How to deal with those family members who are "nurses"?

I've had a bad experience with a pt's family member who I "think" is a nurse. During report, I was told that this pt's daughter, who is the "nurse" and the wife made the day shift pretty miserable and guest relations was called and the day nurse was reported for being "rude".

Well, I work in a MICU, still in orientation, and my preceptor and I decide to be open minded about this family. I work nights and visiting hours are over at 20:30. Well, I get report and I have another pt who is considered "ICU" status, while this pt is considered "tele" status (just waiting for a bed). I'm at the desk looking up my medications and this pt's daughter and wife barged to the desk demanding to know who "my daddy's nurse is" and I need to see her "right now". My preceptor explained that we are just now getting out of report and his nurse is looking up his medications and will be in there shortly. The daughter states "well, he is wet and needs to be changed". I told her I will get there as soon as I can.

Since my other pt was the more critical pt, I went to see her first, grab her vitals and do her assessment. I then go see my other pt, and his daughter "the nurse" had taken out linen, a gown, and pads and placed them on the bed for us to change him. I went to get my preceptor because I didnt want to be alone in the room with them, and we decided I will do my head to toe assessment while we change him. We wash him up, check his bottom for skin break down, and the daugther and wife BOTH is sitting there watching us clean him up and once we turn him back on his back and change his linen, the daughter asked us if he had a bowel movement because she thinks he did! I said, we just checked him, cleaned his bottom and checked for skin breakdown, there was no stool. She says "are you sure because I think he did". I said, "you can check the sheets if you like".

The daughter is dressed in scrubs and as we are trying to bathe him and turn him and assess him, she is looking all in the cabinets, put on gloves and started cleaning the counter with alcohol wipes, took his suctioning canister out and dumped it in the SINK, cleaned it out, and wrote the date on it and placed it back in the holder! She also took his NG gradual and "threw it away" (according to her) because it was "filthy". Not only that, I was doing gastric residual because pt was on tube feeding and I put the pump on hold and pulled out the gastric residual with a large syringe and dumped the residual in a gradual so I can measure it and she tells me I shouldnt do it that way! My preceptor stepped in and told her that I am a new nurse and I am still learning and have been trained to measure gastric residuals that way. She then asks what school I went to, do I have a BSN, etc. I calmly answered her questions, but wanted so bad to tell her if you are a nurse yourself, you will understand you are making a very difficult working environment. I put the residuals back in the NG tube and turn the pump back to feed and she is standing there watching me like a a hawk. She then asks me for a blanket.

I leave the room to get the blanket and in the meantime, my other pt bp is dropping. She also have a 21:00 med due, so I grab the med and head off to her room to give her a bolus of NS, and the daughter sees me with syringes in my hand and STILL asks me for a blanket. I politely told her that my other pt is critical right now and I have to pass meds before she crashes and I'll have to get her a blanket when I'm done. She then "yells" for another nurse to come to the room to give her a blanket. It was way after visiting hours.

This upset me greatly. Something tells me this person was not really a nurse, but probably a tech. And oh, by the way, I caught her giving oral suctioning to the pt. I told my preceptor about it. Any advice on how to handle these types of family members in the future? The ones that are "nurses" or part of the medical profession?

I engage them in conversation, like "Oh, where do you work?" "Do you like it there?" "How long have you been a nurse?", "How long have you worked at XYZ facility?" etc. Often I find out that the "nurse" is really a CNA, but not always. Sometimes they really are a nurse, or a retired nurse. Sometimes it's the patient who tells me "My daughter is a nurse" because they don't understand the distinction between a CNA and a nurse, and I don't correct them. I just run with it. It's really unimportant, since the patient's safety and well being is the priority, not whether the family member is really a nurse. I let family members help with care, unless it is a safety issue, like trying to give a drink of water to Grandpa who aspirates because he had a stroke. Then I step in and educate, politely and respectfully. The other place I draw the line is with looking at the chart. I had a patient who was getting a procedure done, and I caught the daughter, who identified herself as a nursing student, reading the chart. I took it from her hands and said "I need that, thank you." in a polite tone of voice.

I once had a very complex elderly gentleman whose daughter had "a nursing background" (that's all anyone was able to get her to reveal) and was very demanding, antagonistic, and hostile. We all loved caring for the patient, as he was a very nice man who needed a lot of attention, but we hated having to deal with her. Even if we bent over backwards to please her, to be nice to her, to make her Dad our top priority, she never let up on her attitude. She must have figured she had to be a bulldog to get good care for her Dad, and that she was doing the right thing by him. She fired two hospitalists, demanded access to the medical record without going through the legal process, and many other things that just made dealing with her extremely unpleasant. With someone like that, you just keep doing your best for the patient, and don't take their attitude personally. It's their problem. Remain professional, don't let them get you flustered, and do not give them any ammunition if they decide to go after you.

In my short time in the ED, I have had lots of practice at dealing with demanding/rude family members in general. People get really cranky when there is a long wait, they will stand in the doorway and glare at everyone, they will ask the first person in scrubs that they see for a blanket or some soda, even if that person in scrubs has an armful of medications, tubing, syringes, etc. and is walking very quickly, they gripe about how cold it is, how hard the gurneys are, that their family member hasn't eaten "all day", and everything under the sun. You would think we went to their family member's home and dragged them to the ED just so we could torture them.

How I handle them is to just be polite. If they ask me for something I am able to help them with, I just say "Oh, sure, I'll get that for you now.", or something like that. If I can't help them with it, I just politely tell them "I can't do that right now, but I will be there as soon as I can.", then go about my business. If they want to be upset about it, too bad. I just let it roll off my back, because patient safety trumps everything. As long as I am polite to all patients and family members and place patient safety above all else, then no complaint anyone can ever make because I didn't get Grandma some juice or little Johnny a warm blanket, will ever be valid.

I recently have become the "supportive spouse" of my partner, who has been diagnosed with a chronic illness. At his most recent appointment, I instructed him NOT to tell ANYONE that I am a nurse. When I am with him at appointments, I am wearing my "family member" hat, not my nurse hat. Though the nurse hat is in my back pocket, just in case I need it! ;D

I'm guilty of recapping needles everytime I use a filter needle to draw lido out of a lido amp. I need to put the smaller needle on the syringe for the doctor to inject that lido and I'm NOT going to remove that filter needle without a cap.