Nightmare Families and Hospital protocols

[annmariern]

I got a pt the other night, 30 days inpatient, new CA. Fresh from ICU, the reporting nurse tells me, family nightmare. Within 15 mins of arrival, 3 nurses, and the CNA are besides themselves. The bed wasn't right, we need soda, we are staying the night, etc, etc. The day after we get another pt, similar deal in the next room, creating a group from hell. My thought on this is if everyone involved, the doc, admin, the floor staff draw a line in the sand, this crap stops. Instead I see nurses and aides in tears some days from sheer frustration. I mean the family actually barging into the staff

break room with demands. Does anyone work for a facility that actually has a protocol for this nonsense? It has become so common, and we all know, no matter what we do, how much time etc we put into these people they are still going to complain. To the detriment of the 5 other pts and families who are reasonable. Just wondering and appreciate any imput

[jessiern, BSN, RN]

Ok first, someone needs to make a large, colorful "EMPLOYEES ONLY" sign for the breakroom.

Don't know about ya'll, but we have been doing that for years. I put the sign up after a family member got a cup of coffee, and put the empty pot back on the hot plate (ruined it, and stunk for weeks). Doesn't work, doesn't work at all.

[AmericanRN]

Children running around a health care facility really are a danger.

Several years ago, an unsupervised child runnning all over the unit ran into another pt's room, and crashed into me while I was withdrawing an IV needle, causing me to get a dirty needle stick.

I reported the incident to mgmt, but nothing was done. I was so angry, I kind of lost it, and verbally repremanded the monster-child's parents myself. That did have some effect, but the damage had already been done.

We really need to return to the old days of strictly enforced visiting hours, and no child visiters allowed.

Been there and I"m not even a nurse yet. I have seen children skating down the hallway at the local VA hospital here, this hospital is full of elderly people with walkers, canes, etc and there are ton of spinal cord and head injuries coming back from Iraq here as well. Back to the skating kids they had the sneakers with the little wheels that pop in and out. I can't tell you how many nurses and patients were crashed into. Nothing is ever said or done about it.

That being said I think that strictly enforced visiting hours depends on the patient's condition and how the family is behaving and if they stay out of the way. I have quietly sat in a corner of the room at my loved ones requests for hours on end. Some simply have said flat out they don't feel comfortable without someone they already know being with them.

One of my instructors said that families hanging around for days on end has increased because many people don't feel safe with the nurse to patient ratios at all. Hospitals have to look at why so many feel unsafe before they start mandating some blanket rule for everyone.

That being said rowdy, drunken, and rude parties of 20 people in a room should not be permitted. It can be limited to no more then 2 people at a time if the families don't have the sense to set limits themselves. Nor are nurses there to serve relatives drinks and food or to be harrased in their own break rooms.

[AmericanRN]

One of my favorite Clampett family stories...

Years ago, I cared for a young man with a brain tumor; he was minimally responsive, but aware of his surroundings.

One night I walked in and found about 10 people in his room, all standing around holding plates, chowing down. They had moved the patient as far as they could to the side, pressed up against the rails. And laid out on the bed, like a buffet table, was their Thanksgiving dinner. Complete with roast turkey. (or perhaps... possum?)

What a demented family. That poor young man. Did the little banjo player from Deliverance show up as well to add some music to the atmosphere?

Perhaps they were eating possum on a half shell nice and fancy since it was Thanksgiving and all. Possum on a half shell is armadillo.

[Katie82, RN]

This is where the Charge Nurse or Unit Manager should have stepped in and laid some ground rules. Invasion of the break room would have been my first point. Most facilities have rules for families who prove "disruptive" to the operation of the unit, although few enforce this. A little talk with someone in charge advising them of the possibility of having to restrict visitation may have worked. I have always told my staff that they have to give patients/families a little leeway, but when this is abused, it becomes a task for the Charge Nurse/UM.

[TiredMD]

My thought on this is if everyone involved, the doc, admin, the floor staff draw a line in the sand, this crap stops.

I get called for this once in a while, which is amusing, since I have absolutely no discretion over visiting hours or policies.

Call your charge nurse, nursing supervisor, or administrator on-call. But don't call me. I can't help you.

[Ruby Vee, BSN]

i agree with much that is being said like the lock on the break room door. however; i still think how i would feel if i had a family member in the hospital regardless of the problem, especially if it was my husband, i would want to stay the night with him. maybe you just need to be very blunt and tell the family you are doing the best job you can, and their attitude and actions are keeping you from doing your job. sometimes families are so emotional and stressed they don't even realize how much of a nightmare they can be, try and put yourself in their situation and see if you can come up with a solution that not only solves you problem, but doesn't offend the family.

it's usually not the families who don't even realize how much of a nightmare they can be that we're complaining about. it's the ones who know they're being nightmares and don't give a rip. surely anyone realizes that it's "nightmarish behavior" to follow the nurse into another patient's room to bug her about fluffing mom's pillow, walk into the breakroom or steal all the snacks in the pantry!

[EmmaG, RN]

I get called for this once in a while, which is amusing, since I have absolutely no discretion over visiting hours or policies.

Call your charge nurse, nursing supervisor, or administrator on-call. But don't call me. I can't help you.

It's not a matter of you having discretion over visiting hours. If family members are compromising patient care, then I'd think you would be concerned. I've known docs to step in and let visitors (and patients) know their behaviour will not be tolerated. But on the other hand, I'd much rather you stay out of it altogether than be one of those who promise patients and their families things we can't possibly deliver, only to have them make my life a living hell.

[leslie :-D]

It's not a matter of you having discretion over visiting hours. If family members are compromising patient care, then I'd think you would be concerned. I've known docs to step in and let visitors (and patients) know their behaviour will not be tolerated. But on the other hand, I'd much rather you stay out of it altogether than be one of those who promise patients and their families things we can't possibly deliver, only to have them make my life a living hell.

sure, i'll get doc involved, if family interference is affecting pt well being.

just like i'll call the doc if i see a spouse pouncing on his fragile, vented wife.

leslie

[TiredMD]

It's not a matter of you having discretion over visiting hours. If family members are compromising patient care, then I'd think you would be concerned. I've known docs to step in and let visitors (and patients) know their behaviour will not be tolerated. But on the other hand, I'd much rather you stay out of it altogether than be one of those who promise patients and their families things we can't possibly deliver, only to have them make my life a living hell.

I am essentially cut out of anything non-medical that happens on the floors. I have to beg charge nurses to let children under 12 visit their sick parents. I get rebuffed when I ask for spouses to spend the night. Nursing took control of the policies on the floor, so it is therefore nursing's responsibility to deal with those who violate those policies. I can't tell a family member that their behavior won't be tolerated, because I have no way to back up that threat.

So when I get those calls, my answer has become "I'm sorry to hear they're giving you a hard time, but I think the nursing supervisor is better equiped to deal with this issue."

[TiredMD]

sure, i'll get doc involved, if family interference is affecting pt well being.

Ah, now this is a different issue, and one I'm happy to get involved with.

If it's just nurses, techs, or other staff getting irritated with a family's behavior, I'm not your guy. But the moment there are patient care issues, I'll be all over it.

[ZippyGBR, BSN, RN]

Our facility has just announced a switch to "open visitation" for all units (including all the intensive care units). Anyone have experience with this?

in the UK critical care units and paeds units ususally have open visting for family ... in the trust i work none immediate family visiting to critical care areas is at the discretion of the Charge Nurse / Sister on duty and often in consultation with family ... the paeds unit sticks to hospital wide visitign times for generla visitign but will aloow close family in 7am - 8pm or there abouts

on general adult units visting times are stuck to fairly firmly unless patients are critically ill (same kind of rules at the critical care areas ... some of the patients who are close to death but aren't for critical care interventions becasue of prognosis / futility/ advanced directive etc remain on the acute wards )

generally visting in the morning is strongly discouraged becasue of Ward rounds etc and visting at meal times is not allowed becasue of 'protected meal timimes' - unless someoen needs assistance with feeding and family are doing that - after negotiation with the Nurse in charge ... - equally protected meal times mean patients shouldn't be moved off that clinical area or have their meal interupted by any none time critical clinical intervention - about the only things we can do during meal times are dispense meds ...