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??
Specializes in Med Surge, Tele, Oncology, Wound Care.
Npinwch- does the mother have more rights, or is it seen as equal? If one parent refuses the vaccines and the other parent plays it, how does that work?
Also does it matter if the mother is also a patient? Does she have more rights?
Thanks for clearing that up in my post. I worked-surg, so any of my experience is related to my own delivery.
I also thought of this as being a possibly orificeive situation. I know that mommy here would need to ask for assistance, but the staff also needs to assess for that?
OP: Your manager suc&$! They should have supported you better.
If it came down to the mother wanting one thing that the father something else the first thing I'd do is ask if they had questions, give them info if needed and let them discuss it together privately. I'd tell them why we did whatever it was we were doing.
For example, vit K and how the sterile gut doesn't produce any which puts the baby at risk for bleeding for the first 7 days or so. I would stress that the docs wouldn't circumcise boys if Vit K wasn't given due to the risk. I'd also tell them that they had the chance to change their mind at any time and that most things could be done later...
Both parents have rights and honestly I never had a couple that didn't eventually come to some kind of agreement. I doubt I would have given the vaccine if one said no and the other yes. I would have simply told them if they weren't in agreement, then it would be better to wait. Hep B isn't necessary at birth unless mom is positive and at that point it's a public health thing since Hep B is reportable and treatment is mandatory.
Technically, if mom wasn't married to dad, then mom had more rights, at least until dad signed the paternity papers. In that case, we did what mom wanted, but usually she followed his lead.
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.
Of course nothing is written about what to do when patients/families refuse to follow the policy. Just like every other hospital policy. Because in the minds of the people writing the policy, NOBODY ever refuses! And well, if us nurses would just use our therapeutic communication skills, then nobody would refuse. Basically, the policy is there so they can punish the nurse no matter what happens.
When I did adult med/surg, we had a staff meeting where we were told that patients were not allowed to leave the floor to smoke without an MD order allowing it. So when I asked, "And if the MD won't write an order, and the patient insists on smoking, what do we do?" And was told, "Well they can't go smoke." And if they insist on going to smoke, what do we do? Well they can't smoke. So what do we do? Well they can't go smoke.
After going back and forth with this, I finally said: So WHAT DO WE DO? I'm pretty sure I'm not allowed to tie them to their bed or sit on them, WHAT DO WE DO?
"Well you're a nurse, use your therapeutic communication skills."
Administration wants plausible deniability. And they're going to throw the nurse under the bus no matter what happens.
So what do I do? I explain the policy, explain the rationale, chart they refused. And make sure to pay the premium on my malpractice insurance each year. Anything else isn't worth the fight.
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.
There has to be a Charge Nurse or House Supervisor available, right? Someone you can turn to, unless you are one of those persons.
I know people can refuse. YOU can refuse to break policy, too. I'm telling you, if you don't follow policy and someone is injured, YOU are going to seriously regret not following your facility's rules/regulations/policies. I know you're between a rock and a hard place, but you have to look out for yourself. You can never be nailed for following policy. Yes, I know you can get in trouble if people complain because you are a policy enforcer. Don't you see? you can't really win. Better to lose by following the rules, I think.
You're a huge supporter of their rights. Well, I am a huge supporter of you keeping your license, your livelihood, and your job.
Not sure if the father is actually your patient. The way things are these days, family-centered, family-focused care, perhaps the father IS considered your patient. I don't really know. That should be clarified, in writing, by
Of course nothing is written about what to do when patients/families refuse to follow the policy. Just like every other hospital policy. Because in the minds of the people writing the policy, NOBODY ever refuses! And well, if us nurses would just use our therapeutic communication skills, then nobody would refuse. Basically, the policy is there so they can punish the nurse no matter what happens.
When I did adult med/surg, we had a staff meeting where we were told that patients were not allowed to leave the floor to smoke without an MD order allowing it. So when I asked, "And if the MD won't write an order, and the patient insists on smoking, what do we do?" And was told, "Well they can't go smoke." And if they insist on going to smoke, what do we do? Well they can't smoke. So what do we do? Well they can't go smoke.
After going back and forth with this, I finally said: So WHAT DO WE DO? I'm pretty sure I'm not allowed to tie them to their bed or sit on them, WHAT DO WE DO?
"Well you're a nurse, use your therapeutic communication skills."
Administration wants plausible deniability. And they're going to throw the nurse under the bus no matter what happens.
So what do I do? I explain the policy, explain the rationale, chart they refused. And make sure to pay the premium on my malpractice insurance each year. Anything else isn't worth the fight.
I know where you're coming from. The ones who make the rules have no experience with people actually refusing to follow them.
I once had a boss tell me to go take away from a pt bottles of meds she'd brought from home and was keeping in her room. She refused. Looking back, I should have lied to her, told her it would just be for a few minutes, anything to get her to give them to me, or just taken them. I reported back to the boss, who then went in and the damned B###H handed them to her ever so sweetly, thereby making me look like an ineffective jerk. Maybe it's because the boss went in AFTER I'd softened her up, TOLd her she was the boss, whatever.
Instead of TCS, how about Security? No, not for violating leaving floor to smoke rules. But I would do an incident report, I think, and if the boss was in the building, I'd notify him or her. Maybe.
If it came down to the mother wanting one thing that the father something else the first thing I'd do is ask if they had questions, give them info if needed and let them discuss it together privately. I'd tell them why we did whatever it was we were doing.
For example, vit K and how the sterile gut doesn't produce any which puts the baby at risk for bleeding for the first 7 days or so. I would stress that the docs wouldn't circumcise boys if Vit K wasn't given due to the risk. I'd also tell them that they had the chance to change their mind at any time and that most things could be done later...
Both parents have rights and honestly I never had a couple that didn't eventually come to some kind of agreement. I doubt I would have given the vaccine if one said no and the other yes. I would have simply told them if they weren't in agreement, then it would be better to wait. Hep B isn't necessary at birth unless mom is positive and at that point it's a public health thing since Hep B is reportable and treatment is mandatory.
Technically, if mom wasn't married to dad, then mom had more rights, at least until dad signed the paternity papers. In that case, we did what mom wanted, but usually she followed his lead.
What if Mom is Hep B + from being vaccinated or from actual but healed Hep B, not from having active disease? is that reportable?
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.
If the father refused to take the child home in a car seat, the father would still prevail. In most states, mine included, hospital saff have no legal standing to prevent a parent or guardian from leaving the facility car seat or not. To interfere with a parent's "possession" of their child is considered kidnapping. All we can do is take a license plate number and call the cops. Believe me, this has come up and that was the legal advice of the hospital attorney as well as the local DA.
In the OP's example, the only person with a legal right to remove the newborn from the father's arms is the mother. The OP did her best to find an alternative solution which ensured the baby's safety en route to the MBU. In a situation where the father refused to hand the baby over, it would have been foolish to futher escalate the situation by attempting to remove the baby from the father's arms. He sounds unbalanced, possibly abusive and likely to explode. How would that help the situation?
If a baby requires medical treatment and the father interferes with said treatment, time to call the cops.
What if Mom is Hep B + from being vaccinated or from actual but healed Hep B, not from having active disease? is that reportable?
Being vaccinated does not cause a positive Hep B result, nor do you "heal" from Hep B, it's a chronic disease. You always have it once you have it.
Back to the original question, patient autonomy always trumps policy. For instance your facillity may have a policy that all labor patients have a patent iv. A patient can always refuse that, you do not have the right to impose that on the patient. It gets a little dicier with an infant, but the parents are the legal decision makers. The policy of not carrying the infant, while nearly universal, is incredibly overbearing in my opinion. Refusing eyes and thighs is also not a huge issue for most patients.
I probably would have let the father carry the baby out and documented that he refused to follow our policy after explanations as to the risk involved in not following out policy. I tend to let patients make their own decisions even the ones I strongly disagree with.
Or, I might just have thrown the problem into the lap of the charge nurse and documented that I'd initiated the chain of command. Then left the decision and the rest of the charting up to her.
In your case, the next time you have someone refusing to follow your hospital's policy, I'd call that Nurse Manager at home--at 3am. Since she was so unhappy with your judgement in a similiar case in the past, you just thought you should consult her personally to be sure you make the best possible decision in the current situation.
Thank you all for the thoughtful posts. I feel much better about my decision to enforce policy. Having read everything, and given much thought to the matter, I would probably do the same thing again. If my patients father (since my patient is mom and baby) still insisted in carrying the baby, I will call the charge and ask her to inform the pt about the policy, and have HER write a note about what happened...I would feel better about it if I had some sort of back up. The bottom line is MY LICENSE, I am not willing to fry over some Jerk...and...yes, he was very abusive. No, a safety concern is not the same as refusing a procedure or an aspirin!! If there had been water on the floor, and he fell...or if someone had opend a door on him, or run into him...this choice guy would have been the first to sue!! Not worth it to me.
Thanks again, I am feeling much better. And, it's nice to know that my NM will NOT support me, or the other nurses for that matter.
I haven't entered the L&D world yet, but I can tell you I was let go by a previous employer for putting patient safety over customer satisfaction. I assisted a patient to the bathroom after having a blood transfusion, total knee replacement, and on pain meds. It's a very long story, but she she told the NM I made her feel like a child and that I told her she had to go to rehab instead of home because she wasn't safe (I didn't say that, or anything like it). She was so doped up she couldn't even remember my name, but could remember such incredible detail about the conversation. Long story short, my nurse manager told me to let the patients do whatever they want because it's customer service that keeps them coming back, not patient safety, and to document accordingly. That's all well and good for her to say not being a floor nurse and all, but if a patient fell, broke a hip and sued, I don't think it would look good for me in court to testify I knew that patient was a serious fall risk and had altered mental status but I let her walk alone because it's what she wanted, and after all, judge, we're all about whatever keeps the patient happy. My employer told me to go back to pediatrics where the patients are too young to walk and therefore safety wouldn't be an issue. So, that's exactly what I did, and I never thought about that hell hole again!
rkitty198, BSN, RN
420 Posts
Npinwch- does the mother have more rights, or is it seen as equal? If one parent refuses the vaccines and the other parent plays it, how does that work?
Also does it matter if the mother is also a patient? Does she have more rights?
Thanks for clearing that up in my post. I worked-surg, so any of my experience is related to my own delivery.
I also thought of this as being a possibly orificeive situation. I know that mommy here would need to ask for assistance, but the staff also needs to assess for that?
OP: Your manager suc&$! They should have supported you better.