Okay to "babysit" a friend's medically complex child?

[sewinnett, ASN, RN]

Hello,

I am a pediatric homecare RN from Minnesota and have worked 3.5 years for a phenomenal company! I have tried looking on the MN Board of Nursing website regarding this topic, but cannot find specifics.

A family from our church knows I am a nurse and has asked me to provide some daytime care for their baby if their current health status gets to a point where a public daycare center might not be suitable or safe should the need for a colostomy arise (which is looking very possible at this point.) Baby also has some delays in growth and in the near future, may also need time for healing from heart surgery, tonsillectomy, etc... all to come down the road when appropriate. Family has asked if I was willing to provide some care during the day if they do not qualify for homecare nursing upon hospital discharge. I told them I am willing to do that to help out as I work 3 days a week and have 4 off with my own little one.

I need to know the proper steps to follow. Baby would only be in my care if discharged home from the hospital without qualification of skilled homecare nurses, and would be at my home during business hours a few days a week while parents work. I would be providing cares as instructed by the parents. Do I need legal protection if I am basically acting as a babysitter who can change a colostomy bag, do stoma cares, and GT feeds? Where does that line get drawn between "daycare" and "nursing care" when I already have the appropriate skill set and I do not require any further training...?

I am asking for guidance to keep me and the other family safe. :)

If there are other trusted sources out there I should try, please let me know. I will keep searching as well.

Thank you and Happy New Year!

(p.s. Just so we are all on the same page...I am doing this to help a local family who approached me, would pay me a daycare wage - not my nursing wage, and I am not publicly advertising that I offer skilled nursing daycare services.)

[RiskManager]

This gives the RiskManager the vapors. You are essentially providing nursing care in this scenario. You don't have the regulatory and liability protection of doing this as an employee. I am not certain that taking instructions/orders for the parents in providing some degree of skilled nursing/healthcare services is permissible. If something goes south, I would wager that the BON would be parsing that difference between instructions versus orders. What if the child has a medical emergency whilst in your care? A babysitter would just call 911. Are you going to do only that, or call the provider for orders or take whatever actions you deem appropriate based upon your experience, training and nursing assessment?

You would clearly need to have your own healthcare professional liability coverage for this; your employer will not be covering you for this sort of 'off the clock' work. For that matter, even with my own policy, I would want to run this past the insurance company underwriters/risk/claim manager to get their opinion as to if the individual policy would provide coverage.

Were I in your shoes, I would refuse to do this. I would tell the parents that due to regulatory, legal and liability reasons, it puts your license, livelihood and assets at risk. If the parents want to contract with your employer for pediatric nursing homecare and ask to have you assigned, that would be the only way I would provide services to the child. Even then, seeing as they are fellow church-members, could you maintain your professional boundaries sufficiently?

[heron, ASN, RN]

If it were me, I'd check with my malpractice carrier. They might be able to shed light on liability issues as well as insurance coverage limitations.

You will be getting paid - I wonder if that obligates you to meet RN standards of practice, since you would be hired precisely because you have the nursing skills to care for a medically complex child.

The family would basically be getting professional nursing services for a baby-sitter's wages. Great deal for them.

[sewinnett, ASN, RN]

Great information, thank you, this is exactly the guidance I am looking for. I had a gut feeling that this might be a sticky situation, but wanted the point of view from those with more experience in the field. In wanting to be helpful, I know I also need to be watching out for myself and my own family as well. I have not yet looked, but I am betting purchasing my own insurance coverage would end up costing me way more in the long run, and I personally don't want that kind of hassle right now. I think it will be better for me to have the family push to try to get qualified for the skilled nursing coverage at home. I have only been a nurse for 3.5 years and I love this career. It isn't worth the risk!

[heron, ASN, RN]

Sniped by Risk Manager! I was hoping you'd weigh in on this!

[CrunchRN, ADN, RN]

Only if you can do through a professional agency. You must protect yourself.

[Kooky Korky, BSN, RN]

Do not do this, for the reasons others have already stated. Follow your instinct on this and do not do this - unless your attorneys advise that it's not a professional risk for you to care for this child as a day care worker and specifically not as an RN. But I doubt there's a time when we stop being RN's just because we are working in a daycare. You know that the parents would likely say, "She's an RN, she should have _________" if anything were to go wrong.

You can either tell them the truth or tell them your schedule has changed or you are ill or something. Probably the truth is best. Help them in some other ways.

Best wishes to all concerned.