I don't know how I could've handed this differently

  1. 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 hrs, on the hour, 24 hrs a day to remind the nurse to turn the pt. Not only would they call to remind, but the different family members would also want a complete update on the pts condition. So after spending a lot of time with them over the phone, I told them, in a vey polite and professional matter that I would appreciate if they didn't call to remind me to turn, and to talk to each other more about updates. So, they were not happy at all
    And escalated their complaint to the DON. I'm in my last month here, so it doesn't bother me too much, but I was very annoyed that I had to listen to multiple lectures on my behavior, but honestly, I don't know how I could've handled it differently. They were calling constantly and taking up so much time.

    More of a rant I suppose since the situation is over, but I am curious about how others would handle the same situation.
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  2. 27 Comments

  3. by   remotefuse
    they complained about my tone, and excluding family members in the care of the pt
  4. by   Been there,done that
    You could not stop their calls. You could have made the family get a designated spokesman.
  5. by   smf0903
    We have families like this have a designated updater...spending time fielding so many phone calls takes away from patient care. If we continue to get phone calls from multiple family members we simply say "you'll have to please contact Aunt Mary, she is the designated family member who will begivinf updates". If there continues to be an issue, there is an additional meeting with the family explaining why we can't take 47 phone calls per shift to answer questions for 20 minutes per call. Our facility is pretty good about backing us on issues like this...it's understandable to most (although apparently not to some families) that we are not providing patient care if we're sitting on the phone for 5 hours of our shift.

    If DON is lecturing you, I say let him/ her provide their extension to the family members
  6. by   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.
  7. by   remotefuse
    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 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.
  8. by   Castiela
    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.
    I find that relationships with families can be tricky in ICU. Your patient is very sick and there is often a lot of guilt held by family members that can result in anger and unfortunately it often gets taken out in us.

    i agree with the previous posters to try and set boundaries but also address the families fears, it sounded to me they were concerned because he had already developed pressure sores. Acknowledging this and their fear as well as what the previous posters suggested could help.
  9. by   JKL33
    Quote from Castiela
    ...it sounded to me they were concerned because he had already developed pressure sores.
    Developing multiple unstageable pressure ulcers in ICU is not the most likely way that happened. I'm so curious to know if he came from home (no need for the OP to answer...). If he came from LTC I would think the family would be likely to view the ICU as a place that was going to "fix everything" and lay off a little bit. My money is on poor home-based care that people feel guilty about and are looking to scapegoat now that they realize how sick he's become.

    I agree that trying to address these dynamics (which may well stem from something other than pure fear) could end up being a therapeutic endeavor.
  10. by   Crush
    Quote from Castiela
    I find that relationships with families can be tricky in ICU. Your patient is very sick and there is often a lot of guilt held by family members that can result in anger and unfortunately it often gets taken out in us.

    i agree with the previous posters to try and set boundaries but also address the families fears, it sounded to me they were concerned because he had already developed pressure sores. Acknowledging this and their fear as well as what the previous posters suggested could help.
    Bingo. It sounds like they came to the ICU with the pressure ulcers. Appears family may be feeling guilty and now feels this is all they can do. Our hospital has the SW and/or manager sit down with this type situation and find a compromise as some of the above have already mentioned/talked about, especially if the family is seeming angry or unreasonable and is not/has not responded well with nursing to trying to set boundaries. I agree, early boundary setting is key though in these type situations.
  11. by   infinity_rn
    this gets to me-if a loved one is in ICU, why is the family calling? why isn't a family member at the bedside who could receive updates live and give updates to other family members? I rarely have time to speak to family members over the phone, so I keep it short, sweet, simple, and to the point very politely where they understand that they don't have to call, but instead would visit. like the other posters have said, we do have social workers and nurse managers who end up dealing with these kinds of situations, because they understand the nurses are busy.
  12. by   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.
  13. by   remotefuse
    Quote from JKL33
    Developing multiple unstageable pressure ulcers in ICU is not the most likely way that happened. I'm so curious to know if he came from home (no need for the OP to answer...). If he came from LTC I would think the family would be likely to view the ICU as a place that was going to "fix everything" and lay off a little bit. My money is on poor home-based care that people feel guilty about and are looking to scapegoat now that they realize how sick he's become.

    I agree that trying to address these dynamics (which may well stem from something other than pure fear) could end up being a therapeutic endeavor.
    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.
  14. by   Purple_roses
    This is why the customer service mentality sucks. You probably did a great job taking care of that relative. And really, you can't take great care of your patients if you have to give these massive updates every 2 hours. That's ridiculous. I think you sounded polite enough while being firm enough to convey that you have a job to do. Instead of management supporting you for taking care of a critical patient while dealing with the overbearing family, you're left with a reprimand.

    Managers who are on allnurses, this is why you can't keep the good ones at the bedside.

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