We are NOT babysitters!!!

klone, MSN, RN · Apr 1, 2014

I think "do I have to be there?" Is a valid question. If the child is 16+ and drives him/herself, I see no reason why my presence would be necessary.

In fact, the network I work for has school-based clinics in several of the local elementary, middle and high schools. In the middle and high school clinics, parents do not need to attend appointments.

T-Bird78 · Apr 1, 2014

We see peds and adults and perform allergy testing for a variety of things, from environmental to food to PCN to insect venom. Minors can't sign consent forms and even if parent signs consent forms for the testing, we need parental permission to administer epi if pt were to have a reaction. This pt was 15. Our allergy shot pts 16-18 can come alone if parent signs a waiver. Even for a non-testing appointment, I ask pt about medications and sx and obtain H&P but 98% of the time the kid doesn't know what meds they take, and teenagers especially say their asthma is just fine--until mom pipes up and says they're not using the maintenance inhaler and/or wheeze daily or use their rescue inhaler BID. I get a more complete picture by getting info from both underage pt and parent.

ceebeejay · Apr 2, 2014

A parent should always accompany a minor to a medical appointment, especially where testing will be done. The minor is not authorized to make emergency decisions, only a legal guardian or parent can. However, I wonder would the parent so easily ask the doctor to keep an eye on the child? I get that nurses have the reputation of benevolence and safety, but we are not everybody's mama.

schnookimz · Apr 2, 2014

I thought that in a true emergency, anything could be done to save life even without parental consent. Does this vary state to state?

enuf_already · Apr 3, 2014

I thought that in a true emergency anything could be done to save life even without parental consent. Does this vary state to state?[/quote']
A physician who would do a procedure on a minor without parental consent that could potentially lead to a true emergency is not someone who is following, "first do no harm."
A minor who walks in off the street in respiratory distress from an asthma attack is different, but they usually don't make appointments. A provider would render first aid until the ambulance arrived, or at an ER stabilize the patient until the parent could be reached.
In an ambulatory type setting, a minor, unless emancipated, needs consent for treatment by a guardian. I do believe the law is different regarding reproductive health issues (birth control, abortion) but this is not my area of expertise, so please feel free to correct me.
As a previous poster said, teens aren't always reliable and treating one without permission could put a provider at risk for trouble. I am also not the babysitter.

schnookimz · Apr 3, 2014

We see peds and adults and perform allergy testing for a variety of things from environmental to food to PCN to insect venom. Minors can't sign consent forms and even if parent signs consent forms for the testing, we need parental permission to administer epi if pt were to have a reaction. This pt was 15. Our allergy shot pts 16-18 can come alone if parent signs a waiver. Even for a non-testing appointment, I ask pt about medications and sx and obtain H&P but 98% of the time the kid doesn't know what meds they take, and teenagers especially say their asthma is just fine--until mom pipes up and says they're not using the maintenance inhaler and/or wheeze daily or use their rescue inhaler BID. I get a more complete picture by getting info from both underage pt and parent.[/quote']
I was really referring to this. So the parent signs the consent and then there is an allergic reaction and the patient needs epi. So they need another consent for the epi? That didn't sound right to me. If there is an emergency reaction, then can't the epi just be given?

klone, MSN, RN · Apr 3, 2014

I do believe the law is different regarding reproductive health issues (birth control, abortion) but this is not my area of expertise, so please feel free to correct me..

You are correct. In many states, including the two where I have practiced as a nurse, a 15-year-old can make an appointment on her own for exams, STI testing, and/or placement of an IUD or Nexplanon. If they're pregnant, they are also considered emancipated for any decisions related to the pregnancy and childbirth (for instance, they can consent to a Cesarean or epidural). They cannot, however, consent to an abortion without the parent or guardian (something I personally think is incredibly stupid, but alas, I do not make the laws) (and this does vary by state, I am only familiar with my state's laws as they pertain to abortion consent).

xoemmylouox, ASN, RN · Apr 4, 2014

Patents should be there if the child is under 18. Then there is no problem with obtaining their consent. At a previous employer if a parent wasn't there the child didn't get seen.

T-Bird78 · Apr 4, 2014

I was really referring to this. So the parent signs the consent and then there is an allergic reaction and the patient needs epi. So they need another consent for the epi? That didn't sound right to me. If there is an emergency reaction, then can't the epi just be given?

Yeah. Sorry. The consent form does state the testing and any additional medications or procedures if needed, including the epi. We just don't need minors undergoing testing and possible severe reactions without parents. We have had to transport a very few pts if the reaction was too extreme and we couldn't get it controlled with epi, prednisone, neb tx, etc. My whole gripe in the situation is parents thinking we, the nurses and front desk staff, can baby sit their kids at the appointment while they run errands. We're not a daycare, you can't drop them off for us to see them and you go shopping, especially a first visit like this one was.