To care or not to care

[DJ-Adia]

I work in small rural hospital & recently encountered a situation involving a 18 month old child who had swallowed a chocolate covered peanut in which he was allergic to. The ER doctor was very concerned about the child having an anaphylactic reaction and @ risk of requiring intubation so he requested he be admitted to our Med/Surg unit. Seeing as though we care for a minimal amount of Peds patients a year (probably 3-5 a year which are admitted usually for croup) and noone on staff was PALS certified, one of my coworkers had contacted out nursing coordinator to inform her of our concerns to have the child transferred by ambulance to a nearby hospital where the childs pediatrician was located. We felt that we could not provide the specialized care that this child would require seeing as though the oncall MD for hospital admission was 30 min. away & staff did not feel comfortable caring for this child in a critical situation. We do not have an ICU or a pediatrician on staff - so admitting this child, in my oppinion" would only set us up for COURT.

Granted, as nurses, we are trained in CPR and have the general knowledge of the care a Peds patient would require - but why provide care at a lesser level when there is a facility more appropriate for this patient?

The nursing coordinator informed us that there wasn't any reason why we should not have admitted that patient given the fact "we should not have to turn away patients for the lack of trained nursing staff". We were also told that staff should become certified in PALS (despite the fact that the hospital will not pay for the class or the staff's time for attendance). Should we have admitted this patient?

[SuesquatchRN, BSN, RN]

No.The nursing coordinator's fiction that nurses are magically qualified in courses the hospital neither offers nor finances is based in her unwillingness to either battle for more money or to look bad for having to turn away patients.

Look at it this way. Should PALS have been required and the child died as a result would you be questioning your action?

I didn't think so.

That said, get the certification.

[Jolie, BSN]

IMO, no.

You knew upfront that you were not capable of providing the intensive care (no specially trained MD, no experienced peds nurses, no intensive care unit, and probably no up-to-date pediatric sized equipment) that this child was likely to need.

In my opinion, to admit this child would be the equivalent of assuring his parents that you WERE capable of providing for emergency care. You should have stabilized and monitored him until a transport team from a referral center arrived to pick him up.

Your nursing supervisor was concerned with only 2 things: 1.) This child was a source of revenue. 2.) To transport him would be the equivalent of advertising to the public that your facility is incapable of handling pediatric emergencies. (Which it is.) But that's something they don't want the public to find out.

I believe that the only worse option would have been for someone from your hospital to have accompanied him on a transport to another facility, creating the possibility of an airwqay crisis en-route.