Home Health - concerns with unstable family

[Jplvn]

Hello all, I want to share with you guys some things I've experienced so far with the family I've been working with for almost 3 months. Maybe you guys can give me some insight....

I work with an 11 month old baby born with a genetic disorder due to gestational diabetes and the mom being a chronic weed smoker. So baby has a few issues that need nursing care, but is super easy to take care of. He is no harder to take care of than a healthy baby. Other than all his medical appointments this month (annual medical follow ups) as it's been quite busy, this baby is a delight to take care of!!

With that being said, does he need 80 hours of nursing care a week? Probably not, but.. me and the other nurse report to a job, and that's what we do. I originally came onto the job, ready to help mom out because shes having trouble, can't afford a babysitter, and needed to go to work. Well, she worked for about 3 weeks since I was assigned, and ever since she's been working her own hours with Lyft. Which is ok! She has a job! HOWEVER! She's not really working? She works probably a maximum of 10-15 hours a week...which I have feelings about only because:
1. The baby will not have his basic needs sometimes including diapers, wipes, water, one time-- formula. (even though she gets it free). It's come to the point where me and the other nurse will communicate to each other to buy the baby some before coming onto the shift--which is not ok in our company to buy things for the family, vice versa.. but what else are we to do?
2. She smokes weed 2-3x daily. And I know weed---it is NOT cheap. With the amount she smokes, she easily spends minimum of $100/week to satisfy this vice. She prioritizes her high over many other things. (She's quite open with her finances so this is how I know)--apparently, she overdrafts her account a lot, she's late on her rent and car payments and insurances at least 2 months, and she rarely had food at home. Mind you, she has another 9 year old kid who all she eats is cup noodles and cereal everyday. I make her food from home when I can. But, there were times she's asked me for $20 here and there and to borrow my phones hotspot so she can earn some money on Lyft because her phone bill wasn't paid. I never gave her money or let her do this because I know my professional boundaries but I can't bring it up to her that it's not appropriate. My response has always been, "sorry I don't carry cash, or.. I'm waiting on an important phone call today" just to get out of it.
3. She eats out everyday. ? Never cooks at home. The 3 months I've been here, she's cooked something maybe 4x. Everything else is bought...

Now, to be put in her shoes... I know what it's like to be low income.. but she has plenty of help. She's got section 8 housing, her son gets SSI, free insurance, she has 80 hours of nursing care that she can take advantage of to work somewhere full time..the list goes on. And I know that this can come across as judging her..but! This to me is reality. My heart goes out for her kids....and it's not that me and the other nurse are here to give her respite anymore, it's more to protect her kids from her...
I've thought many times to call CPS or tell my company what goes on in this house, but I'm afraid. She does care, but she needs a lot of help. There are a list of many other things that put her kids in a lot of danger ..many. I'm not sure what to do.
The other nurse and I share the same feelings but I don't think shes one to report either. I guess none of us are ones to separate families. So far, I'm just bottling it up.

[caliotter3]

Well, you are judging her, but from the standpoint of a professional healthcare worker. You need to have a case conference with your employer or a meeting where you present the whole nine yards, in writing. Based upon the action, or inaction, that the agency takes, you will be able to make a decision about whether or not you will report anything to CPS. Be prepared to be let down by the system and also be prepared to work somewhere else. Agencies do not want to hear anything that smells like a problem and they like, even less, to do anything about those problems. Their answer to situations like this is usually to enforce the status quo and get rid of the nurse who "brought on the trouble". I've seen too much of this over the years. Once you have made your report(s), you will definitely need to watch out for your own interests, one way or the other.

[JKL33]

21 hours ago, Jplvn said:

But, there were times she's asked me for $20 here and there and to borrow my phones hotspot so she can earn some money on Lyft because her phone bill wasn't paid. I never gave her money or let her do this because I know my professional boundaries but I can't bring it up to her that it's not appropriate.

Sure you can. No, you don't tell her she's inappropriate but you absolutely say that you won't do it, no excuses. "No, I am not allowed to be involved that way." If you really feel that more information is required, just say, "It is a professional boundary that protects patients and nurses. Nurses are not allowed to be involved in that way."

Making excuses is discouraged. First, you have to keep coming up with them and second, your client knows they are excuses/not true--that won't help your rapport with her in the long run.

Do NOT capitulate on boundary issues.

21 hours ago, Jplvn said:

It's come to the point where me and the other nurse will communicate to each other to buy the baby some before coming onto the shift--which is not ok in our company to buy things for the family, vice versa.. but what else are we to do?

No you can't buy things for the baby. Stop this.

I mean this kindly: Whatever the underlying causes of the situation are, you are effectively helping to hide the situation and enabling it to continue.

This is a matter of getting this baby (and mother/family) the help they all need, not a matter of reporting someone from a place of judgment. The reason you are having trouble doing the right thing is because you are thinking about it wrong. Think in terms of getting help for the children.

If you go to that home and basic life-sustaining supplies are not available, you have an immediate problem and you need to take care of it immediately by informing your supervisor and following your policies. If you are objectively concerned about neglect, you must report this--you are mandated by law to do so. None of this is to punish this mother but to get the appropriate help in the home. Keep in mind plenty of children have grown up on cup-o-noodles, cereal and the like; use care to be objective in what causes you alarm. But at the same time if there is no formula in the house or the children are being objectively endangered then you have to get help.

21 hours ago, Jplvn said:

The other nurse and I share the same feelings but I don't think shes one to report either. I guess none of us are ones to separate families.

Again, you're thinking about this wrong. It isn't about whether someone is "one to separate families." Or "one to report." If you are a nurse you had better be "one to report" when the situation calls for it; you are mandated by law to do so! If this family were to be separated it would have to be a fairly extreme situation--and if it is, then what is the excuse for leaving the children a minute longer than they need to be? And if it isn't (an extreme situation) then CPS/DCFS will not remove them and will be looking to see what else is needed to help the family and help them come up with a plan.

Do you have questions, or how are you going to handle this?

[NRSKarenRN, BSN, RN]

PA state passed Act 31 in 2014 requiring Child Abuse recognition training. RN's and all professionals with a PA license required to take training. Registered Nurses are mandated reporters of suspected child abuse.

From what you've you posted, a call to Child Protective indicated for lack for formula/food in home for children under age 18. Both nurses need to inform your supervisor of concerns, ask for a meeting with parent regarding HER responsibilities and report situation. By NOT reporting, you are jeopardizing YOUR LICENSE if/when BON contacted regarding nurses involvement in child's care --especially if harm occurs to child.

In PA, CPS has resources to provide parenting support rather than just removing child from the home.

Take advantage of the FREE online CEU offered by Pennsylvania Child Welfare Resource Center to help protect your license: https://www.reportabusepa.pitt.edu/webapps/portal/execute/tabs/tabAction?tab_tab_group_id=_2_1

List PA CEU courses available: https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Pages/Act-31.aspx

[DallasRN]

You've gotten some excellent advice from the first three posters. This is a situation I know nothing about but was wondering about being a mandated reporter. I work with senior citizens and we (licensed staff) are mandated to report to Adult Protective Services. Just had an excellent inservice presentation last week. Tough decisions to be made and best wishes to you and your co-worker.

You are a mandated reported and there are several reportable offenses in this post- even just the fact that his basic needs are not being met (you having to buy him formula for example).

ETA- CPS is not always punitive. Many times the caseworker is able to plug families into services they might not know about, offer resources, etc. It is not purely to punish mom and try to take her baby away.