Possible adult admit with minor child in tow

[Monkey Nurse, ASN, RN]

I work in a rural and impoverished community. Our circumstances are unique and things happen here that shouldn't or wouldn't happen other at 'normal' places.

Anyways-- I was being asked to take an admit on the inpatient floor which I refused with the charge nurse blessing, because she had a minor child with her (less than 12y/o). They had no one to come get the girl and I said I can't admit a patient and just have her kid hang out here.

What does a normal hospital policy look like in regards to patients who present to an emergent care facility and then need admitted?

[TiffyRN, BSN, PhD]

I've had the same thing happen except she brought 2 school age kids (I didn't refuse). We fed the kids, get them recliners & blankets. They passed out almost immediately.

What's the option? Keep the family in the ED? Call child services to come take the kids? I'm pretty sure my hospital didn't have a policy. I heard later mom was able to find family by the AM and they came and got the kids. Mom was very sick (though coherent at admission). She passed away during that hospital stay.

[Monkey Nurse, ASN, RN]

I can't think of a precedence here and both my senior nurses (one being the charge) said we can't take the patient and the child. I asked the ED to call up a senior person to get approval and guidance if they want me to take the patient. Mother was coherent but supposed to be on fall and seizure precautions with bedrest and q3 neuros.

I'm really surprised that you were able to admit with 2 children. It just seems a huge responsibility on the nurse and legalities to essentially take charge of a patient and then two minor children (or one in my case). I'm not really sure what other options would be available other than a prolonged stay in the ED until the morning.

I intend to address the issue with our seniority so we have better guidance going forward so I hoped the community had some beneficial input.

[nutella, MSN, RN]

There were few cases when a patient had a child or more than one and no one to come and pick up the child. In those cases I have called the social worker and they call child protection. If a parent needs to be admitted and is unable to take care of the child and there is nobody else, they will place the child with emergency foster parents for that short while. I have actually met people who have been "emergency" foster parents and they do not take long term kids, they usually stay only short term.

[Horseshoe, BSN, RN]

This is a scenario I've never encountered, and frankly never even contemplated. But reading the OP, I imagine this could actually be a fairly common and challenging dilemma.

[brillohead, ADN, RN]

Like mentioned above, the social worker calls CPS and arrangements are made through the foster system.

If there is a friend or family member who can take the child but they have no transportation to come collect the child, the CPS worker facilitates that. If there is simply no place for the kid(s) to go, they get placed into temporary emergency foster care until either the parent can resume care of the child, or someone else is able to take over (family comes from out of town, etc.).

[Here.I.Stand, BSN, RN]

I'm not really sure what other options would be available other than a prolonged stay in the ED until the morning

I would think children would be safer on the floor until arrangements are made (family or emergency foster care) than in the ED. I mean the ED nurse isn't any more able to handle the situation than you are...maybe even less so because of the very emergent situations that the ED has to manage.

[RainMom]

I was blindsided with an admission a couple yrs ago like that. Received a young woman to the floor on night shift, 5 days s/p c-section with preeclampsia. Mind you, this was the ortho floor. (Huh? You can have preeclampsia AFTER baby is delivered? And apparently, our OB dept won't take such a pt after delivery!)

Anyway, her parents & newborn were with her when she came up & as I did the admission. The grandfather mentioned that the baby needed diapers & I stated something to the effect that it was their responsibility as the baby was not a pt (although if it was gonna be a huge issue, I could have been able to get a couple from peds). Grandfather mentioned going to pick up some food & left the floor. Within the next hr or so, pt put on her call light & when I went in, I discovered that grandmother had decided also to leave but baby was still with pt who I had started on a mag drip & was on seizure precautions! Found out her parents were not coming back.

It was near the later part of the shift by that point, 0500, so I notified RN supervisor who felt it would be fine to wait until a later time to call family (though I did explain to pt why it was not a good idea to keep her baby with her without another family member present). Luckily, it was a decent night with a good group of pts; the aide & I stayed near that room, watching like a hawk.

...an experience that makes me hyper-aware when kids are brought up with a parent who is admitted...

[RainMom]

Forgot to mention I'm also in a rather rural area. I recall another instance when we had a mother admitted after an MVA. She was traveling thru the area & had her 2 kids with her, ages around 8-12 maybe; no family available to help. They were allowed to stay with her & games from peds were brought to them to keep them occupied.

[canigraduate]

Like mentioned above, the social worker calls CPS and arrangements are made through the foster system.

If there is a friend or family member who can take the child but they have no transportation to come collect the child, the CPS worker facilitates that. If there is simply no place for the kid(s) to go, they get placed into temporary emergency foster care until either the parent can resume care of the child, or someone else is able to take over (family comes from out of town, etc.).

This just happened on my unit two nights ago. We had a gentleman admitted to OBS who had his 12 year old grandson with him. It was the middle of the night and the mother had no transportation to the hospital and there was no other family available. His options were to involve CPS and find emergency placement with the possibility of a CPS investigation, have a relative come get the child, or leave AMA with him. Our night emergency case manager got a taxi voucher for him to take his grandkid home and he left AMA. We told him to come back in the morning when the buses were running or call an ambulance if he needed to come back that night.

[bgxyrnf, MSN, RN]

I'm not really sure what other options would be available other than a prolonged stay in the ED until the morning.

Which solves nothing besides leaving the kids in perhaps the worst place... with the drunks and crazies and all the other ED chaos.

[applesxoranges, BSN, RN]

The closest thing I have seen are moms who want to breast feed their babies. We discourage it because the healthy child is potentially being exposed to dozens of germs. We encourage pumping in the mean time. Our rule is we will allow an infant to stay as long as there is a non-hospitalized adult to stay with it. However, we haven't had a case where no friend or family could take the child.