I don't know how I could've handed this differently - page 2

I was reprimanded today after a family complained about me. The pt is in the icu with sepsis and multiple unstageable pressure ulcers Family members decided they would take shifts to call every 2... Read More

  1. by   mmc51264
    We ask that one family member be the point person. If they are calling you every 2 hours, get the secretary to tell them you are in pt's room turning them. They don't need an update every 2 hours. Once a shift or if there is a change. Your boss should be backing you up. You cannot answer the phone every 2 hours.
  2. by   TriciaJ
    Quote from remotefuse
    I really like your phrasing here, it probably would have been received better. It's a shame though that we have to give thought to scripting like this.
    Your biggest error was in trying to accommodate their obnoxious behaviour as long as you did. Think of a toddler who gets the first 5 things he asks for in the grocery store and then throws a tantrum when he is denied the sixth thing. With people like this it actually works better to say no a lot earlier in the game.

    The other thing is to get your management involved as soon as you smell a problem family or patient. I once had a manager who loved throwing nurses under the bus and always believed the first story she was told. The trick was to get to her first. I would inform her that I was bending over backward for a particular patient/family and was having difficulty pleasing them. Then she could either help make them happy or set limits or at least be prepared for their inevitable complaints.

    When people behave like this, it really isn't because they are concerned about their loved one. They either have something to feel guilty about or they just want to be important. You'll get better at nipping this crap in the bud if you want to have time to provide any actual patient care.
  3. by   hppygr8ful
    Quote from wondern
    You told them in a polite and professional manner and you were honest so to me you did the absolute right thing. If they had time for constant calls then maybe one of them could manage to be there somehow to help turn q 2. Or maybe just call the charge nurse that day q 2 and let her explain the nursing shortage/challenges that they are oblivious to. Calling q 2 borders on harassment when you're trying to take care of multiple patients and are short staffed most every single day.

    Or maybe suggest a sitter who can answer their calls constantly. I guess that's up to them to figure out maybe or maybe it is okay to suggest in a polite and professional manner of course.
    It's been my experience that it is never a good idea to mention nursing shortages or staffing issues to patient's families. They don't care and this will surely get you in Dutch with the hospital management. I have a large family of siblings and a mother with dementia. The appointing a family spokesperson/designated updater seems to work best. I have had some nurse even be kind of rude about it. Being a nurse myself I understand. I have one sister-in law who can be quite unreasonable about these things and she's not even related to my mother. Also family at bedside are not permitted to perform care or turning for liability reasons. They certainly do not relieve a facility of liability where falls are concerned. In fact in one facility I worked in the facility lost a huge lawsuit when a patient with a family sitter fell and injured the family member who was not trained in how to prevent the fall.

    Some days you just can't win.

    Hppy
  4. by   ruby_jane
    Quote from remotefuse
    I'd like to answer, the pt did come from home where she was left in horrid conditions. Hair was completely matted and she smelled like she had not had a bath in ages. It was an incredibly sad situation. But that Just made it all the more frustrating when the family treated is that way.
    And this is one of the reasons I disliked the ICU. Here, let us do everything possible to fix the downward slide that's been happening to your loved one for months/years.

    I am sorry the DON was not on your side here. But you have a lot of really good advice if it happens again.
  5. by   Apple-Core
    Quote from remotefuse
    I'd like to answer, the pt did come from home where she was left in horrid conditions. Hair was completely matted and she smelled like she had not had a bath in ages. It was an incredibly sad situation. But that Just made it all the more frustrating when the family treated is that way.
    I think this is going to be one of my biggest challenges when I enter the nursing field (I'm currently a student) because what I'd really love to ask is how the **** a patient was allowed to get into this condition in the first place.

    From everything I've read, the job of nursing is awesome...it's dealing with all the people that sucks! LOL!
  6. by   Here.I.Stand
    Quote from hppygr8ful
    It's been my experience that it is never a good idea to mention nursing shortages or staffing issues to patient's families. They don't care and this will surely get you in Dutch with the hospital management. I have a large family of siblings and a mother with dementia. The appointing a family spokesperson/designated updater seems to work best. I have had some nurse even be kind of rude about it. Being a nurse myself I understand. I have one sister-in law who can be quite unreasonable about these things and she's not even related to my mother. Also family at bedside are not permitted to perform care or turning for liability reasons. They certainly do not relieve a facility of liability where falls are concerned. In fact in one facility I worked in the facility lost a huge lawsuit when a patient with a family sitter fell and injured the family member who was not trained in how to prevent the fall.

    Some days you just can't win.

    Hppy
    I agree that selfish people don't care about being short staffed, but I think it is absolutely appropriate to point out that these lengthy q 2 hr calls are taking away from the care of THEIR loved one. Even if the ratios are 1:1 or even 2:1, a 20 min. q2hr phone call will pull that RN away from the bedside for 2 HOURS per 12 hr shift! That is a completely unreasonable and unsafe expectation. Even if they don't care about staff, we can frame it as being detrimental to the ***patient.***

    In situations with so many close family members, I let them know upfront that we will designate one family spokesperson; all requests for info will be referred to that person. This is 1) to maximize the RN's time ***nursing the pt*** and 2) for pt privacy -- with some of these huge family/friend networks, it is nearly impossible for the staff nurse to keep track of every voice on the phone.
  7. by   Ddestiny
    Quote from JKL33
    I turf these sorts of things ASAP (ask others to get involved, such as requesting a care conference and letting management know that q2hr phone updates is not a viable plan that I will be able to accommodate). In direct dealings with family members I would entertain this phone call one time, and "cheerfully" try to establish as good a "phone rapport" as possible, then toward the end of the conversation make a different plan for the rest of the day ("May I call you between 6:30 and 7pm to let you know how the day has gone? Unfortunately because I'll be busy actively working with patients, I won't be able to give full updates every two hours, but I will contact you if there are changes during the day...other than that, let's plan to talk again this evening..."). If I received a call two hours later despite having made a reasonable plan, I would kindly state, "I'm sorry, I'm with a patient and can't talk right now, but I plan to call _____ near the end of my shift to give an update."

    This phrasing is a little more focused on positive terms about what I'm going to do rather than making a request about what I don't want them to do. It's too bad it's so tricky talking to people such that a word or two (or a change of phrase like I'm suggesting) makes the difference between people being irate vs. reasonable, but that's the way it is.

    None of us can fault you since you were mindful to be polite and professional. We are often encouraged to make reasonable plans like what I'm suggesting, but then when people get angry anyway we may be undermined - avoiding the opportunity for others to undermine us is accomplished by getting them involved early on as I suggested above.
    I really like this suggestion! It establishes appropriate boundaries while also forming a way for everyone to be kept informed.

    The only other thing I would emphasize is that, in noting the family's concern about the pressure ulcers, I would definitely make it well known that it is also a concern of yours. I say this because, maybe the family interpreted the suggestion to not call every 2 hours, as also meaning that the nursing staff doesn't care about the skin issues. Maybe, maybe not, but I could see it definitely increasing anxiety (which really fuels that anger in those high-stress situations such as an ICU admission for a loved one) when you think that those entrusted with your loved one's life don't care about something that YOU care about. Obviously we as nurses know that we are constantly assessing and trying to improve on skin issues, but maybe they don't have that background, maybe they're suspicious of healthcare, or it could also just be the guilt that was previously mentioned.

    I imagine a conversation something like this:

    "Don't forget to turn Mom every 2 hours"

    "Yes, we are aware of the skin issues and we definitely want to make sure that we are promoting an environment of healing for them. This includes turning every 2 hours, avoiding friction/shearing, dressing changes every ____ and managing protein intake for wound healing. We will be assessing the skin every 4 hours and as needed as part of the standard head-to-toe, and we will be turning at least every 2 hours".

    I know it's kind of a mouthful, but I really do find that when people are anxious about their loved ones care, they really do like to be in the know down to the smallest little micro-care, and it helps to ease that anxiety. Not everyone needs that, but showing right up front (especially if the previous nurse has been able to give a heads up that the family is really anal about *this*one*particular*thing*) can establish confidence that yes, you do give a **** about this, it's not something you're going to forget, and thus you as an adult professional don't need phone calls Q2H.

    A similar example...I had a patient recently in the unit for an extended period of time. Each day I'd give the daughter 1-2 updates and included even the smallest things (i.e. IV fluid changes) and tried to give a basic understanding of why we were doing these things. The daughter is in her early 20s and has no medical background so she acknowledges that she didn't fully understand all of the things that we were doing, but she appreciated our explanations. If it was something complicated (i.e. respiratory acidosis being compensated for metabolically) I'd preface it with saying "This is pretty complicated, but in order to be transparent want to make sure you know everything that's going on". She liked hearing these things because it made her feel like she was in the loop and that we were trying to help her to have all the information she could understand. Just that minor thing that only took a few minutes helped to keep an anxious family member with minimal outside support, to feel supported by us and to help her feeling positive about her loved one's care even though the progression was quite complicated. I could see her being someone that called constantly if she didn't feel like we were willing to be open and upfront with her.
  8. by   JKL33
    Quote from Ddestiny
    She liked hearing these things because it made her feel like she was in the loop and that we were trying to help her to have all the information she could understand. Just that minor thing that only took a few minutes helped to keep an anxious family member with minimal outside support, to feel supported by us and to help her feeling positive about her loved one's care even though the progression was quite complicated. I could see her being someone that called constantly if she didn't feel like we were willing to be open and upfront with her.
    Good work. Probably one of the best way to build rapport and gain family's confidence. Besides, people simply deserve to be treated this way, generally-speaking.
  9. by   3ringnursing
    Yeah (sigh) ... they would never understand that the amount of time they were taking from you every shift was actually being lost in their loved one's direct care.

    In one way you can't blame their alarm, and feeling that if they were more on top of things in the past the decubs's now may not be so bad. Whether or not this is true, they will never understand poor protein stores making skin like tissue paper, or poor circulation/perfusion having a part to play in the train wreak situation of now. Some patient's are just too sick to be able to heal, and will continue to decompensate no matter what.

    I had one family in particular pop into my mind while reading your post from ... 1998??? it was a large family, and EVERYONE called wanting updated reports. I attempted to gently explain that their loved one required much of my direct time, therefore every time I had to leave isolation, remove my PPE's and wash to take each individual call was taking time away from their loved one who really needed my undivided attention more than they as a group did.

    I suggested that they appoint a spokesperson (someone who I could recognize by voice as really family - not that I said that) to call for updates perhaps once or twice a shift whom could then in turn give report to the rest of the family as a compromise. The person I spoke with said, "I don't care" in response to the fact if I was busy on the phone with multiple extended family members that I wasn't where I really needed to be: with the patient.

    Alrighty then ...

    In that case there was no winning, or even compromises to be had.

    If they couldn't understand that at least 6+ calls in a 12 hour shift to be "reminded" by them to do your job was offensive, or really how much time was being lost in necessary direct patient care by taking these calls, then there was never anything you could have done to make them understand that. The fact management jumped on the family's side instead of making this glaringly obvious point clear to the family is just another slap in the face, as it contributes to further demanding, selfish behavior in future and potential future loss of staff. After all, if you don't feel supported by management when it counts who is going to stay on long term?

    Sorry you had to endure that my friend.
    Last edit by 3ringnursing on Dec 6
  10. by   cpfjme014
    It sounds to me like you handled it well. I also work in an ICU and frequent phone calls be be extremely disruptive to patient care and workflow in the unit. Most places I have worked ask for a designated family member on admission and we will only allow updates via telephone to that person. I have often had similar conversations (not quite to this extreme) with family members about coordinating updates, talking to each other, or physically coming to the hospital together to all get an update. It is unfortunate that the DON could not hear your side of this situation and understand patient care can be negatively impacted by an overbearing family. Family involvement is key, but when a family is trying to direct care at a level that is this disruptive, that is unacceptable. Ultimately you are there to care for the patient, not the entire family, although in the ICU, we often have no choice.
  11. by   Orion81RN
    Oh, I completely lost my cool once when a family member who called multiple times a shift called one night to "ask" me to go in his wife's room and help her. (Her call light was on and she had called him to complain) This pt had severe anxiety issues with enabling behavior from the husband and rest of the family. Her PRN med was "due."

    I knew he was about to call bc the CNA was IN HER ROOM when she called him to complain no one answers her lights at lightening speed. The CNA immediately notified me.

    He called, and I cut him off immediately and VERY firmly told him that I would be in her room right now if it weren't for my being on the phone with him at that minute. Reminding him how the phone at the nurse's station was at the opposite end of the building of his wife's room AND my med cart, and how much time is taken away from direct pt care walking up and down that long hall.

    I also made sure to inform him that the CNA was in her room while the pt made that call to him. Thus my ability to cut him off knowing what he was calling for. He apologized and never called me again.

    While I should have handled it in a more kind manner, sometimes you just lose it.
  12. by   RJ 55
    I understand your frustration. I am a nurse and I have had family members repeatedly call to check on their loved ones and ensure quality standards of care. I have found that my designating one family member to be the recipient of information and the communicator to the rest of the family it does cut down on phone calls and questions that I have to repeatedly answer. I think that the family response isn't an attack on you or your nursing skills bit rather from the fear and stress of their loved one being in ICU. Maybe it is their only way to feel a sense of control in this situation. Usually I will encourage family to come and visit with their loved ones. When my sister was in a coma in ICU after a bad car accident, my mom and I would stay with her in shifts so that she would never be without one of us. It gave us a sense of control and peace in a terrifying time. I was not a nurse then but my mom was a medical professional. I was so grateful to her nurses that kept her alive and gave us information on her condition. It was heartbreaking for our family. The nurses would give us "jobs" such as rubbing lotion on my sister's feet or reading her favorite books or braiding her hair. It gave us some form of purpose and control.
  13. by   vintagemother
    Quote from RJ 55
    I understand your frustration. I am a nurse and I have had family members repeatedly call to check on their loved ones and ensure quality standards of care. I have found that my designating one family member to be the recipient of information and the communicator to the rest of the family it does cut down on phone calls and questions that I have to repeatedly answer. I think that the family response isn't an attack on you or your nursing skills bit rather from the fear and stress of their loved one being in ICU. Maybe it is their only way to feel a sense of control in this situation. Usually I will encourage family to come and visit with their loved ones. When my sister was in a coma in ICU after a bad car accident, my mom and I would stay with her in shifts so that she would never be without one of us. It gave us a sense of control and peace in a terrifying time. I was not a nurse then but my mom was a medical professional. I was so grateful to her nurses that kept her alive and gave us information on her condition. It was heartbreaking for our family. The nurses would give us "jobs" such as rubbing lotion on my sister's feet or reading her favorite books or braiding her hair. It gave us some form of purpose and control.
    When my dear Grandma was in an ICU, I didn't call. I just went to her bedside. I wanted to get into her bed...but I didnt. I, instead, spoke with her nurse who was kind enough to explain her current situation.

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