Moms visiting while impaired

[BabyLady, BSN, RN]

Anyone in the NICU knows the growing problem of infants born with NAS or who have mothers that test positive for drugs.

In our unit, there are several times when the mothers come to visit, while obviously impaired with slurred speech, problems with coordination, etc. However, if you ask these Mom's if they are "OK", they always claim that they are sleep deprived.

Our management has always permitted these mothers to stay, hold the babies, feed them unless they are literally, stumbling to the floor or falling asleep holding the baby (which has happened more than once)....I get the blanket answer, "Well, we can't drug test them if they are here and unless the court has taken away their rights to visit, we have to let them in."

This is especially a problem because our unit also has 14 private rooms, which many NICU's are implementing.

What is the policy in your units??? I understand that we can't drug test the Moms, but surely the liablity rests on us if something happens to the baby.

[babyNP., APRN]

If a mom is stumbling around, known to have a history of drug abuse, I will call my charge RN and security straightaway, while not leaving the bedside (get a fellow nurse to alert)...usually they escort mom out and then later on social work tries to make a contract with them (obviously not legally binding) that they won't come to visit while impaired.

[BabyLady, BSN, RN]

The problem is, these are Moms who have already been reported to social services and have been assigned a case worker as well as working with the hospital social worker. The charge nurses are always informed, our management also knows about these Moms.

Yet, they are STILL permitted to visit/care for the baby. Management won't allow the staff nurses to call security because they say it "causes problems" and unless they are acting violent, we don't have a legal reason to ask them to leave because they have a "right" to visit their baby.

Now you know why I posted the question.

[dawngloves, BSN, RN]

I have flat out refused to let an impared parent to hold a baby, be them drug abusing or on ordered morphine for pain. I have even been told that I should sit with an impared parent while they hold their baby in case they start to drop the baby! What??!!! No way! I am in a critical care setting. I may have to jump up at a moments notice to attend to a life threatening situation. I can't be worried about putting a baby back in an isollette so the parent doesn't nod out and drop them!

I suggest to the parent that they come back when they are not, "tired" because I am sure they don't want anything to happen in case they "fall asleep"

[UTVOL3]

Well, as I see it you may not have a right to ask them to leave, but can you refuse to let them hold without another staff member present?

From your post it seems like your problem lies more with management than with the impaired parents.

[BittyBabyGrower, MSN, RN]

You can't keep them from visiting, but you can set limits. That is within your boundaries. We have told parents that they seem really sleepy and we just can't permit them to hold the babies. We are pretty open, esp if they seem to be way out of it. "Miss G, you seem really out of it, sleepy. Everything alright? Right now, I can't let you hold Baby G because I'm concerned you could fall asleep and drop her, and we certainly don't want that to happen" If they get belligerent, then we say, "We are only looking out for you and your baby, if you cont to make a scene, we will have to ask you to leave" If it escalates from there, then we say" Okay Miss G, if you don't stop/leave the unit, then we will have to call security to have them escort you out." And then they either cool it, and mumble under their breath, or they con't to escalate and we have to call security. Calling security should be the last thing that goes on.

Make sure you are documenting everything you see, say, etc. And if possible, since you have private rooms, you have someone come with you to be a witness to the event. If something does go wrong, this type of documentation is needed.

[NeoPediRN]

We usually turn it over to SW for a 51A to be filed.