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?

[Kooky Korky, BSN, RN]

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.

Don't you have at least a Social Worker to refer to?

[Kooky Korky, BSN, RN]

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.

What cultural rights? What culture condones leaving young kids with a demented woman in a hospital bed?

[bgxyrnf, MSN, RN]

Don't you have at least a Social Worker to refer to?

Nope, not on NOC shift (or weekends, I think). Only one of the four places that I've worked has had social workers available 24x7... and two of them, not at all.

[CraftyCats]

I have been the child in this situation. I head two adults with me and both needed emergent care. One had cardiac issues and the other ended up seriously ill. A nurse watched me and occupied new for a few hours until my mom got off work.

[Axgrinder]

I know a social worker whom had been in a car accident - she lived out of state at the time, away from any family. Her son was maybe 10 or 11 at the time. She was divorced, and the boy's dad never showed up for him - she said she had no choice but to tell them they had to set up a cot next to her hospital bed.

It was an ugly situation, and she had no other options. Personally I'd hate to be in that situation myself - both as mom/pt, or the RN.

I had a pt whom cared for her granddaughter - grandma was admitted and granddaughter slept in a pull out bed in the room. She was 11-12 y.o., sweet as pie, and not a problem. This facility encouraged family to stay if they wanted to, and all rooms were private with the ability to comforably accomodate 1-2 extra people so it was no big deal at the time, but if the facility took a different stance it may have been. This facility's shtick was a "heart hospital" wanting to cater only to cardiac pt's, but it never really works that way, does it? Most people never have just cardiac issues alone. This hospital has closed since then, and this young girl is now in her early 30's.

[msfb]

Nope..kids gotta go. If they are under 18 they can not stay unless admitted. We were fortunate in burn that we always were able to find family or friends but cps would be the next option.

[Labmom1118]

We have had this situation with admitting OB patients who are dropped off with their kids. We also have older children staying with their mother after delivery without another parent or support person there. We have no policy that I know of to address this. Thankfully there haven't been any issues.

[CammieFairfax]

Work in an inner city OB unit. Lots of moms bring their toddlers on the big red taxi for a labor check. If no other adult is present, we have mom call someone to come and take over child care. If there is a life threatening condition, DCF would get called. A labor check is hard enough if the mom has no one to take care of her small child, I can't imagine what we would do if I had a placenta abrupting and we had to get her to the OR. Where would the little one go?

[Beverage]

Slightly off topic but similar... I requested not to be assigned a patient who had a dog with him (not a service animal). Pt was a homeless man with a scruffy dog who barked and growled at anyone walking by pts door or entering the room (I'm sure the dog was frightened) I have a fear of dogs having been bitten as a child. Never understood why administration didn't call animal services to take the dog for safekeeping during patients stay. There was no way to identify if the animal had current vaccinations and its behavior was a huge liability. I believe staff put an ultra sorb pad on the floor to be used for elimination purposes and the pt fed it from his meal tray. A child is not like an animal, but I've encountered visitors children who were unruly, screaming, running in the hall' touching sharps container and playing in the pt restroom sink splashing water everywhere. I would not accept an assignment with a child in tow, social services would be involved.

[CHESSIE]

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 can understand why you might have been reluctant to take a postpartum mom and baby on an adult Ortho Unit. At our hospital, it was not unusual to have a postpartum patient be readmitted due to her issue or that of the baby. In such cases both mom and baby were admitted to our pediatric unit. Due to possible infection, readmission to the Mother/Baby Unit was and still is contraindicated and not permitted by JHACO. Peds had diapers, and, also, formula for the baby, if mom was not a nursing mom. Usually, the issues were the mom had a DVT, or the baby had a high bili, and jaundice.

[toomuchbaloney]

I have not read all of the comments.

It is not uncommon for poor single parents to have no person available to care for their children on short notice.

The hospital you work for surely has MSWs who would be responsible for dealing with that scenario.

It is sad to me that the necessary care of a poor parent with no resources is delayed or refused because of their dependents.

[CHESSIE]

I have not read all of the comments.

It is not uncommon for poor single parents to have no person available to care for their children on short notice.

The hospital you work for surely has MSWs who would be responsible for dealing with that scenario.

It is sad to me that the necessary care of a poor parent with no resources is delayed or refused because of their dependents.

The RN on the Ortho Unit mentioned that, in an emergency, she could have obtained diapers from the hospital's Pediatric Unit. I was wondering why the mom and babe were not admitted to the Peds Unit? In most hospitals, that is where mom's and newborns are usually admitted, if either the mom or the newborn have medical issues a few days post discharge from the Mother/Baby Unit. Pedi Units are equip to handle both children and women, especially postpartum women who develop medical issues.

I fully realize that CPS could be called to temporarily take the baby, or small child/children. However, the fear factor, especially for a poor family, would make an all ready, apprehensive, and sick mother even more anxious.