Possible adult admit with minor child in tow

Nurses General Nursing

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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?

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

RIGHT...and codes or traumas or other such terrifying things.

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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...

I hope you filed an "assignment under protest". Why not just call the Social Worker? If none, Police or Child Services for your area.

I'm glad it all went well, but I would feel tremendously put-upon if I had to watch kids plus do all my other duties for my group of patients. What if kids go in the dirty sharps box? Fool with equipment or IV's? What are they eating? Where sleeping?

Not at all right if kids are ambulatory especially, newborn still an issue.

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Specializes in ICU.

But why call CPS? What did the mother do wrong? She didn't have anyone to take her kids and was obviously seriously ill. If she had to be on fall and seizure precautions was it better to send her out in a car? If you are thinking legality issues, that's honestly a big time legality issue. Can you see my point?

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Specializes in Complex pedi to LTC/SA & now a manager.
But why call CPS? What did the mother do wrong? She didn't have anyone to take her kids and was obviously seriously ill. If she had to be on fall and seizure precautions was it better to send her out in a car? If you are thinking legality issues, that's honestly a big time legality issue. Can you see my point?

CPS isn't just for neglect. It's an emergent social worker that has greater resources than a hospital worker to locate kin and can assist in getting family to the child or child to family and secure temporary guardianship for non-immediate family until the parent recovers. It's not to file a complaint against the ill parent. It's to secure emergent social work services and safe placement.

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Specializes in Labor and Delivery, High risk OB.

This is an interesting thread! At my large level one trauma center we allow children 14yo and older to be a pt's support person. We also allow newborns to stay with mothers who are readmitted due preeclampsia on the high risk OB floor. (Preeclampsia can be diagnosed up to six weeks post partum). There must be a support person to care for the infant due to the fact they are not considered a pt. When working in our OB/GYN triage we have often been forced to deal with young children coming in with our female patients. If they are going to be admitted, then social service is called for emergency foster care. Often when we start this process, the patient is then able to call out of state family who can pick up in the AM. If a child gets hurt, or lost while the mother is a patient, it ultimately is the organizations responsibility. This is why states have emergency foster care.

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Specializes in Emergency.

We contact social work who gets child protective services involved.

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Specializes in NICU, PICU, educator.

I work in the inner city and this happens a lot! We call the social worker on call to come and handle it. It's interesting how quickly they can find family to come once they have been told DCFS is going to be called. On our medical floors it happens when a grandparent takes I'll and they are the ones who are the kids guardian. That is sad :(

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I get calling CPS/Social Services but for us, that is not necessarily and immediate response thing, especially on the weekend. The family structures out here are so broken. :S Honestly, in another part of the country this mom may not even have custody of this kid (btw who is less than 10 y/o). There are no taxis or buses out here, and if there was, still no relatives to accept the child.

So..here we are, going on day 2 of babysitting.

I am very happy they did not ask me to take this patient because I would have been furious that nothing further had been done to get this girl to suitable care. I'd be responsible for a child who is at the nurses desk every 10 minutes requesting things for the mother. I mean that means we are the guardian and legally responsible for this child and any mischief she gets into, if anyone should touch her wrong, if she should play with dangerous equipment, wander off ward, disappear with a stranger, eat something she's allergic to, fall down???

I don't know--its such a tricky situation where you really want to make sure this patient is cared for but taking a personal risk in a very non-ideal situation. And we've set a precedence now that I'm not sure I'm comfortable with.

(I could do mom's and neonates-- no problem as anything super acute for mother would not be at our hospital and also we are "Baby Friendly.")

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This would necessitate a social service consult to assist with either scouring the landscape for family, friends, faith community to come take supervision of the child (or even stay with the child at the bedside while arrangements are made) versus a protective filing to alert DCF to arrange emergent foster placement. The focus would be to be as creative as possible to support the family.

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@rainmom....Preeclampsia and eclampsia can surface prior to delivery, during the peripartum period, or during the 6 week postpartum period!!!! What the heck is wrong with your obstetric unit???? If they can't manage postpartum onset hypertensive disorders, there is something seriously wrong. But i digress....we would contact the social worker. In our hospital, DCF is often consulted to take emergent custody.

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Specializes in PACU, pre/postoperative, ortho.
@rainmom....Preeclampsia and eclampsia can surface prior to delivery, during the peripartum period, or during the 6 week postpartum period!!!! What the heck is wrong with your obstetric unit???? If they can't manage postpartum onset hypertensive disorders, there is something seriously wrong.

I know, right?! It's not that they can't handle it, but apparently it is our policy that once the mom delivers & is discharged, they aren't an appropriate admit to their unit. Believe me, I questioned OB & my shift supervisor. Makes ZERO sense (let's send her to ortho, lol). I had to call OB to send a nurse to come help at least do part of the initial assessment. I can assess the surgical wound but palpate a fundus? I don't think so. Pt ended up being sent to ICU at start of day shift since mag drip with VS q 1-2 hrs isn't appropriate for the floor, haha.

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The kid is 12 y/o. Hardly, a bother I think. Depending on the mom's condition, I'd admit and deal with guardians later.

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