I'm afraid for my pt. and afraid to go to work.

[nursemike, ASN, RN]

I agree with Vera that much of what is described may be a matter of ineffective coping with grief and/or stress, but I also concur that notification to the proper authorities of abuse/neglect is warranted. The threat with the vent tubing sounds like clear-cut abuse, and whether the parents are unwilling or unable to provide adequate care through the night, it's a problem that needs to be addressed.

I also think the OP would be well-advised to get out of this situation at once. As much as I don't think it's right, I can be a little forgiving of families in the hospital who are rude or disrespectful of the nursing staff. I can understand that they may feel helpless, that badgering the nurse for pain meds (for example) may feel like the only thing they can do for their loved one. It ain't right, but sometimes you can work with them to improve the situation, and in any case, you can pretty much go home and forget about them at the end of the shift. However, in the OP's position, I would have to take seriously the risk of matters escalating to physical violence. Obviously, there is no legal issue of abandonment if you finish your shift and choose not to go back, but I would add there is no moral issue of abandonment, either. The nurse will be of no use to the patient if she is killed or hospitalized, and must think of her responsibility to herself, and perhaps her own loved ones, first.

Personally, I don't know that I would make too much of the marijuana use. I don't see laying around the house smoking dope while the wife works as a very manly occupation. It sounds like the OP is describing frequent, or even continuous, use, as opposed to "occassional." I'd be inclined to ignore occassional use altogether. More frequent use could be seen as one element of the child's neglect, but still, drinking beer would be no better, and possibly worse.

Finally, since I'm throwing my two cents around, I think the OP would do well to find other employment than an agency so unsupportive of her concerns. It's a sad fact that a lot of nursing administrators fail to back up their nurses when they ought to, but leaving a nurse in harm's way shows a serious deficiency of the spine, and their handling of the pot issue shows a lack of judgement, in that it could only serve to make the situation worse.

In a perfect world, a child-welfare agency might be able to step in with education and assistance to help these people better care for their child. In a perfect world, the parents would be willing to accept that help. I can't say I am optimistic that matters will turn out that well, but in any case, it appears the OP's position is untenable, and getting out of there would be the prudent course.

[SeychelleRN]

After a few months, I found I was getting yelled at almost everytime I was there, by the Dad. I also smelled pot occas. I saw arguments between the parents. And I came to realize when the evening nurse left at night, the parents didn't do anything and the pt. didn't get care 'til the nurse in morning arrived, (other than, hopefully, they were listening for alarms from the ventilator).

I talked to my supervisor about the Dad being angry with me, and especially smelling pot. She callled him to address the pot issue, he denied all. She was subsequently not supportive with me. Next day, I got yelled at, "this is our house, maybe we have pot, heroin, coke, it's none of your business."

These people are the kind that would probably come after me, (there are guns in the house).

If I quit all together, I will feel like I'm abandoning my pt.

What a nightmare! I agree with everyone. Please contact CPS. You will continue to enable the behavior of the parents and your supervisor, if you continue to work in this environment. Most of all, your patient will continue to be in danger when a nurse is not present. Please do yourself and your patient a favor, by getting the proper authorities involved and find yourself a new job before something more severe occurs.

[tencat]

Maybe the little boy needs you, but YOU need to be safe. Your safety is the most important thing. If dad gets out of control and hurts you, how can you be there to help ANYONE? I'd get my happy tail out of there as quickly as possible while dialing CPS on my cell-phone. You have a legal obligation to report this, even if your supervisor won't. So sad for the little guy, but the best way to help him is to help get him out of that environment.

[mscsrjhm]

It is already established by actions that you can be victimized, so don't go back to that house.

Calls to make: Pt.s Physician first, hotline, case worker, finally your agency.

You are required by law to hotline any suspected abuse. As you believed the child wasn't being cared for while under the parent's care, you should hotline.

I'll bet the kid's lungs were crappy every time after being in only the parent's care- required lots of percussion and suctioning? I've seen that too.

Don't get yelled at while doing your job!!!!!!

[Cranmans]

CPS all the way. Many case workers are over worked, but try to get one there. You can sometimes get a police officer to call it in--then it might jump start it. Depending on the words--it could be abuse, too, towards you.

[dlxrn]

SO right! ANd if we knowingly allow the child to remain in these circumstances...we are just as guilty and liable. Look at the whole meltdown of the social services sector in Dc..and the deaths of those children left in the care of the mother...and these professionals KNEW!. Bottom line. you supervisor had no business having an interaction with the father. That is out of her realm. There has to be alot of documentation...of the care you provided for the child and the environment you observed the child to be in. I just wonder about leaving the pt that night when you perceived him to be uncomfortable. Maybe because I am a Hospice nurse and comfort is our number 1 priority. Perhaps you could have phoned the MD to discuss the pt with him/her because obviously the family is not advocating for the pt.

[Luv2care0907]

I just wish it hadn't escalated to this point. That dad is going to be even angrier. Like I said, very few people recognize the grieving process that parents go through when they have a child that is never going to be "normal."

Please don't misunderstand though, my post wasn't to suggest that calling CPS at this point was the wrong thing to do, but to share why what was happening was happening in the hopes that when the parents get help, they will get the right help. The parents needed counseling many moons ago.

This is why I am very cognizant of the effects of anger in the grieving process. It can be downright scary when someone is angry at the world. I would never consider giving someone the green light to vent on anyone for the reason.

Vera

[dlxrn]

Of course the dad will be angrier. But does that mean that we ignore the situation because we worry he will be angry? No...that family needs alot of intervention and the first step is to get the Social Services Dept in there. YOu are not advocating for the child if you do not intercede on his/her part. Deep down...I think you know that. I really do not mean to be harsh....but just want to let you know...that the fact you recognize this child is not in the best of situations is commendable. The fact you reported the situation is also commendable....but you have to trudge on ...and do the right thing.

[Luv2care0907]

Of course the dad will be angrier. But does that mean that we ignore the situation because we worry he will be angry? No...that family needs alot of intervention and the first step is to get the Social Services Dept in there. YOu are not advocating for the child if you do not intercede on his/her part. Deep down...I think you know that. I really do not mean to be harsh....but just want to let you know...that the fact you recognize this child is not in the best of situations is commendable. The fact you reported the situation is also commendable....but you have to trudge on ...and do the right thing.

I guess I'm not communicating this very well. Of course, this is the next step. This must be reported to someone who has the authority to step in. No question. Hands down, that is the right thing to do.

In my reading I found this as well,

Occupational Safety and Health Act

1. The Occupational Safety and Health Act (OSHA) requires that an employer provide a safe workplace for employees according to regulations.

2. Employees confidentially can report working conditions that violate regulations.

3. An employee who reports unsafe working conditions cannot be retaliated against by the employer.

Saunders Comprehensive Review pg. 62.

I fault the supervisor more than the parents because the parents are not thinking rationally at this point. They need as much help as the child. It was wrong of the supervisor to side with the parents. That aspect should be reported as well.

Vera

[FireStarterRN, BSN, RN]

I once did private duty nursing. I will never, never do it again and I did not have situations as difficult as you describe. I agree with the others, child protection must be called. You are a mandated reporter, in fact.

When you work private duty, you are on the family's turf. One of my patients was a severely brain-injured man who was a quad. The parents were very controlling, like you describe. The mother was a retired nurse who had never really worked, except as a school nurse. Every day I was there she was breathing down my neck. She drove many nurses away.

The agency will probably not help since their goal is to cater to the families who are their bread and butter. They do not want to lose lucrative clients.

Good luck, I'm sorry for this poor boy.

[pagandeva2000, LPN]

I would call CPS and whoever else I could possibly think of. Maybe calling the hospital is not a bad idea, either, but I would certainly be calling an outside agency to inform about this situation because it seems that this child has the ability to communicate somehow and is cognizant of his surroundings. Poor child!

I know this is not what you wish to hear, either, but, you are probably a wife, mother, friend, cousin, something to someone. You do not go to work to possibly come home in a casket. In other words, I would not be going back there, either way.

[caliotter3]

When you reported your misgivings to your supervisor and she talked to the parent and then you were yelled at, that was the time to remove yourself from the case. It does not make sense to keep going to a place that is as hostile as this is. You will never be able to make a difference for this patient but these hostile family members can make a difference for you and you won't like it. Get out of that case. Since your supervisor does not support you in your desire to work in a safe environment, I strongly suggest that you investigate the other home health agencies in the area. You will never be safe while you work for this agency.