When you don't agree...

double_minority · Mar 12, 2013

You document.

JustBeachyNurse, LPN · Mar 12, 2013

You speak with your clinical manager, document, and unless it is harming the child, yes you bite your tongue. The only other issue would be if what mom wants goes against the physician's diet order.

PerfectlyPlump, ADN, RN · Mar 13, 2013

Is the alternative formula a whole lot of work for mom, or extra expense for the family?

I knew a family where the mom did a great job creating a formula using products I had never seen before. She also put in pureed food and supplements. The child thrived, was very resistant to infection, and had such great skin. Mom was able to get the expensive ingredients ordered by the doctor, and the rest ordered 'at mother's discretion' .

It seemed worth the trouble to me. What are your concerns?

PixieRN24 · Mar 13, 2013

Unfortunately the mom has been going against what is ordered by the physician. I spoke with the case manager and they will be doing a supervisory visit on Friday. I feel badly but I can't put my license at risk, I only just got it!

My main concern is that what the mom wants to do a doctor won't write an order for and I can't give it without an order! So it puts me between what mom wants done and what I'm limited to do

JustBeachyNurse, LPN · Mar 13, 2013

Call your supervisor for support. If what mom wants is not going to harm the child, let her administer the feeds in the interim and chart that parent administered XYZ and related information; otherwise contact your nursing clinical supervisor/manager and/or the physician for direction and support. And document.

allnurses Guide · Mar 16, 2013

I agree with JustBeachyNurse. Unless what she is doing is harming the child, let her choice prevail. When I started doing PDN, I was advised of the balance we must strike doing in-home care. The parent is usually the primary caregiver. In younger kids it's really important that the parents not usurp their autonomy to the agency nurses and bonding with their chronically ill and/or developmentally delayed child that is more important than most other things.

If the child is older they've usually developed rituals that help them cope with the constant pressure of taking care of a child who will not grow out of their present state and may have a deteriorating condition. Sometimes we need to stand our ground, but I was advised to save the battles for only the most dire or unsafe situations. Hopefully a compromise can be made.

SinikRN101 · Mar 25, 2013

If you don't have an order you can't do it. If what the mom wants is against physician's orders, then the mom can do it herself, or the order can be changed if it is appropriate.