facility, the newborn is to be transported in mom's arm via wheelchair, or in a bassinette to the MBU after delivery. This dad said to me when we went to leave L&D for the MBU "No, I will be carrying my baby!", I told him that he couldn't, that we had a hospital policy against that and that I would be happy to get a bassinette and he could push that if he wanted to, he refused, saying "I know my rights, and this baby is mine and I am his parent and I have rights, I have 6 kids, I know how to carry a baby!!" Well, i told him, that yes, he did have rights and he was very competent and experienced as a parent, and I knew that, but that it was a safety and liability issue and I would be happy to provide him a copy of the patients' bill of rights. He got billigerant (sp?) and upset, but eventually handed the baby to his wife. (Let me say that he also refused consent for the baby's eyes and thighs meds and refused to sign the refusal form...however his wife signed it when he went out for a smoke, but asked that I never tell her husband that she signed it and to pass that on to the other nurses).
So, we went to the MBU all the while he was complaining that he had rights and giving me the evil eye. It was awkard. Soooo...then I get back downstairs and I am asked did I "bag" the baby (for a UDS), I said no, I didn't (mom had a medical MJ card), as I didn't see the purpose since we all know it would be positive, we didn't genarlly get a UDS on baby when mom has a medical MJ card anyway, and (she had it legally) and the doctor didnt' have any issues with further drug testing. So, the charge L&D RN went upstairs and approached them about needing to get a UDS on the baby.....can I tell you how well that went over??? LOL!! NOT!!
Fast forward about a month and I get called into the ANM office and ask if I remember this case, and what happened, after I racked my brain, I recalled this event and told the ANM what happened. She said that they complained to the director of the Women and Children's Svcs and she need to see what actually happened. After I told her about this incident. She said I was wrong, that I should have let him carry the baby, and made a note in the chart that he was aware of the policy and refused it and I was allowing him to carry the baby in his arms. She said that him refusing to follow that policy should be no different than him refusing the baby's E&T or any med or procedure in the hospital:devil:...So, now I ask:
1) was I wrong to enforce a policy here? Or should 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?
I felt like my manager completely threw me under the bus. She said I set him off, and that if I had not done that, then he would have had a better experience at our hospital.
Let me also say that I am a very attentive bedside nurse. I give wonderful care and I am constantly getting writeups by my patients about how much they loved my care and appreciate me as a nurse. This was the first time I have had a patient complaint of any kind at all.
I am needing some neutral input here. If I was wrong, then I want to know, but I felt that I did the right thing. Thoughts?? Please??
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
Well if the supervisor, manager or administrator was available at 11pm then maybe they would have been involved, as it was they weren't available and my nursing judgment was to let the man carry his baby and chart it. I am a HUGE supporter of patient rights. They have the right to refuse ANY treatment, even if it is policy. A patient/parent can REFUSE any test, even a drug screen UNLESS you have a court order that says to get one. Our policy said first bath was done by nursery personnel, but if a mother or father insisted on giving that bath I would set it up, stand by, watch and offer advice, but let them bathe the baby. Me touching the baby at that point could be seen as battery. Even if a patient signs a consent they have the right to revoke that consent at ANY time.
I still believe what I did was the right thing for the situation. Trust me, there were some fathers who asked to carry and I quoted hospital policy, they said okay and policy was followed. I usually stated policy and gently tried to enforce it, if they refused so be it. There were some fathers who I would NOT have allowed to carry their kid, no matter what, I would have called security if needed.
Based your description of what happened, I think most people would agree that the dad is a JA, however, if something does happen, that defense will not stand up in court, etc.
As for orientation...you will not handle every possible situation on orientation. Even if you think you saw a lot, I guarantee you did not see it all, and your NM and experienced nurses on the unit should realize this. They should realize that when you ask them for advice on a situation like this on. If they do give you grief about asking...well, ask anyway.
Upon further reading, there is a difference from him refusing a test, or med and caring the child. It is apples and oranges. That father was not a patient, but even if he was, he can refuse giving a med or procedures, but never over ride safety. If he told you he was bringing that baby home without a car seat, who would prevail? That is more along the same line as carrying a baby, not testing, or giving a medications.
You do not cya if you note a patient or family refused to follow policy. If something goes wrong risk management will throw you under the bus. They will say "here is our policy and she was not following our policy."
If a policy is not followed you need to document and notify the doctor. Of course that is ridiculous in this case. I'd just love to hear what a Dr. says when a nurse calls with that!
Your manager gave you terrible advice. Your policy needs to be re-visited.
Just my two cents, but you did right! The policy is there for a reason. If you had made an exception for this dad, it would have been based on WHAT? Because dad got his knickers in a twist?Because he got his feelings hurt? Because the policy caused him what, some inconvenience? When he went out for a smoke, how do you know it was just that? (I understand that he could do the same in the bathroom, but the fact that he left the floor is important.) Your patient is the baby and the mom, not the dad. You make your decisions based on their welfare, and you had evidence that the mom was intimidated by the dad anyways. So now the dad drops the baby and sues and how are you gonna defend yourself?? This way, you can say you followed hospital policy. If they tell you that you should have made an exception, ask them to show you where in the policy it says you can make an exception. You did absolutely, 100% right.
Do you carry malpractice? Call your malpractice company and ask what their advice would be. They are the experts (love em or not) in what constitutes a risk. And remember. The state issues you a license, not your employer. Don't be swayed!
"They have the right to refuse ANY treatment, even if it is policy."
1) My understanding is that treatments tend to be covered by orders, not policies.
2) You list yourself as a NP. A regular RN does not have the scope of practice that you do.
3) A patient DOES have the right of refusal for treatment. However, this is a safety issue, not a treatment. If the posters hospital wants to grant exceptions to the safety policy, then they need to spell it out how to go about this so that there is no gray area.
I have been in your shoes before, sigh. You try to enforce hospital policy and get no support from those who create and approve it. Your manager's response should have been "I understand you were enforcing policy but this hospital has decided to lighten the wording of that policy to reflect a more customer oriented approach, thank you for bringing this to our attention". " "keep up the good work"
"They have the right to refuse ANY treatment, even if it is policy."
1) My understanding is that treatments tend to be covered by orders, not policies.
2) You list yourself as a NP. A regular RN does not have the scope of practice that you do.
3) A patient DOES have the right of refusal for treatment. However, this is a safety issue, not a treatment. If the posters hospital wants to grant exceptions to the safety policy, then they need to spell it out how to go about this so that there is no gray area.
Orders are often covered by policies are they not? A doc may order a treatment/med, but there is a policy in place for how to preform that treatment or give that med. Double checks on meds, how to mix the med, how fast to give the med, how to change a dressing, start an IV...the doc orders it, but the hospital says how it is to be done. Even the order, "Admit to ICU" is covered by a policy. How that admission is done is up to the hospital.
In this case I used my judgement and in my judgement letting certain fathers carry their newborns instead of me, through an attached, uncluttered hallway between OR and the nursery, a trip of no more than 15-20 feet, was not a safety issue. After all the parents could carry babies in the room without us telling them no and the rooms were cluttered. We weren't talking about a slimy, squirmy newly delivered infant, but one wrapped in blankets en route to the nursery. Did I violate hospital policy? Yes. If he were to have tripped and fell carrying the baby COULD I have been sued? Yes. If I carried the baby, tripped and fell after insisting I carried the baby WOULD I have been sued? ABSOLUTELY.
I violated policy when, in my nursing judgment, I felt it was better for my patient to do so. At one point we had closed visiting hours, no one under 14 in the unit at all unless they were patients. A patient with 7 kids at home gave birth to a stillborn little girl. Technically, her other children were not allowed. Did I violate policy to let those kids in to see her at 9pm? Heck yes I did, all 7 of them.
I violated policy when I let a few mothers bathe their babies. Policy said it was to be done as part of admission to the nursery, by nursery personnel. I would instruct that it was against policy and if the patient insisted, "It is my child..." and the baby was healthy and stable, why not?! Against policy? Yep. Would I do it again? Yep. I provided a safe place, warmth and the tools, then I supervised.
We had a rash of falls over in med-surg where patients fell from bed. What did the hospital do? Decide any patient with an IV was a fall risk and needed bed alarms on. COME ON!!! A routine lady partsl delivery, who still has an IV several hours after delivery, but is through recovery and stable is on a bed alarm? None of us used them. Not just me, but the entire unit. We staffed 2 RNs and no techs on nights. Babies roomed in. There was no way I could be in all the rooms every time a baby needed tended to, mom needed up or heck sometimes it was because she shifted in bed.
Every nurse I worked with violated that policy, why because it was reactionary and impractical. Sure, it was supposedly a safety issue, but it was ridiculous. We eventually convinced the DON it was silly and the policy was changed, but only after we violated it for 6 months and had no incidents. So many policies in nursing are put into place after a single near miss or 1 stupid mistake. The problem: not only would the policy be reactionary, but it would be over the top.
I wasn't always an NP. The incidents I spoke about were all while I was a staff RN in a L&D unit.
Orders are often covered by policies are they not? A doc may order a treatment/med, but there is a policy in place for how to preform that treatment or give that med. Double checks on meds, how to mix the med, how fast to give the med, how to change a dressing, start an IV...the doc orders it, but the hospital says how it is to be done. Even the order, "Admit to ICU" is covered by a policy. How that admission is done is up to the hospital.
In this case I used my judgement and in my judgement letting certain fathers carry their newborns instead of me, through an attached, uncluttered hallway between OR and the nursery, a trip of no more than 15-20 feet, was not a safety issue. After all the parents could carry babies in the room without us telling them no and the rooms were cluttered. We weren't talking about a slimy, squirmy newly delivered infant, but one wrapped in blankets en route to the nursery. Did I violate hospital policy? Yes. If he were to have tripped and fell carrying the baby COULD I have been sued? Yes. If I carried the baby, tripped and fell after insisting I carried the baby WOULD I have been sued? ABSOLUTELY.
I violated policy when, in my nursing judgment, I felt it was better for my patient to do so. At one point we had closed visiting hours, no one under 14 in the unit at all unless they were patients. A patient with 7 kids at home gave birth to a stillborn little girl. Technically, her other children were not allowed. Did I violate policy to let those kids in to see her at 9pm? Heck yes I did, all 7 of them.
I violated policy when I let a few mothers bathe their babies. Policy said it was to be done as part of admission to the nursery, by nursery personnel. I would instruct that it was against policy and if the patient insisted, "It is my child..." and the baby was healthy and stable, why not?! Against policy? Yep. Would I do it again? Yep. I provided a safe place, warmth and the tools, then I supervised.
We had a rash of falls over in med-surg where patients fell from bed. What did the hospital do? Decide any patient with an IV was a fall risk and needed bed alarms on. COME ON!!! A routine lady partsl delivery, who still has an IV several hours after delivery, but is through recovery and stable is on a bed alarm? None of us used them. Not just me, but the entire unit. We staffed 2 RNs and no techs on nights. Babies roomed in. There was no way I could be in all the rooms every time a baby needed tended to, mom needed up or heck sometimes it was because she shifted in bed.
Every nurse I worked with violated that policy, why because it was reactionary and impractical. Sure, it was supposedly a safety issue, but it was ridiculous. We eventually convinced the DON it was silly and the policy was changed, but only after we violated it for 6 months and had no incidents. So many policies in nursing are put into place after a single near miss or 1 stupid mistake. The problem: not only would the policy be reactionary, but it would be over the top.
I wasn't always an NP. The incidents I spoke about were all while I was a staff RN in a L&D unit.
Bolding mine. I don't work in OB but this is happening everywhere and it's SO true, it's just making things harder (for staff AND for patients/families) by the day.
Specializes in Med Surge, Tele, Oncology, Wound Care.
Your manager is WRONG!
This is a child who's safety is in your care. If the father wants to refuse things about his healthcare, then so be it, but this is about the care of a voiceless child.
I don't understand how a father is allowed to make such decisions. The child is a patient and the mother is a patient, NOT the father.
You are there to protect the child by providing safety, and I would have followed the policy when the father wanted to carry the infant.
The mother, without the father's consent, wanted the child to recieve medical care and asked you not to tell him. That should give some insight into what this relationship is like and to have more descretion. Not that you probably saw this during the time he wanted to carry the baby.
I would have went along with continuing to do a UDS. Are you kidding, this poor child sounds like it is going home to some real winners...If it comes back positive with other than marijuanna, then it might serve to protect this child in the future (if the child needs some form of legal protection). (If I understand correctly the reason for the UDS in the first place).
I would take this further up and find out what to do when this happens again, because I am sure it will.
If that father dropped the baby, and you didn't follow the policy to a T, you would be sued and never forgiven yourself. Policies are there for safety and you did the right thing.
I think we have different definitions for the same things. To me, how to administer meds, carry out orders etc, is a procedure, not a policy. But I'm not sure that is even the point of the posters question. If you repeatedly violated policy at your organization because you didn't agree with it, and nothing adverse happened, then great for you. If you got the policies changed that you didn't agree with changed as a result, then I'm all for cutting red tape. But in a legal case, the poster would not have a leg to stand on. The policy may be stupid and unworkable, but it is the policy. I personally ended up in a fact finding task force because of a violation of policy which was not completely in my control, because the family was threatening to sue. Thankfully they didn't. I think you are a breath of fresh air on the way to more nurse autonomy, which I am all in favor of. But in a court of law, the poster would not have a leg to stand on concerning a violation of this policy. A 'prudent nurse' cannot violate policy because she doesn't like it or doesn't agree with it.
I agree and in my first post stated that you can never go wrong following policy. I also agree the manager was wrong to tell her to violate policy. I never expected ANYONE I worked with to violate a policy because I did. My choice, my butt on the line.
To rkitty198: The baby is the patient, but the father is still considered the parent and legal guardian and has rights as being such.
From what I remember from the first post the father was refusing to sign the medication refusal form even though he was refusing the treatment. That is what the mother signed when he left. I think this guy is a jerk and it sounds like he might be abusive, and mom should be screened for abuse, but unless she asks for help there isn't a thing we can do.
NPinWCH
374 Posts
Well if the supervisor, manager or administrator was available at 11pm then maybe they would have been involved, as it was they weren't available and my nursing judgment was to let the man carry his baby and chart it. I am a HUGE supporter of patient rights. They have the right to refuse ANY treatment, even if it is policy. A patient/parent can REFUSE any test, even a drug screen UNLESS you have a court order that says to get one. Our policy said first bath was done by nursery personnel, but if a mother or father insisted on giving that bath I would set it up, stand by, watch and offer advice, but let them bathe the baby. Me touching the baby at that point could be seen as battery. Even if a patient signs a consent they have the right to revoke that consent at ANY time.
I still believe what I did was the right thing for the situation. Trust me, there were some fathers who asked to carry and I quoted hospital policy, they said okay and policy was followed. I usually stated policy and gently tried to enforce it, if they refused so be it. There were some fathers who I would NOT have allowed to carry their kid, no matter what, I would have called security if needed.