Possible adult admit with minor child in tow

[Monkey Nurse]

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?

[Monkey Nurse, ASN, RN]

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.

Nay, I knew the kid is less than 12 y/o... the kid happens to be 8.

[TiffyRN, BSN, PhD]

Show of hands here, who has called their hospital social worker after MN? I have (or witnessed it). Real lucky if they answer half the time. And we are not a sketchy facility. I'm not sure they have the job threats for not answering when on call that nurses and doctors do. And I love me some social workers. Don't get me wrong. But good luck getting them to help in the middle of the night!

[lifelearningrn, BSN, RN]

This would be tricky, as some kids are a hot mess, while others would sit quietly watching TV and be a bother to nobody. Working with elementary aged kids, I'd say NO WAY do you take on both sick parent and well child. What happens when the child is one that can not be left to him or herself for more than a minute without getting into something?? No way is that safe. Obviously mom has an acute medical condition and can not care for the child. And nobody else around willing to take on the responsibility? Is that because they have no friends or family around or because they have no friends and family willing to take over care of that particular child?

I'm not trying to be mean. But some children need 1:1 attention every waking hour. You can not do that and take care of 6 patients as well.

[paroxetina]

Huh? You can have preeclampsia AFTER baby is delivered?

Actually, I read recently (though I can't remember where, so I don't have a citation) that most deaths from pre-eclampsia/eclampsia occur after delivery because that's the time when she's not being monitored as carefully, or may be at home, and preoccupied with care of her baby. In other words, the patients who have pre-eclampsia prior to delivery are more likely to have it caught in time.

[psu_213, BSN, RN]

This would be tricky, as some kids are a hot mess, while others would sit quietly watching TV and be a bother to nobody. Working with elementary aged kids, I'd say NO WAY do you take on both sick parent and well child. What happens when the child is one that can not be left to him or herself for more than a minute without getting into something?? No way is that safe. Obviously mom has an acute medical condition and can not care for the child. And nobody else around willing to take on the responsibility? Is that because they have no friends or family around or because they have no friends and family willing to take over care of that particular child?

I'm not trying to be mean. But some children need 1:1 attention every waking hour. You can not do that and take care of 6 patients as well.

Out of curiosity, what do you recommend? I agree with a PP who said that the ED is just a bad (maybe even worse) for the child. I agree that the nurse should not be responsible for the child in addition to the pt., but refusing the admit is not the answer.

Something similar happened at on a unit where I used to work. Parent admitted in the middle of the night. Not super sick (i.e., not intubated, on pressors, etc.), but sick enough to be on a step-down unit. Child stayed with the pt. overnight. In the morning, social work was involved. Turned out the parent had two older children (still minors) at home who were at home and not at school. The situation ended up being super shady--SW, CPS, etc. involved, but no longer the nurses' responsibility to babysit. Not ideal to have the child sitting around all night in the room, but we certainly can't put the child out in the cold, so to speak, if the parent is admitted.

[BittyBabyGrower, MSN, RN]

I don't understand why social services was not called. I can bet my butt that your legal department would be up someone's skirt about this. Even on weekends there are social workers. So what if this mom takes a turn for the worst? Sorry, but everyone involved has dropped the ball.

[dec2007]

Many years ago had an elderly lady as a patient. It was a Friday night when her young adult children came to visit with their small children in tow. The next time the nurse entered the room, the young adults had gone "out" and left the small children for "gran" (who was bedridden and had Alzheimers) to "watch". The children's parents were unreachable; apparently did not answer their cell phones while "out". It was late at night. Staff administration said not to call CPS, that it would violate the patient's "cultural rights", so we babysat until the parents returned. As I said, this was years ago and probably wouldn't happen now, but I remember how difficult it was to accept that as staff nurses we had nowhere to turn for help.

[TiffyRN, BSN, PhD]

I'm going to reiterate, don't refuse the admission on the theory that it's somehow not right. What's not right is that the children shouldn't have a mom who's sick, and no one to turn to. ER should (amongst their million other duties), notify CPS as soon as it becomes clear mom's being admitted and there isn't a responsible adult to pick up the kids. Mom also needs to understand that we are going to turning the kids over pretty soon so it's in her best interest to find someone (if she's capable).

But keeping the family in the ER does no good. And as someone else mentioned, may be additionally traumatic to the kids.

And once more let me know how frequently y'all have luck getting your social workers to respond in the middle of the night. Even good ones.

[BittyBabyGrower, MSN, RN]

We have never had an issue with social services. Maybe because we are a large inner city county hospital and we utilize on call when we need to do so.

[brillohead, ADN, RN]

And once more let me know how frequently y'all have luck getting your social workers to respond in the middle of the night. Even good ones.

If my in-house on-call social worker didn't return a page within the hour that they're required (by our facility's protocols) to do, I would simply call CPS myself. Let them know that I had an underage child who did not have competent adult supervision due to parent being admitted, and let them come collect the child and arrange for emergency foster care.

[Horseshoe, BSN, RN]

From a liability standpoint, it seems really really risky to allow kids to stay with a sick, admitted patient. WHO will be held responsible in the event of a negative event?

When I was hospitalized a week after giving birth, the charge nurse made it very clear (politely) that my baby could visit, but could NOT be left with me. I was capable of caring for her, and I wanted to, but they were firm, and I accepted it. I was in nursing school at the time, and the student in me understood their position.

I cannot imagine any hospital lawyer or risk manager being even slightly okay with having unsupervised children on a unit and allowing the staff nurses to have any responsibility for them whatsoever, whether "official" or not.

[siegolindoRN]

I have experienced this many times in my ED career, sometimes we were able to get family come in, sometimes we have called ACS, sometimes the NYPD. The one common denominator all the situations had, a sitter (support staff) is placed with the child(s) until whatever arrangements are made, materialize (obviously involve leadership early). A floor cannot refuse a patient admission based solely on a sick relative having children with them; other factors, such as private room availability, destination floor, service, etc have to be taken into account. In all instances, the sitter will travel with patient to destination unit. Regardless of the liabilities involved (whether believed or actual), the organization must make every effort possible to make reasonable arrangements. Failure to safeguard a minor carries far more legal troubles than the act of accommodating for the situation. If it happens often enough, then a policy and procedure must be created.