I am a new nurse in the NICU, and I'm just trying to decipher whether or not I made the right call.
I had a patient being discharged to absentee teen parents. They had difficulty obtaining a car seat, didn't have adequate transportation, and so on. Because the parents didn't bond in the NICU with their baby, they had no idea what to do or how to prepare for homecoming.
Anyway, the patient was supposed to be discharged at 0900, but when I came onto shift at 1900, nothing had been done because the parents had not come to the bedside. When I finally discharge them at 2230, I find out that they have no formula for the baby. When I asked them what the plan was, the mom stated she was planning on going to WIC in the morning for formula. The baby has to eat at night, right?! So I decided to give them formula to last overnight and she promised to go to WIC first thing the morning.
Now, this was probably a horrible idea in hindsight because that puts my facility at a very real risk of losing their baby-friendly status. Maybe I should have involved social work (sometimes on call at night)? My charge nurse was in an assignment and also helping with admissions, and I just didn't think to involve her in something with a 'simple' solution.
Additionally, because this was such a prolonged discharge, I was feeling pressure to 'get it done' and accept a new baby transitioning from Level III to Level II status, and the housekeeper was only available to clean until 2300.
I plan on talking to my manager, who is aware of the situation, but I guess I'm just looking for any sort of reassurance because I do know I was wrong (by the books), but I can't help but feel like I did what was best for the patient--what would you have done?
I don't see the problem with giving formula. The baby is formula fed. My hospital gives out formula all the time.
The problem I see is with the discharge plan. If the parents showed up 10 hours late to pick up their baby, the discharge should have been delayed. Social Work should be involved from the get-go with teenage parents. Did these parents ever do a 24 hr stay where they were responsible for the baby's care? That is a requirement for first time discharges of babies who've been hospitalized since birth in my area. Presumably the baby has Medicaid. Does Medicaid in your state not offer transportation? In my state it does. If it doesn't, Social Work should have been able to provide cab vouchers for the parents to come to the hospital more frequently. If such resources were provided and the parents didn't utilize them or used these cab vouchers to go elsewhere, I'd say we're getting into child protection territory...
I am the biggest advocate of breastfeeding you will ever meet. HOWEVER, you absolutely did the right thing. I daresay, this is going to be the LEAST of this little ones upcoming problems....
You did the right thing. Sadly, my hospital forces late discharges before 1130 because of the housekeeping thingy too. The idea of the baby going home with these parents scares the hell out of me.
I would have held the discharge. "Come back tomorrow, bring your car seat and the baby's clothes; be prepared to spend 2-3 feedings." Pass on in report, if they don't show, have Social Worker call CPS. (Yes, tell the parents that's what the plan is going to be.) Write it up for the nurse manager in case there's a to-do. Teenagers need a wake up call. If they think you're a b----, oh, well.
I had a teenage mom show up to get her baby; she had a diaper and a tee-shirt for a premie--in February. Yes we live in San Diego, but it's COLD in February!! She didn't see a problem. Sometimes, I think they want to see how much stuff the kind hearted nurse will give them.
We did have donated corificeats available for dire situations.
Specializes in Public Health, Maternal Child Health.
I know this happened over a month ago, but just wanted to add my experience as a public health nurse who visits a lot of these babies in the home. It does sound like a situation where a SW or discharge planner should have been invloved, and hopefully connected to resources after discharge. Of course you did the right thing by giving them formula! But maybe should advise social work or supervisor to make sure someone calls them in a few days to make sure the family is doing okay, and make sure they went to their pediatrician appt!
2 things I can tell you our county does in these situations, we have a Nurse Home Visiting program through public health maternal child health, where nurses come visit these high risk babies for at least an hour and weigh the baby, assess feeding, assess social situation and parents, provide them with ongoing resources, education on health and infant care (and many topics!) and developmental assessments until 1 year old.
Another thing our county does is we created a form that hospitals can fax to WIC that says "I authorize ____ hospital to inform _____ WIC office that I have delivered my baby and we are going home on _____. I authorize WIC to contact me for me to schedule urgent appointment. Special feeding instructions for my baby include:" i.e. Breast pump or order for 22 kcal formula, etc etc.
you can only do so much as the NICU rn! Get to know what family resources are available in your area to help at risk parents succeed. Some are CPS referrals but many are not that are still at risk for neglect but not enough to have CPS involved.
I don't think there is anything wrong with providing enough formula to get them by. My concern would be that they were obviously unprepared both in terms of material things (formula, car seat, diapers and other necessities?) and probably also in terms of education as they were teen parents who had not spent much time in then NICU with their infant.
One way my unit handles the latter of the two is by requiring new parents to spend a night or two in "family stay" where they are primarily responsible for all of the feedings and care. They keep track of everything on a paper we provide. They give a bath as well and have the nurse close by to help provide guidance and answer any questions that they have. Generally they say that this experience helps them feel more prepared and confident prior to discharge. With some of our patients the neonatologist make this night or two in family stay mandatory prior to discharge.
You were thinking of your patient which to me is far more important than some status. As we strive to do what is best in our facilities there is always an exception. As you grow in the NICU it will become more clear.
hawaiicarl, BSN, RN
327 Posts
I can just read the headlines in the local paper now. "Newborn discharged from local hospital at midnight with no food" ....
You did the best you could.
My question would be where was dayshift, and especially case management? Who discharges newborns at night?
Cheers