Noncompliant parents. Do I have any rights to protect my license?

[RNC-NIC]

We currently have a baby on the unit whose parents refuse to allow necessary medical interventions. They refuse to allow this patient to use mist with the trach collar because they think it's too loud, they leave the floor with the patient without resuscitation equipment or even informing nursing, they refuse suctioning even if the patient is bubbling over and desatting (oh, they'll cough it up and come up, this happens a lot) and they won't allow chest PT despite the patient plugging.

They accuse staff of not responding to other patient alarms and are constantly eavesdropping on other patients and are hypervigilant for mistakes in care. They also will not allow nursing to assess the patient overnight and when this person is sleeping.

The parents have been spoken to repeatedly about at least informing nursing before leaving with the patient and to bring the BVM and safety equipment but they repeatedly state they'll be back soon and that they just suctioned the patient so bringing a portable machine isn't necessary. They absolutely will not grasp the concept that anything can happen at any moment (this patient has a critical airway), and just because they just performed suctioning does not mean the patient may not need another if they're a half hour away from the unit on a walk. The patient isn't even CLEARED to leave the unit.

Security has been involved, social work has been involved, and the parents don't care. "It's my child and I'll do as I see fit." It isn't for a lack of education as many MANY nurses and even practitioners have attempted to educate this family.

Our unit rotation is coming up and I'll be taking care of this baby. I want to make them write a statement saying I'm not responsible if something happens to their child due to their refusal of interventions. I want to put it back on them that "Okay, so I can document you're willingly risking your child's life?" if they refuse to take the resuscitation equipment.

I would actually like them to request me NOT to be their child's nurse, as I will refuse to withhold the necessary care like suctioning just because the parents don't want it done, UNLESS they are willing to release me from liability. Has anyone ever had this happen? Did you have any recourse other than documenting the parents' response?

[RLeeRN]

Oy! I have stayed out till now....Lee, you remember what assume means? with the "patient is always right" attitude these days, it would not be immpossible to see this not reported and still rise to the level of abuse/neglect. TPTB wanting to keep the parents happy to avoid bad press, etc. I would find it hard to believe that there isn't ONE nurse that hasn't already try all of your suggestions over this period of time.

Morte,

The idea that management or administration is willing to allow children to be abused to prevent "bad press" is another talking point thrown out when issues are not handled exactly how the staff would have wanted. Oh , and assume is defined by Merriam-Webster' Collegiate Dictionary as: To take as granted or true: to Suppose. Thanks.

Lee

[umcRN, BSN, RN]

I agree with the through documentation using quotation marks. I would also be writing incident/event reports. Getting my department manager, CPS, and risk management involoved. This poor child. I cannot even imagine what parent in their right mind could risk harming thier baby after they have been educated. I would do anything for my child, and would never directly do something that a experienced NICU or Peds nurse told me could be harmful. I am sickened. I hope this child is ok. My thoughts and prayers are with this little precious one. Thankfully the baby has you to be his/her advocate. :heartbeat

Don't doubt the ability of parents to harm their baby even after education...they think what they think is right and will have it no other way

[hiddencatRN, BSN, RN]

You make a good point in that nurses are mandatory reporters of abuse by law. Obviously, anyone with authority within the hospital has found that there is no "abuse" going on or that the parents are not a "threat".

The reason we are ALL mandatory reporters is because we are supposed to rely on our own assessment, not on the assessment of those with "authority" in identifying potential abuse or neglect. Those with "authority" can be wrong, can not have the same interactions with the parent and patient that might spark concern, can miss things, etc.

Regardless of how many parents or family one meets it is in the best interest of the patient, family, staff, and facility to treat each and every encounter with a high level of professionalism.

I guess I don't see involving DHS as a breach of professionalism. And maybe I've missed such posts but I don't recall seeing anyone advising the OP to be rude to the parents.

However, instead of using this as an excuse to not have a "rosy" outlook about parents and becoming hardened to them, there is an even greater need to find ways to communicate in a way that is beneficial to all. Being genuine, warm, empathetic, and respectful go along way with patients and family. Even parents who "suck" can pick up on the value judgements nurses are making. Thanks.

It's not about becoming hardened or cynical but about realizing that there are situations where people skills just aren't enough. Sometimes kids need to be taken away from their parents. Sometimes we need court orders to medically treat patients. Sometimes parents need to be banned or limited to supervised visits only. Sometimes it doesn't matter how "genuine, warm, empathetic, and respectful" you are. Is this one of those situations? I have no idea. I do believe that most people are good, that most parents want the best for their child and that most parents love their children regardless of how effective they are as parents. But I also note that the OP seems really concerned about the situation. Maybe the OP lacks strong therapeutic communication skills and works on a unit staffed by people who don't work with parents well, but I'm inclined to give the OP the benefit of a doubt.

[Katie5]

It's a child. A parent's love is being tested here.So your way is not working now. Come at them another way- get them to share a story or thought or their fears with you. Communicate openly- I'm sure they want the best for the child.

Again it's a child, you worry about your license, they worry about a life. I will never discredit your worries(I'd worry too), but be gentle. Try another tact.

[morte, LPN, LVN]

Morte,

The idea that management or administration is willing to allow children to be abused to prevent "bad press" is another talking point thrown out when issues are not handled exactly how the staff would have wanted. Oh , and assume is defined by Merriam-Webster' Collegiate Dictionary as: To take as granted or true: to Suppose. Thanks.

Lee

you left part of the def out:

"to take for granted or without proof; "

and i would think you are well aware of the way assume is viewed in the nursing community? it makes an a$$ out of u and me????

[EodwifeRN]

RNC-NIC,

I would say document until the cows come home. For me documenting not also is for you yet it is also for the patient that you are caring for. Regardless of what anyone else says you know what is best for you with the care for the patient. I am sure that you will make the best decisions for the patient and yourself.

[kbrn2002, ADN, RN]

This is what I don't understand though. I could understand battery if it was an A&O adult refusing a treatment, however this is an infant who cannot communicate their needs or advocate for themself. The parents have this baby as a full code with no restriction on intervention. With that form signed, how can they refuse care in a situation that has the potential to lead to a code?

Simple answer...unfortunately they can. Parents have total control over their children's health care decisions, even when the child is old enough to have input themselves. I agree with others here, your best course of action is complete and thorough documentation, unfortunately that is all you can really do. Any more invasive course of action, especially performing procedures expressly against the parents wishes, could result in losing your job, possibly your license and even put you at risk for criminal charges. I understand the frustration, but we don't have the right to violate a patient's, or that patient's responsible party's wishes.

[NicuGal, MSN, RN]

I have to respectfully disagree with the thought that parents can refuse anything. What those nurses want to do is provide the basic care that is called for this child. They can refuse anything, but if it is going to endanger the child then we can overrule it. This isn't talking about a DNR or don't do an LP,etc, this is about maintaining a clear airway. Like I posted earlier, we had a simialr situation and we had to call security to allow us to do our jobs. You better bet your bottom dollar that if I don't do what I need to do to that child I will be in a heap of trouble more than if I let that kid lay there without a clear airway.

Peds is a very different world, we are their advocates when their parents can't be or won't be. We are able to get emergency injunctions because of this. With enough documentation and everyone on board, my best bet is that one day these parents will not have custody of this child. We hate to see that happen, but, some people just don't get it and it is all about them.

If the parents really don't like it then they can ask for a transfer or a AMA (which will get a judge involved), but the standard of care isn't going to change.

[CrimsonAlchemist]

Hey, what ever happened to the child? This situation caught my interest, and I'd like to know if the parents ever became compliant? Or did the child's condition improve? Or what? What happened?