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?
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.
The hospital should have a policy and protocols in place for this. When there are demented patients that require 1:1, what do they do? Have a sitter available? The hospital needs to have people available, or be prepared to have social service involvement.
Regardless of the liabilities involved (whether believed or actual), the organization must make every effort possible to make reasonable arrangements.
Right, and basically telling a nurse to just "deal with it" for several days (as described in an earlier post) would not qualify. "We are actively working on getting supervision for the child" and then doing so in good faith is a different story.
A nurse can delegate a support staff member to watch a patient, they need not wait on a supervisor to make that decision. Charge nurses on various units can also coordinate the use of support staff in coordination with the supervisor. At the end of the day, whether you like it or not, disagree or agree, anything tied to your patient becomes your responsibility. Every situation has a fix, sometimes it requires thinking out of the box. I once had an elderly patient I kept within the central nursing station, next to me and delegated non clinical tasks to her (shuffling blank papers, arranging staplers) in order to keep her mind from thinking of walking out (dementia).
...whether you like it or not, disagree or agree, anything tied to your patient becomes your responsibility.
ROTFLMAO...
Anything tied to my patient is my responsibility? Their lack of insurance? Their inability or refusal to fill their scripts? Their lack of education? Their lack of housing? Their dog? Their utility bills? Their kids?
Nope, my role is to carry out the legitimate orders of the physicians and help the patients help themselves. Watching their kids, though? Nope, that's what CPS is for... Child ** Protective ** Service... which role requires education and experience very different than nursing.
When I had a mom brought in for meth psychosis, her kid was not my problem... and I refused any attempts to make it so.
KindaBack, Ill admit, "anything" wasn't the best word to use as those other items I would agree are not our responsibility (not as primary RNs at least). What is in our scope is addressing the potential mental/behavioral health issues that a patient would have when the safety of their child is in question, when alternatives are either delayed or do not exist, for that child to be placed somewhere safe while the patient is receiving care.
In your meth situation, how long did it take from the time CPS was alerted to their actual handling of the child? During that time, what measures were taken to safeguard the child? Where any policies created as a result?
KindaBack, Ill admit, "anything" wasn't the best word to use as those other items I would agree are not our responsibility (not as primary RNs at least). What is in our scope is addressing the potential mental/behavioral health issues that a patient would have when the safety of their child is in question, when alternatives are either delayed or do not exist, for that child to be placed somewhere safe while the patient is receiving care.
In your meth situation, how long did it take from the time CPS was alerted to their actual handling of the child? During that time, what measures were taken to safeguard the child? Where any policies created as a result?
I don't know how long it took because I was busy taking care of my patients. I left it to the supervisor to figure out that part of it. I explicitly refused to accept any responsibility for the kid, both verbally and in the chart. I refused to accept the patient from EMS until the immediate issue of the child was addressed by the supervisor.
Anything tied to my patient is my responsibility? Their lack of insurance? Their inability or refusal to fill their scripts? Their lack of education? Their lack of housing? Their dog? Their utility bills? Their kids?
Nope, my role is to carry out the legitimate orders of the physicians and help the patients help themselves. Watching their kids, though? Nope, that's what CPS is for... Child ** Protective ** Service... which role requires education and experience very different than nursing.
When I had a mom brought in for meth psychosis, her kid was not my problem... and I refused any attempts to make it so.
I think you've responded to a statement that was probably a bit broad with one that's also probably too broad. Our job as nurses isn't just to be a doctor's assistant and execute the plan they put forward, our job is to incorporate the physician's plan into the overall plan for what the patient needs. If a patient comes in because they were unable to fill their scripts, then yes, that's absolutely something the nurse needs to deal with, typically this means referring this issue to someone who can deal with it directly, but to say it's not your problem as the patient's nurse isn't really accurate.
I'd say in general that if you're worried about liability, then being too eager to hand the kid off to someone else isn't necessarily the best way to protect yourself or the facility liability-wise. Just because you get a-hold of someone claiming to be the kids uncle, and who enthusiastically says "I'd love to have an 8 year old girl spend the night at my house", doesn't make that a wise move in terms of liability.
Every place that I've worked has had some way of boarding both parents and kids. Typically, there is a unit or nearby units where one takes peds and the other takes adult medical patients. We don't board the kid directly, technically we refer the kid to CPS who then places the kid with us.
I'd say in general that if you're worried about liability, then being too eager to hand the kid off to someone else isn't necessarily the best way to protect yourself or the facility liability-wise. Just because you get a-hold of someone claiming to be the kids uncle, and who enthusiastically says "I'd love to have an 8 year old girl spend the night at my house", doesn't make that a wise move in terms of liability.
Every place that I've worked has had some way of boarding both parents and kids. Typically, there is a unit or nearby units where one takes peds and the other takes adult medical patients. We don't board the kid directly, technically we refer the kid to CPS who then places the kid with us.
In my opinion, the absolute worst way to handle it was to refuse the admit. The ED is probably the least safe place for the child to be. Take the patient and try to room close to the nurse's station, then work out alternative arrangements. Leaving the patient and child in the ED was not a good option.
Im a floor nurse, and this Us vs Them mentality (which it WAS, no doubt about it) resulted in a less safe situation.
I think you've responded to a statement that was probably a bit broad with one that's also probably too broad. Our job as nurses isn't just to be a doctor's assistant and execute the plan they put forward, our job is to incorporate the physician's plan into the overall plan for what the patient needs. If a patient comes in because they were unable to fill their scripts, then yes, that's absolutely something the nurse needs to deal with, typically this means referring this issue to someone who can deal with it directly, but to say it's not your problem as the patient's nurse isn't really accurate.
Nope, 'cuz the reality is that there is nobody to refer them to.
People like to pretend that there exists this safety net that provides what patients need simply by some magic referral. There isn't.
If I try to take on the weight of their afflictions, it will drown me. My job is to deal with the emergent medical needs of the patient. The doc writes the script, I hand over the script, teach about the meds and then leave it to the patient to figure out how to fill the script.
And while I'm at it, have the patient clear of the room within 10 minutes of the discharge orders.
The social problems are simply beyond my scope, expertise, and capacity.
I'd say in general that if you're worried about liability, then being too eager to hand the kid off to someone else isn't necessarily the best way to protect yourself or the facility liability-wise. Just because you get a-hold of someone claiming to be the kids uncle, and who enthusiastically says "I'd love to have an 8 year old girl spend the night at my house", doesn't make that a wise move in terms of liability.
Every place that I've worked has had some way of boarding both parents and kids. Typically, there is a unit or nearby units where one takes peds and the other takes adult medical patients. We don't board the kid directly, technically we refer the kid to CPS who then places the kid with us.
That's the point... I won't get hold of the kid's uncle... that's not my responsibility and I won't assume it.
lifelearningrn, BSN, RN
2,622 Posts
The hospital should have a policy and protocols in place for this. When there are demented patients that require 1:1, what do they do? Have a sitter available? The hospital needs to have people available, or be prepared to have social service involvement.