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

Nurses General Nursing

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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?

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
no, it is not anal - - it's against everything we have been taught about infection control. do not recap needles. that's when we get stuck. i come from the days when i saw nurses uncap needles with their teeth, and accidently stick themselves in the lip. clean needle, maybe, but now they may have injected someting in themselves. so i learned that this is not a good thing.

i come from the days when we rarely wore gloves - but we wear them now to excess.

i repeat we are not supposed to recap dirty needles.

getting hepatitis or aids or anything else, including the med still in the needle is not the way to go.

no, we're not supposed to recap dirty needles. but unless you were precepting or otherwise evaluating this nurse as part of your employment, it's none of your business. mind your business!

I usually dont tell people i am a nurse anyway but some of the nurses i have met have been nasty. not sure of thier motive, i try and do the best i can with my patients and give them the best care that i possibly can. The nurse who emptied out the canister was wrong in doing so. Baths and blankets ice chips are nice to provide for patients but i hate when like one of the posters said you are running to someone with tubing and iv bags they have to wait. thats why as nurses we had to take so many questions on nclex on prioritizing. My mother was in and out of the hospital with cancer for 6mos and i never thought that the nurses were doing a bad job i didnt badger them for the chart etc. i understand that this is thier family member and they love them but some people really do cross the line and its up to the nurse to set limits

Specializes in Med/Surg, Home Health.

I remember when I was a patient in a far-away hospital, I sneaked and read my bedside chart. Inside it was a note that read "patient is a nurse". I had not told them, they had read in on my data sheet, I presume. I did not want them to know, but honestly they treated me with such respect and gave me wonderful care. They knew they didnt have to talk to me in lay-man' terms, they could tell me in medical terminology and I could understand it.

I now work homehealth and I had a patient whose "friend" was a retired nurse. she hadnt worked in years. But she found fault with everything I did. She went as far as to call my director to complain about me and request another nurse. Come to find out...the family had NO idea she had done this and was asking where I was. Honestly, I was glad to be out of that situation. I tried my darndest to include this friend in every precedure/teaching I did, but she just had to be the "better" and "smarter" nurse than I. When I worked in the hospital, I had family members do the same...claim to be a nurse when in actuality they were a nurse's aide....ticked me off. They tried to argue the most rediculous things because they didnt know (thought they did).

Its hard to deal with scrutinizing family members. BUT if you compliment them and include them in conversation and tell them how lucky the patient is to have them by their side, try to befriend them, offer them comfort, etc, they will usually come to like you and appreciate you. Most people just feel "lost" in the situation. I try to be a nurse to the family as well as the patient. I explain everything as I do it, I tell them why if Im asked, I explain meds if Im asked, etc. Then I tell them how its wonderful that they are interested and ask questions.

But with some, nothing you do is good enough but just remember..ALWAYS REMEMBER that you are intelligent and dont let anyone make you feel inferior. All nurses do things differently. If a family member is a nurse, she may do things differently, which does not mean her way or your way is wrong. I would definitely set limits when something they do is affecting your work, such as emptying the gastric container.

And FYI, I measured gastric contents the same way as you, especially if there was more than the large suction syringe would hold.

I also usually don't admit I'm a nurse either. I don't like to make them nervous. But my husband who has medical problems always pipes up to tell everyone.

As far as the blanket. Why couldn't she have grabbed one since she seemed willing to do everything else? I've seen that nurses are busy and gone to get one myself.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
We just had a big discussion thread on this same topic. It's really not a matter of the family member's background - it's usually a matter of loss of control. If there are actual visiting hours, you can ask security to enforce them when they get difficult.

I always tell the staff that I am a nurse; my family member has probably already told them. My nursing knowledge has literally saved the lives of two of my family. When my then-fiance' was getting Levaquin and kept getting red all over, I begged them to stop giving it to him. They wouldn't listen, and the next time he got it, his BP dropped - and I turned off the drip and demanded a doctor. They stopped the med.

When my dad was desatting, and SOB, I noticed that he had only 10cc - TENcc's of urine output in 20 hours. I loudly demanded a doc immediately - and a few hrs later he was back on a respirator and the balloon pump.

He hadn't been able to cough up a huge mucus plug, and went into near-total organ failure.

There are other stories I could tell you - too many, unfortunately - and it makes me so sad that I feel I have to be so watchful for my loved ones.

When I was just recently in the ER for my own issues, I overheard a nurse giving blatantly wrong information to a patient in order to get her to agree to a test. I piped up with a question. I saw a nurse recap a needle in the air - no one-handed scoop kind of thing. I should have called for a supe, but I was too tired to intervene.

I hope I have been a better nurse than the examples I have given here. The ER things were in the past 3 months, by the way.

We all know the ER doesn't permit much privacy, but you violated that privacy by acknowledging that you heard it and are aware of details of the conversation. :o

thank you so much for your reply! i didnt want to "rock the boat" by asking her where she worked, what school she went to, etc.

i understand her father was sick, but i wondered why she wasnt just in the "family member" role, considering if she was a nurse herself, she can see both sides of it. i understand all too well what's it's like to see a family member in the icu, although you've see plenty of pts, it's nothing like seeing your own flesh and blood. so, i certainly understand her frustation. i think you'd have been justified in saying, "how about you? where did you go to school, what's your degree, your experience?" in a gabby, non-threatening sort of way, of course. just conversation.

but i just couldnt understand the "criticizing" of my care, although i'm a new nurse. i tried not to let it get to me, but it did upset me. if she is a nurse, she understands how it feels to be new, at one point in time. it doesn't matter, she's now the dtr of a patient. she's not in nurse mode. she was awfully rude to behave the way you described, dtr, nurse, whatever or not.

as far as suctioning goes, this pt was getting oral care q 4 hours. i guess i had an issue with her dumping the canister in the sink (we take the entire canister to the dirty utility room and replace it with a new one), then cleaning it out and writing a date on it. she was not at her job, she was a family member of a pt, so i think that kinda crossed the line, in my opinion.

you should have told her what you told us, minus the line-crossing part. btw, it's "graduate", not "gradual". can't blame her for doing a little suctioning or mouth care - it keeps her busy and, if not contraindicated, what's the harm? but it sounds like she did mess up your residual measurement/replacement and she needs to know not to do that - no emptying the canister without asking you first. explain why - nicely.

i don't know how you guys can take families like this. i thank god i don't have to deal with this much at all.

Specializes in ER.

I usually don't have a chance to tell people I'm a nurse- my friend/family member does it for me! In the rare event I've not already been outed, I usually don't mention it unless I can do it offhand. I hate when pts/family announce 'I'm a nurse' as if I should hustle hustle and do nursey tricks for them.

On the other hand- I've taken care of all manner of healthcare professionals. I have found that most healthcare professionals I see on 'the other side' have always been very polite and helpful. I usually chit-chat and have no problems. A few though- wow, they can be monsters!

I refuse to play the game w/ the worst. You know, the ones who refuse to outright say they're a nurse, but keep their arms crossed, watch you like a hawk, and drop impressive medical terms left and right. I won't ask if they are a nurse. I refuse to. I just raise an eyebrow at some of the more obvious stuff- and go about my business. Honestly- if you're going to play passive-agressive Blues Clues, get a handy dandy notebook and get out of my way. Why are they always in the way??? These are also the ones that usually cannot so much as fix the bed so their loved one will be more comfortable- but hit silence (or turn of!!) the IV pump. Guess you fooled me- I am the horrible nurse who didn't know by telepathy that there was a teeny bubble in the tubing.

The ones who feel guilty because 'did I miss something?', or feel helpless or that they have no control- I can deal w/ that. The ones whose family member has a complex case or rare disease- I appreciate their insight. My kids on peds w/ rare genetic syndromes- Mom usually knew tons more then any of the staff, even better if she was a nurse.

I understand how it is to have a critically ill family member, a terminal loved one, or a child no one can diagnose. I know that in healthcare I'm not seeing people at their best. I've been there. I try to ask their opnions, thoughts, concerns when I can. It's no biggie to me to start an IV on someone w/ cruddy veins in the L. FA if family says it's my best bet. If they make a reasonable request and I can't comply, I don't mind explaining the rationale. If I'm told something that really doesn't matter, I just thank them for the info and go on. I'll even note it for future use. It may not matter to me at that particular time that Dad w/ STEMI is lactose intolerant- no milk in the protocol, lol- but it's nice to say "I'll put in on his history so when he's recovering they'll know". It implies that I expect him to recover. ((When my hubby was crashing they asked about allergies as he was septic- I went into a ramble about how "his Mom said he was allergic to sulfa because he got a rash but it ended up he really had mono and not strep so I don't think it was sulfa to begin with and don't you get a rash to 'cillins if you really have mono, but I don't think he's allergic to those either, and he's really probably not allergic to anything". I'm sure after the "I don't think he's really allergic to sulfa" they just tuned the rest out. They looked interested, though. Made me feel better and realize I needed to get a grip on myself. It's not easy to watch your loved one circle the drain- even worse, I think, when you realize excatly how critically ill they are.))

The twits, on the other hand, I just won't play. If it really gets nasty- innuendos and veiled threats- I refuse to apologize if nothing's been done wrong. I am, however, extremely polite and matter-of-fact. May I get you the supervisor? Shall I call the Doc? If you don't feel comfortable/safe/whatever, we cannot hold you here against your will. You have the right to request a second opinion/transfer/etc. You have the right to refuse this med/lab/IV/whatever. I have found that usually, when you put some of the responsibility back on them they settle down a bit. You give them the choice- in a very pt-advocate manner, and there's nothing left to argue with. The simple 'You have the right to refuse....' can make things pretty clear at times.

Specializes in ER/Trauma.

I'm ALL for involving family in care - many a time in the ED confused/combative patients often calm down/co-operate when family is around.

BUT, you cross a line when you step in and do stuff like throw away body secretions/excretions, label items in the room, suctioning (!) etc. Now you're no longer a family member - you're interfering in patient care and if you continue to do it despite my requests to cease and desist; you'll be asked to leave (and escorted out if need be).

My $0.02 worth.

cheers,

Specializes in Pediatric Intensive Care, Urgent Care.
No, it is NOT anal - - it's against everything we have been taught about infection control. DO NOT RECAP NEEDLES. That's when we get stuck. I come from the days when I saw nurses uncap needles with their teeth, and accidently stick themselves in the lip. Clean needle, maybe, but now they may have injected someting in themselves. So I learned that this is not a good thing.

I come from the days when we rarely wore gloves - but we wear them now to excess.

I repeat WE ARE NOT SUPPOSED TO RECAP DIRTY NEEDLES.

Getting Hepatitis or AIDS or anything else, including the med still in the needle is not the way to go.

It is a lil anal...just admit that it's anal. there are more important things like a patient desating with SOB and only 10cc's of urine output in 20hrs!!! Now why that would of gone 20 hours without being noticed is beyond me...those are the battles you should fight...

As far as recapping the needles...how do you know that was the only time that nurse did so???? Telling a nurses supervisor that you just saw a nurse recap a needle is so beyond being anal that if i was the super i would of looked at you like you had three eyes...c'mon man...we are saving lives...and your gonna get hung up on the ONE time you saw a needle recapped...really???? thats only gonna buy you ill will...and your complaint will not be taken as YOU want it to be...

Reality Check,

Mex

Specializes in Pediatric Intensive Care, Urgent Care.
Nurse or not I always ask family members to leave the room during any procedure particularly if changing a bed or bathing, peri-care, ng care, etc. During that time you wont feel there is someone looking over your shoulder constantly. Also stick to the visiting times and only permitting the amount of visitors permitted by the facility in the room at the same time. Even though they are family members a pt is entitled to his/her dignity and personal privacy. Something as simple as "I need to do my VS and assessment on your father, would you mind stepping out and you may return as soon as I've completed". I never allow visitors to stay in room during my procedures or tasks. I use the "it's hospital policy" alot!

Absolutely!! if they stay while i'm changing a diaper or a bed [the diaper not so much...especially if its a little one, but often times i have the family interject and say i'll do it, I LOVE PEDS ;-)] they most definately will be asked to do something...i dont allow family members to just stand there and not participate in the care of THEIR family member...and I work in pediatrics where its rare to see a family member not take charge in those things but it happens and i "handle" it. The great thing about peds is that it looks really bad if your asked point blank to help do "something" for YOUR child and you say no...i love it! ...and you better believe that i use it! I've even caught the unsuspecting dad off guard, sitting their with his crackberry (i can relate, i have a crackberry, lol) while me and his wife are handling a "difficult" situation but instead of calling for another nurse (because the task is so trivial, anyone can do it) i get him involved. I only had one time when the guy said no it's ok and stepped out...the funny things is you should seen the look his wife gave him...it was priceless...i bet you a million dollars he will never say no again...LMAO!!! In my area of practice parents need to feel as if they have some sort of control in the care of their child and they welcome it...if you use it to your advantage...it can be a very helpful thing...

Mex

Specializes in Ortho, Case Management, blabla.
BUT if you compliment them and include them in conversation and tell them how lucky the patient is to have them by their side, try to befriend them, offer them comfort, etc, they will usually come to like you and appreciate you.

Or the exact opposite - I've shut people down in the same exact way. "Oh, you're a nurse!" Then I turn my attention back to the patient, "Well aren't you lucky to have them here?!?" Then I immediately redirect my focus to the patient and conduct what I need to to. I'm not there to make friends with family members, I'm there to provide care. I don't have all day to chitchat about why dad is still on NS 2 days after the surgery and I don't care that he had a horrible reaction to Morphine one time yet is tolerating Dilaudid just fine (Everyone from the Doctor to the Pharmacist to me knows so drop it!). The ones that kill me are the ones that have a little bit of knowledge in a certain area but then turn around and try to apply it to mine. One of the most annoying was an ICU nurse at the hospital I worked at whose sister had surgery and she was trying to micromanage every detail. She was flipping over everything, asking me to call the doctor literally every hour over EVERYTHING. "My sister is getting a cough." I'd acknowledge it. Just, all sorts of stuff like that (and her sister, the one who actually had surgery, would be like, "It's no big deal seriously I'm fine"). Then an hour later she'd approach me and ask if I called the doctor about it yet. THIS WENT ON ALL DAY LONG. I took her aside and told her how awesome it must be to have an intensivist available 24/7 over on the unit, to only have 2 patients, and the HGB may be 8.5 but to trust me we see it all the time and the surgeon won't care nor do anything about it! Aghhhh. I don't even really care what she thinks or thought, bottom line it threw me off, hindered me rather than helped, and interfered with the care.

Specializes in ER.
I'm ALL for involving family in care - many a time in the ED confused/combative patients often calm down/co-operate when family is around.

BUT, you cross a line when you step in and do stuff like throw away body secretions/excretions, label items in the room, suctioning (!) etc. Now you're no longer a family member - you're interfering in patient care and if you continue to do it despite my requests to cease and desist; you'll be asked to leave (and escorted out if need be).

Trust me, I've done that. It's easier to give the boot in ER or ICU at times, because mgmt seems more inclined to back you up. I try to not boot the simply annoying ones- it ends up being more of a pain and hassle in the long run.

The really bad ones hang themselves. Eventually, they try to confiscate HIPPA material, throw a fit at the nurses station, follow you into another pts room- it never fails. They always cross the line. I'll catch them messing w/ the IV, 'shopping' in the cabinets, whatever. Out they go. It usually ends up that this type of 'nurse' family are no longer employed in the medical field.

I have to give my docs credit as well- they will openly confront someone who is hassling the nurses. They've stood up for us many times.

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