Family members that work your nerves!!!

[BluntForceTrauma]

Maybe I am overreacting....or maybe I would be the same way if my family member was hospitalized...

I work in a busy ICU. Today my patient was s/p MVA, suffering from ARDS, multiple fractures. During visitation, the pt's brother in law, who is a nurse, came in and stripped the pt down in front of all the other family members. He had his own stethoscope, pen light, and did a full head-to-toe assessment. He then proceeded to take off all of the pt's dressings and look at what was under there.

I'm suprised he didn't attempt to look at the pt's chart. When I saw him doing this, I was speechless. I didn't know what to say to him. He comes in the room, asks different nurses the same questions to "test our knowledge"...which is what I heard his say under his breath to the other visitor.

Am I just over reacting...or should I have just let him do what he wanted to do??

[angel4gramma]

I have had many families "quiz" me and I usually try to joke about it. I think families have been out of line for years now and the management tells them they can (do what they want) because they want their business. If a family member is in the hospital I usually have to make my brothers and sisters back off and let the nurses do their job. If this happened in the last 3 hospital I worked at I know management would tell us just offer help.knowing this is how it is I can be pretty good at becomming freindly with the family and offering my time to answer all questions and concerns. I usually tell them we have opening and if they do it right they might be offered a job here. That usually stops more questions for now. My inner child wants to tell them to go home and never come back unless they are taking family member home. :)

[NurseyBaby'05, BSN, RN]

It appeared to me from the OP that this was the first time the bil had visited since the MVA. This bil was not known to the OP'er.

I feel he "crossed" the line when he stripped the patient and when he took off the dressings. I could deal with the stethoscope, pen light and assessment but I have to advocate for my patient first and deal with the family dynamics later.

That's exactly what I would want my nurse to do for me if I were in the same situation. I would be apalled if my sil (who really is a nurse) did this to me.

I wouldn't yell, scream, throw a fit or anything even remotely along those lines. I can be angry on the inside and calm on the outside. I would ask him to stop and if he didn't I would reach for the phone.

I feel that RNwriters post is excellent but did not address what she would do at the time of the incident. It's easy to look back later and reflect on the situation but at the time of the incident you have to act in the best interest of the patient and figure out what to do about the bil later. Just IMHO.

RNwriter, what would you have done at the time of the incident?

:yeahthat:

I could deal with the "quizzing" and superiority complex, but he had no business messing with the patient; especially since he had an "audience." He needs to know he cannot behave like that. As a professional courtesy, I would let him know this in no uncertain (but not unkind) terms. Anyone else would have been asked and made to leave until he could act appropriately.

[rn/writer, RN]

i didn't get the impression that rn/writer was condoning bedside analysis at the time of the incident.

clearly, strict and immediate limit-setting is indicated.

the bil (or anyone who violates boundaries) should have been stopped in his tracks.

RNwriter, what would you have done at the time of the incident?

Thank you, Leslie and Joanna. I'm sorry I didn't address the acute situation more clearly in my posts.

If you walk in on a family member stripping the patient or doing their own dressing changes, a well-timed, "What do you think you are doing?!" can certainly do wonders to establish your authority and pull the offender up short. There's a lot to be said for the shock value of meeting invasive and abusive behavior head on. An immediate demand to cease and desist has to be obeyed. If it isn't, then it's time to call security. You won't get any touchy-feely hesitation from me at that point.

From Leslie:

my immediate reaction is to firmly and physically stop them from what they're doing.

while i am imposing these limits, i also include, "while i understand that you are feeling immensely ______________, or whatever it is i think they're experiencing, i will not allow you to ________.

the look on my face and the inflection of my tone, is usually sufficient.

but, i also make sure that i address these behaviors at another time.

not to chastise them- far from it.

but to let them know i understand their anguish, and the crazy things they feel driven to do.

i always get our social worker and chaplain involved, whatever is appropriate for the situation.

From Joanna:

I wouldn't yell, scream, throw a fit or anything even remotely along those lines. I can be angry on the inside and calm on the outside. I would ask him to stop and if he didn't I would reach for the phone.

I totally agree.

You both demonstrate the skill of showing righteous indignation rather than personal anger, which rarely improves such a volatile situation. And you both gave good examples of setting and enforcing limits. I'm all for that.

The attempt to connect on a more positive level can be extremely beneficial (some ICU patients are on the unit for a looooong time, so developing a working relationship with the family is a worthwhile investment), but it has to be done with the idea that certain things are non-negotiable. Anything that interferes with or compromises the patient's care is forbidden and may result in ejection from the unit. End of story.

Once the boundaries are established, then you can try to find common ground and build a working relationship.

You can't allow folks to cross the line between visitor and caregiver. If you include them in the care, that's one thing, but they should never feel okay about trespassing into your territory.

But at the opposite end of the spectrum, it's unwise to miss opportunities to address their real concerns, however poorly they express them.

I guess, as with most important things, it's a matter of balance.

I did get concerned with the great number of responses that expressed rage and seemed to leave it there. Then again, I wasn't at all clear about the boundary issues.

Thanks, Les and Joanna, for your thoughts.

This really has turned into a great thread.

[Kymmi]

Whoa.

He put his name on the board in place of yours as her nurse?

First, I'd sincerely thank him for his offer to take over her total care for your shift. Whee! One less patient to worry about!

As far as his question, I'd simply tell him that although I am licensed as an RN, it's quite obvious which one of us has the BS.

:yeah:Took me twice reading the last part about "which one of us has the BS" to fully get the humor but once I got it I was laughing so hard I choked on my pepsi!

[Kymmi]

Rn/Writer-------I have to say I agree totally with whatever poster complimented you on your communication skills. Before I read her post I was thinking to myself as I read your post what a great job you do at defining the point and expressing and explaining it. I have noticied this about some of your other posts also and I enjoy reading all of them. There has been a few posts of yours that I remember thinking I didnt agree with your opinion on certain things however your writing is very well thought out and well spoken. I do not mean to offend when I say I havent agreed with some of your thoughts/opinions in other posts I just brought that up to make the point that even though I dont have the same views as you do on certain things I enjoy reading what you do write because it does make me think about my ideas/opinions. I know that it is quite possible for 2 people to have 2 different views on issues and both be "right" for a lack of a better word.

[DutchgirlRN, ASN, RN]

Thank you, Leslie and Joanna. I'm sorry I didn't address the acute situation more clearly in my posts.

If you walk in on a family member stripping the patient or doing their own dressing changes, a well-timed, "What do you think you are doing?!" can certainly do wonders to establish your authority and pull the offender up short. There's a lot to be said for the shock value of meeting invasive and abusive behavior head on. An immediate demand to cease and desist has to be obeyed. If it isn't, then it's time to call security. You won't get any touchy-feely hesitation from me at that point.

From Leslie:

From Joanna:

I totally agree.

You both demonstrate the skill of showing righteous indignation rather than personal anger, which rarely improves such a volatile situation. And you both gave good examples of setting and enforcing limits. I'm all for that.

The attempt to connect on a more positive level can be extremely beneficial (some ICU patients are on the unit for a looooong time, so developing a working relationship with the family is a worthwhile investment), but it has to be done with the idea that certain things are non-negotiable. Anything that interferes with or compromises the patient's care is forbidden and may result in ejection from the unit. End of story.

Once the boundaries are established, then you can try to find common ground and build a working relationship.

You can't allow folks to cross the line between visitor and caregiver. If you include them in the care, that's one thing, but they should never feel okay about trespassing into your territory.

But at the opposite end of the spectrum, it's unwise to miss opportunities to address their real concerns, however poorly they express them.

I guess, as with most important things, it's a matter of balance.

I did get concerned with the great number of responses that expressed rage and seemed to leave it there. Then again, I wasn't at all clear about the boundary issues.

Thanks, Les and Joanna, for your thoughts.

This really has turned into a great thread.

:yeahthat::clphnds:

[Runman1914, MSN, RN]

Do you even know for a fact this family member is a nurse? I would have called security STAT!!!

[Clipping]

before I read your post I knew it was going to be a family member that had some sort of medical background... alas I was right. What the family member did could very likely have his license taken away if he is in fact a licensed nurse.

I would have politely asked him to step out of the room and in the presence of my manager, charge nurse, or other available nurse I would have very plainly pointed out that he does not have authority to care for this patient as a nurse and doing so puts everyone in the situation at risk for disciplinary action.

That type of behavior CANNOT continue. I would fill out an incident report and make sure your manager knows....

[Antikigirl, ASN, RN]

OMGosh! I would have flipped! I would have immediately asked the family to leave for just a moment and asked the patient if this is how they want to be treated? If they said yes, then fine...put it as part of the care plan...but to look at the chart...nope, gotta fill out the approprite paperwork then they can see it.

I use to be so much into families being there for the patient...after years of being an RN...I cringe at the thought now. They can do many bad things in the guise of being family, not to mention getting in the way and questioning every action you do! UHGGGGGGGGGG! Now, when I care for folks, I have learned to have all family leave for a moment so that the nurse/patient bond is still there! Some folks won't hear of it...but there is a nice security department in my hospital that knows hipaa well, and will support me (as well as my docs!).

[leslie :-D]

Now, when I care for folks, I have learned to have all family leave for a moment so that the nurse/patient bond is still there! Some folks won't hear of it...but there is a nice security department in my hospital that knows hipaa well, and will support me (as well as my docs!).

i too, insist on having that time alone w/my pts.

the difference being, if your admin supports you.

there are too many facilities that encourage the benefits of customer service, and the 'client/families' always being right.

there are many, many nurses who just do not get support, when they should.

even when a nurse intervenes appropriately, often, they get disciplined by tptb.

and it sucks.

but i suppose, that's a whole other thread...

leslie

[EmmaG, RN]

Do you even know for a fact this family member is a nurse? I would have called security STAT!!!

Good point. How many times have you been told that a relative is a 'nurse' (or doc or attorney or *whatever*) only to find out later they are not?

[Antikigirl, ASN, RN]

OH goodness yes there is still many many companies that believe that 'customer and their families (for some odd reason) are always right!" Yeah, if they were right, why are they here asking for our help??? LOL!

I CHOSE not to go with a company with that mindset too strong! I got so lucky!!!!! I am in a community hospital that was founded and started by a single NURSE! Nurses have the say in all of this...too bad they are hiring nurses that are burnt out and in admin without a single memory of how things really go...but all in all things are good, especially if I have to put in my two cents (yes, my fellow nurses have me do that from time to time...that is why I faulter on union...if I join the union I am seen as bias...uhgggggg!).

Families should only be in the room during a set number of hours during the day in my book, and not complain at all about having to leave for a few moments during treatment or questions so the nurse can do their jobs without interuptions or questions from people that are NOT their patients! (yes you have to put them into account appropriately...but sheesh!).