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

[Vito Andolini]

What an awful situation to be in but that little boy needs you. What a heartbreaker. He'll be in my thoughts and prayers. Be strong for him.

The child needs proper care from someone, not necessarily from the OP.

It is admirable that she wants to help but she does not owe any patient, even this little angel, her life. She needs to report to the authorities and GET OUT. She is in danger and is not required, legally or ethically, to remain there.

[Luv2care0907]

My head is full of NCLEX questions. I thought this would make a good one, don't you think?

The nurse has a debilitated pediatric home health client whose father is acting irrationally, has bursts of anger toward her, has psychotic episodes and may possibly be smoking marijuana as the nurse smells it from time to time. The nurse has attempted to report him to her supervisor, who has refused to listen to her report. What is the next step for the nurse? Check all that apply-

1. Call CPS and report the situation immediately

2. Understand that this man is angry because of his son's condition and be sure to tell him that it is "ok to be angry for a time."

3. Do nothing.

4. Get another job.

5. Purchase a gun for protection knowing that there is a possibility that he will come after her later.

I just couldn't resist. BTW, #2 answer comes from a post that I wrote on this board concerning an NCLEX question. I was an RN for 10 years and have let my license lapse. I am attempting to get it back. I opted to retake the NCLEX.

https://allnurses.com/nclex-discussion-forum/one-these-questions-372907.html

Vera

[rn/writer, RN]

I would call CPS and anyone else I could in a minute if I had some solid proof. So far- smelling something, and verbal threats toward the pt./fighting is not things CPS would be able to get involved over and maybe pull a child out of the home for, I don't think.

But I may call CPS at some point.

It isn't your job to prove anything. Your job is to report what you have seen (or heard or smelled, etc.) and let CPS sort it out from there. CPS doesn't have a choice about whether or not to get involved once something has been reported. They are mandated by law to investigate, just as nurses are mandated to report.

Your suspicions are enough to start the ball rolling. I would think the medical fragility of this child would make him a higher priority than kids who are able-bodied. Have you talked to the teachers about whether they have seen things that suggest abuse/neglect? In many states, teachers are mandated reporters as well. And they could certainly back you up on the important point that, given the right circumstances, this boy can communicate. What about other nurses who have cared for him. Surely, others have seen things.

If people had to have proof of bad stuff in order to notify CPS, no one would ever call. And we wouldn't need them in the first place because all the leg work would have been done. Mandated reporters often have nothing more to go on than a gut feeling. Those who work for CPS understand this.

Please, don't wait any longer to call. Let CPS do its job and maybe rescue this kid or at least open the door to regular scrutiny.

[Purple_Scrubs, BSN, RN]

Thanks, To All Who Responded,

I would call CPS and anyone else I could in a minute if I had some solid proof.

As mandated reporters, nurses and healthcare workers are required BY LAW to report if they have the SUSPICION of abuse. Proof is irrelevant.

[psalm, RN]

Thanks, To All Who Responded,

I would call CPS and anyone else I could in a minute if I had some solid proof. So far- smelling something, and verbal threats toward the pt./fighting is not things CPS would be able to get involved over and maybe pull a child out of the home for, I don't think. The Dad told my supervisor they had been smoking expensive cigars. They would deny not caring for him at times, like at night, and say they didn't say the things they said.

The problem is, too, where would a ventilator child go?

But I may call CPS at some point.

Right now, only two teachers who come to the house and me realize (and encourage) that he moves his thumb for "yes" to answer questions. If some other people, like his Drs. could be made to realize this, he would have more of a voice and it may change the whole senario for him.

Document! Document! Document! Does homecare or agency nursing not have incident reports a nurse can fill out? Ask CPS to come by unannounced to check on things.

This can all be done after you resign that case, too.

[RN1982]

Peggy, I hate to say this, but if you don't call CPS on these parents then you are just as guilty as them. I do hope you call them. It's in the child's best interest.

Like others have said, you only need to have the suspicion that there is something dangerous about the child's home environment, not the proof, that is up to CPS to prove that there is something amiss.

If something happens to that child and it was known by you that there were problems in the home, you could be held liable.

[twinmommy+2, ADN, BSN, MSN]

Wow, what a rough situation. A call to cps is definalty justified here given what you posted. It is your license on the line if something happens to that child and you didn't report it.

Like others have stated, report the drugs in the house, keep your lisence intact, and find a new agency to work with.

[canoehead, BSN, RN]

If you make the call to CPS do it soon, and mention that the child is in the hospital. The investigation will be safer and smoother while he is there with security to assist, and the hospital staff may have their own information to add. They may be able to prolong his hospital stay until supports are in place, or they may be able to admit him to a pediatric nursing home from the hospital. Good luck.

[Luv2care0907]

I just wanted to share some of the limitations of CPS. I think in the olden days, they were more like the Cavalry. But today, for whatever reason I do not know, they are apparently more reserved. I think there must be laws governing them so that they have limitations and I'll tell you why.

My husband and I are Christians and part of what we do is to share our faith with people. We purposely target places where we know we will find people acting wild and crazy. One such event is called Fantasy Fest. It is down in Key West. Fantasy Fest is an event that is X rated where folks can act out their favorite sexual fantasy. There is a tremendous amount of public nudity. It was one thing for these folks to act so perverse publicly but what bothered us the most was the number of people that brought children (any age) to this event. I have footage that I can't even put up on Youtube because it is that explicit where children are being shown all sorts of things. We've tried twice even edited and youtube took it down. It is really about as bad as it gets, worse than anything you can imagine. So we took our footage and sent it to CPS. They wrote back and said, "Sorry, there is nothing we can do. If it doesn't happen in the home, we are not able, by law, to do anything." That, to me, exposes a huge amount of limitation since their purpose is to protect children. I mean, I have never seen anything as flagrantly horrific like what I saw in these clips and it blew me away that they were so apathetic. There was no change the following year.

So apparently, they can no longer bombard a family without some real solid proof. In the case of pot, I happen to know that you have to have possession of the stuff for them to make a case. This very difficult to do. I am not even sure that they could initiate a Marchman Act based on a nurse's suspicions. A Marchman Act would force the man to be drug tested.

The other aspect is the irrational behavior and anger. I still contend that what needs to be done is for a social worker to be called to get this man some counseling. He needs to work through these very difficult issues.

Vera

[mscsrjhm]

Maybe you could talk anonymously to the local Police Narcotics Unit?

[RN1982]

I read about Fantasy Fest in the Florida keys, the website says nothing about acting out sexual fantasies. Looks like just a bunch of adults dressed up in weird costumes, some scantily clad. Not something that's family oriented though. Don't really know why people are taking their kids there for that. As long as children aren't involved, I really don't see any problem with adults dressing up in weird costumes and expressing themselves.

Yeah, i'm sure there are some limitations to CPS, however, given that the OP is already aware that there are issues in the home, I don't think getting CPS involved is a problem. Yes, in your case there is, in the OP's there isn't.

[rn/writer, RN]

So we took our footage and sent it to CPS. They wrote back and said, "Sorry, there is nothing we can do. If it doesn't happen in the home, we are not able, by law, to do anything."

What the OP describe IS happening in the home. And to a defenseless, medically fragile child.

The other aspect is the irrational behavior and anger. I still contend that what needs to be done is for a social worker to be called to get this man some counseling. He needs to work through these very difficult issues

Counseling for the man comes way down the list of priorities. First and foremost, his son needs to be safe.

It would be interesting to know what the guy was like before the son was born. If he was already a self-centered, reality-escaping bully, perhaps grief isn't what is motivating him now. I'm sure the boy's deficits were a shock to the man, but the kind of behavior the OP described (unreasonable anger, physical threats, substance abuse) sounds less like grief and a whole lot more like a character defect and a conduct disorder.

Counseling is wasted on those who don't think there's anything wrong with what they're doing. Maybe the guy would reach out if the child were taken away and he was jolted into reality. Then again, maybe he would just rail against the loss of the SSDI check and feel sorry for himself that everyone is picking on him. I guess I've seen enough of the latter to know that there are some hard-hearted individuals in the world. Seems like someone who could threaten to strangle a disabled child--his child, for Pete's sake--with the kid's own vent tubing, might fall into this category.