I work in a NICU and we have a parent who is hostile and aggressive toward the staff. Also, he is refusing certain interventions for his baby. I understand his right to refuse, but one day he threatened a nurse and today doctors charted both parents seemed high and the dad seemed intoxicated. He has been escorted out of previous units by security but has been allowed to return. The official response seems to be that we should be increasingly accommodating. He seems a safety risk to both his baby and the staff. The lack of intervention by the administration seems to place the hospital at potential risk of liability; especially since it has been noted that he seems impaired. There is no DCF file opened yet, according to the social worker. What can be done to protect everyone from hostile, aggressive or impaired parents?
Nancy Brent replies:
Your concern for the newborn child is important. Clearly, parents have a right to refuse treatment for their infant, but one wonders if those decisions are being made with a clear mind or are clouded by the use of alcohol and/or drugs. The social worker apparently believes a report to the DCF is not warranted as yet, but do remember as a mandated reporter, you have a duty to report a good faith belief that child abuse or neglect is happening. You might need to talk with your CNO and/or risk management to determine how your state law defines abuse and neglect and the rights of the parent to refuse treatment.
Most child abuse and neglect statutes prohibit another from blocking a mandated reporter from filing a good faith report. If you do not get the answers you need, consulting with a nurse attorney or other attorney who can advise you of your obligations in this situation would be a good idea.
The situation you describe sounds very precarious, especially for the safety of the NICU staff. If this has not been brought to the attention of risk management and your CNO, it should be as soon as possible. Incident reports, for example, would be essential.
Administration needs to evaluate carefully whether these parents should be allowed to visit when they have already threatened nursing staff and exhibited the above-mentioned behaviors. Perhaps having security in or near the unit when they visit would help with a quick response to any threats. Contacting the police when the behavior is occurring would be necessary so the police can evaluate what needs to be done to protect the staff and the infants in the NICU. Also, staff should be instructed on how to conduct oneself with a violent family member or patient so they are as safe as possible until help arrives. Some examples are never to approach such a person from behind, to stay calm, never be alone with the person and not to inform the person the police have been called.