The physical and emotional absence of parents persuades grandparents to assume responsibility for their grandchildren. Several reasons exist for this situation including parent absenteeism secondary to drug use. An increase in deaths associated with substance/drug use, despite regulations, indicates a growing trend toward grandfamilies. Such social and family dynamics have consequences for grandparents, children, health care providers, and other members of the health care team. This article examined the literature for the reasons leading to grandfamilies, the consequences, and the nurse's responsibility.