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

[shoegalRN]

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?

[HeartsOpenWide, RN]

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.

the harm is that she does not work there, she is a visitor. nurse or not, she has no business "taking care" of some one else's patient.

[AOx1]

I must say that this is the type of family member that irritated me the most until recently.... when I became one. I have always been the first to try to help out, to change linens, clean someone up, turn someone, etc as I know well how stressful nursing can be at times.

Let me preface this by saying that my main background is in ICU. I do not announce I am a nurse or anything when I see a family member in the hospital because really, it isn't usually relevant. I think most of us are reluctant to do so, because we don't want to be "that relative." There are some things that there are ways we prefer to do things, and others that endanger a patient's life. I try to be conscious of that. The care my family and friends in the past have received had never warranted any objection as any differences I saw were simply a matter of preference. Unfortunately, this time was different.

I watched a post-surgical relative drop her mean arterial pressures and she was barely producing any urine at all After quite some time of nicely asking the nurse, then insisting on speaking to the physician I became really angry. I went to the front desk only to find that the nurse, instead of calling the physician as I had insisted, was laughing and taking cell phone pictures of her coworkers, with her feet up at the desk. I kid you not. I know I never even have time to pee at work, let alone prop my feet up when someone is not doing well.

This nurse had not even assessed my relative properly.... her entire assessment consisted of taking a quick peep under the gown to "check" the dressing. That's it. After insisting again on speaking to the physician and her supervisor, she finally called in her supervisor. I demanded to speak with the physician again, or the house officer. The supervisor realized what was happening to my relative, saw that things were serious, and got the house officer who over the next several hours, gave her several fluid boluses to correct it. The nurse did not seem to think prior to that that pressures in the 60s were cause for concern. The only way I got her to do anything was to keep insisting that if she didn't call rapid response/physician/house officer that I would do it myself. During the several liters of fluid she received, the nurse did not once check her pressures again, assess in any manner, or seem remotely concerned. In fact, she incorrectly set up a liter of fluids with potassium in it as the bolus, which I had to discuss with her. I told her supervisor I wanted a different nurse, anyone else. I would have preferred the tech who at least seemed to realize something had changed.

I ended up doing assessments on my own as I did not trust that nurse, until a new nurse was assigned. I reported that nurse to risk management needless to say. I will not go into much more detail, except to say that you never know what has prompted someone to behave in the way they do. I was without sleep for nearly 48 hours at this time, and after dealing with this nurse, if you could call her that, for quite some time, I was much less polite than I ordinarily would be. I don't feel poor care excuses bad behavior, but at a certain point, things get ridiculous. You never know what people have gone through by the time they get to you. My relative's surgeon said that had I not have insisted on calling and getting help, it is quite likely that things would have not gone so well. He also has asked that the nurse be fired.

[jessiern, BSN, RN]

>

Isn't that a little anal?? I mean, sure its the wrong way to do it.. but come on! Call the supervisior because someone recapped a needle incorrectly? Lol

Seems to be a whole lot of drama over this one comment, and I think it has been misinterpreted by some. I don't think she was calling the previous poster "anal" for pointing out that recapping is wrong, because she even admits that it is the wrong way to do it. I think the problem she had, and I as well, is that someone in the facilty as a patient would even consider calling a supervisor about it. (If I am wrong, KeechieSan, please feel free to correct me)

Yep, agreed, the action is dangerous for the nurse, and not something I personally practice. BUT, it did not directly affect the poster as a patient, and did not place her in any danger what-so-ever. If she were truley concerned for the nurse's well-being, then why not mention it to the nurse in question? Why try to get the powers-that-be involved, unless she was annoyed at before mentioned situations and grasping at straws trying to find some way to get the nurse "in trouble" with the higher ups. And I am sure she has never strayed from the text book in her own nursing career, so she is in a perfect position to get on a high horse and criticize others.

[carebear01, BSN, RN]

Kudos to you for doing such a great job in handling the situation! Your story made me reminisce about the many patients that I have taken care of whose family member was a "nurse". Some are great and sooo helpful, some make you want to rip your hair out!!! If you take a look at her actions, she may be a nurse but obviously does not completely know what she is doing. Dumping gastric contents down a sink...that's a nice one. I've dealt with a few "nurses" before that have run me into the ground. In my experience, those are the nurses who suck at the jobs and don't know what their doing. Keep up the good work! Don't ever feel bad for taking care of your most critical patient first instead of getting the other patient a damn blanket. We are nurses, not waitresses!

[nerdtonurse?, BSN, RN]

Here's what I do:

If they say they're a nurse and start touching stuff, I say, "well, as a nurse you know that you are not allowed to touch the equipment/change settings. That's to safeguard YOUR license." And every time they say, "I'm a nurse" I say, "and as a NURSE, you know you shouldn't..." They want to wave the nurse flag, I'll beat them to death with it if they're being stupid.

If they are writing down everything, asking about everything, I quiz them back. We have one family, the daughters come in and set up camp, write down everyone's name, what you came in the room for, what you said, what you did. I bring in the computer, and I'm like, "and what's YOUR name? and what's YOUR relationship to the patient?" I go over to the patient and ask the patient if they authorize me to discuss their condition with them. I write up on the board that I turned the pt to the left at 0130 and sign my initials. I come back and she's back on her back, I ask who turned her back onto the stage 3 decube and ask them to spell their name while I'm putting it into the chart. It's amazing how they leave me alone now and let me do the job of looking after their mom.

I've also been on the other end. My dad was really sick, and I got on the phone with the nurse. I said, basically, "I know my mom's upset and I'm at work 50 miles away. I just want to make sure mom hasn't forgotten to tell you that dad's history is....and I can fax you his med list (I keep a copy of both their med lists in my wallet)." I make sure they know dad's a diabetic (he forgets to tell folks since he thinks if you don't take insulin, you don't have "real" diabetes), and that mom has had periods of extreme hypertension, and if they could keep an eye on her until I get there. Other than that, I stay out of the way. He's my dad, she's my mom, but they are that nurse's patient, not mine.

[dscrn]

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.

yes, I generally don't volunteer that I'm a nurse...but my husband loves to make the announcement..and defer any paperwork, etc to me.:heartbeat Funny, I don't usually bring up what he does for work....

[dscrn]

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,

when my daughter required an e/c/s, one of the anesthesia residents kept asking the staff if I could come into the OR(had been a rough labor, rushed to OR once, baby's hr stabilized, back to labor room, back to OR)...my daughter was literally trying to climb off of the table-with an epidural on board) I really was trying to maintain my role of support person. When I finally was allowed in I was able to "talk her down"...

I really do think that family members can make a big difference...as long as they maintain their places, and allow staff to do their jobs

[mustlovepoodles, RN]

I NEVER tell people I'm a nurse when my loved ones are in the hospital. Usually, they catch on once we start talking. I do ask a lot of questions, but not in a superior or accusatory way. I just wanna know why they're doing stuff and what their expectations for treatment are. I don't take names, but I do bring candy, cookies, and sheet cake!

Now, my mother is another thing altogether. She has outted me a few times. Not only that but she has several times walked in wearing Tshirts that read "I AM A REAL NURSE." Oy...then she proceeds to change things, do things the way she wants, etc. When my sister was in labor(at my mother's hospital--big mistake!) my mother sat with her all day, turning her pitocin up and down, managing her epidural, and basically wouldn't let the nurses do their job. I was surprised that the staff didn't throw her out. She was so obnoxious that my sister and BIL sent pizza to the staff with a note of apology!:imbar

[Lacie, BSN, RN]

Now on the other hand, when my son was in the pediatric ICU with respiratory distress and kalwasaki's disease I was asked to jump in on his care. Particularly after 2 different nurses stuck him 2 times each to no avail. I couldnt stand it anymore and did the IV myself on the first attempt rather than continue to let them stick him over and over. (something I have a gift for doing and thats venipunture and I was a CVICU nurse in this same hospital). After that blood draws or new lines I was asked to do on him. If I was working my shift then they would page me to the peds unit to do. He was also calmer with me doing rather then strangers at 3 years old. With me doing these task there was no tying down or restraints, most of all no screams lol. Funny as now he is 22 years old and still wont take a shot unless they allow me to administer it since he drops like a rock and hits the floor. He doesnt pass out if I give it. Cant figure that one out yet. Same with my 29 year old lol. guess they always stay mama's boys dont they LMAO.

[elizabeth8503RN, MSN, EMT-B, NP]

I haven't had much issues with patient's family members being nurses and problems, but I have taken care of doctors, and their families, and they have been pretty decent to me (maybe because they know that nurses rule all LOL...KIDDING)

But I have also been on the recieving end too. In the past three months, I have spent more time visiting hospitals than I could ever imagine... (see thread My Crazy Month) Both my gma and my gpa were in the hospital....two seperate ones (opposite sides of the family) and I spent ALOT of time visiting them.

My gma F was in the hospital for 8 1/2 weeks (one hospital for a week, the second hospital for the remainder of the time on three different floor/wings). By the time she left, every one of her doctors, nurses, aids, physical therapists, respiratory therapists and anxillary staff knew I was a nurse, and knew my mom was an x-ray technologist. Had my mom and I not know my gma F, visited my gma, and been around and asked questions, gma F would have died. Granted her care was excellent there, they just didn't know gma like we did. The only problem the staff had was with my gpa F who was stubborn as all get out....and for him....I apolgised profusly to them.

As for my gpa M, he was only in the hospital for a total of 8 days, but the poor staff of the two three wings had my ENTIRE family to deal with, including my witch of an aunt, and my bull headed uncle. While I was there with my gpa M, I was basically a wall flower and let my family, my gma M, my dad, and my aunt and uncle do all the talking and asking questions, and if they had questions, I would answer. (gpa M died due to an MI....complications of a lower leg amputation)

So....I have been on both sides....and for any of you who may of dealt with my gpa F, or my crazy azz family on my dads side.....SO SO SO SO SORRY!!!!!

[Moneypitt]

Oh Gosh I have had family members like that and I sympathize. First off you did a great job considering you are not an experienced nurse. Later you will be able to set some boundries and if you are lucky you will be able to do that with a great big smile on your face as you hand them the coke or coffee you had offered them. :wink2:

Don't forget to notify your supervisor if you think you need help. Of course he/she might be busy at the moment writing the unusual occurrence report about a needle observed being recapped by another nurse. :icon_roll But they should intervene if you feel that you can't provide patient care due the actions of the family member.

MP

[Caffeine_IV]

I've had many patients with family members as nurses...one occasion I was about to restart an IV that was leaking on the patient and had to leave the room for whatever reason and when I returned she had started the IV on my patient.

She was very pleasant woman but that was a little odd for me.