RNC-NIC

Hi RLee. I am not talking about suctioning every 10 minutes, I'm talking about standard q4h suctioning, as well as in between should the baby need it. The parents will allow us to turn up the O2 if the patient persistently desats, but not to suction because they do not want the baby woken up. Again, this is a baby with a tiny trach and a critical airway without trach mist. It's not a far stretch for this baby to plug off - and has come close. The tail chasing goes in a circle until the parents decide to suction the baby. Unfortunately, this is an intensive care setting, assessments and vital signs must be done. At this time the baby is not able to step down to a lesser level of care because its condition is serious. I don't want to get into too much detail because of HIPAA.

This is what I don't understand though. I could understand battery if it was an A&O adult refusing a treatment, however this is an infant who cannot communicate their needs or advocate for themself. The parents have this baby as a full code with no restriction on intervention. With that form signed, how can they refuse care in a situation that has the potential to lead to a code?

This really bothers me to hear. I have been a NICU nurse for almost 10 years and have never had this problem. Recently our unit has been taking readmits that were discharged from our NICU and retaining chronics for a ridiculous amount of time instead of graduating them because of a steady decline in census, and it has opened doors to things we haven't had to experience before, such as a situation like this. I don't understand how parents don't have the right to refuse a blood transfusion on their child for religious reasons, yet I can't suction a baby who is demonstrating signs of respiratory distress such as audible secretions and low sats (keeping in mind the baby has a critical airway with a neo tracheostomy tube. It doesn't take much for a trach that size to plug off).

I do have my own malpractice insurance, however I don't see why I should end up paying the price for parents who will not heed medical advice about their child, yet practically threaten nursing about keeping their baby safe. It's gone way up the chain of command and then dies on deaf ears. My fellow nurses have been trying to follow policy/procedure but the parents won't allow us to do so.

We currently have a baby on the unit whose parents refuse to allow necessary medical interventions. They refuse to allow this patient to use mist with the trach collar because they think it's too loud, they leave the floor with the patient without resuscitation equipment or even informing nursing, they refuse suctioning even if the patient is bubbling over and desatting (oh, they'll cough it up and come up, this happens a lot) and they won't allow chest PT despite the patient plugging. They accuse staff of not responding to other patient alarms and are constantly eavesdropping on other patients and are hypervigilant for mistakes in care. They also will not allow nursing to assess the patient overnight and when this person is sleeping. The parents have been spoken to repeatedly about at least informing nursing before leaving with the patient and to bring the BVM and safety equipment but they repeatedly state they'll be back soon and that they just suctioned the patient so bringing a portable machine isn't necessary. They absolutely will not grasp the concept that anything can happen at any moment (this patient has a critical airway), and just because they just performed suctioning does not mean the patient may not need another if they're a half hour away from the unit on a walk. The patient isn't even CLEARED to leave the unit. Security has been involved, social work has been involved, and the parents don't care. "It's my child and I'll do as I see fit." It isn't for a lack of education as many MANY nurses and even practitioners have attempted to educate this family. Our unit rotation is coming up and I'll be taking care of this baby. I want to make them write a statement saying I'm not responsible if something happens to their child due to their refusal of interventions. I want to put it back on them that "Okay, so I can document you're willingly risking your child's life?" if they refuse to take the resuscitation equipment. I would actually like them to request me NOT to be their child's nurse, as I will refuse to withhold the necessary care like suctioning just because the parents don't want it done, UNLESS they are willing to release me from liability. Has anyone ever had this happen? Did you have any recourse other than documenting the parents' response?