Rude Family Members: Just Venting! - page 2

Ok, so last night was probably *one* of the worst nights I've ever had working. Not because my patients were totally sick (one fresh post-op thoracotomy w/ R upper lobectomy; 2 fresh from the cath... Read More

  1. by   DusktilDawn
    Quote from SunStreak
    Chalk it all up to "Customer Service"......

    The Visitor's Code of Conduct sounds like an EXCELLENT idea. Never heard of that before; and I doubt if I every will AGAIN (at least, around here!)

    All of the acting-out family behaviors seen by nurses are caused by this policy of "Customer Service" to the point of absolute absurdity. It makes no sense from the get-go and this is where it has brought us.
    Quite shocked myself when it was brought up during a staff meeting. Apparently because of problems with visitors, in the future they will be photo ID with the area they are supposed to be visiting on a card they will be given. Seems there was problems with "visitors" being in areas they shouldn't be in (as in they weren't there to visit). We also see a lot of GSWs/assaults/stabbings on our unit who's identity is supposed to be protected.

    I've also seen visitors physically fighting with each other or with the patient. Stealing is a big issue also. Threatening staff, assaulting staff, inability to control crowds, lack of respect for the other patients and staff, the issues are numerous.

    Right now it hasn't been implemented and I really hope they stick to their guns on this one.

    It's not about just dealing with family member who may have actual reasons for being upset anymore. You're absolutely correct about where Customer Service has brought us SunStreak.
  2. by   KatieBell
    Quote from BabyRN2Be
    I don't know if it would work, going back to visiting hours that is. I see it at every hospital I'm at. At 9:00PM a general announcement is made saying that visiting hours are over... there are so many people who I know heard the announcement, but think, "that's for other people, not me." And then proceed to stay all night.

    Sometimes I wonder why they even bother to make the announcement.
    Visiting hours are only visiting hours if they are enforced. But then again, sometimes it is really nice to have Sister Sue sit with her confused Great Aunt. Its a toss up for sure.
  3. by   anewnurse2005
    Had 2 of them last shift. His IV site was hurting and had infiltrated. I told them that I would be back in a moment to restart the IV DC the bad one. Shouldn't have taken the old one out pronto, I know that now. She was all over my behind for the next 15 minutes. The second was an elderly lady with an AKA that had stage 4 pressure ulcers ALL OVER her buttocks. She had stage 1 across greater portion of her back. I changed her dressing to the stage fours at the appropriate hour, cleaned and packed the wounds, then placed "magic butt cream" again on the areas that weren't covered at 0600. She had had a bowel movement cleaned her up at the same time. This sweet lady came from home, her daughter in law had been taking care of her. From report I heard that she assumed no responsibility for the stage 4's that she had. "People are going to think I am awful because of these sores. I didn't know that we had to turn her". When I went in to initially see her at the beginning of shift, her daughter in law was on her cell phone. I did my intro asked if I could do anything to help and she waved me away with her hand, didn't even speak. This morning I was almost done with report when a nurse comes in and says 24's family wants to speak with a nurse. I go in to find the daughter cleaning furiously. "Did she vomit last night. Look at her gown and sheets. Look at this, she's been in sh##". I tell her no she hasn't vomited, it's probably the cream that I put on her buttocks. I cleaned her up about an hour ago, she must have went again. An older nurse told me that guilt and fear will do this to some people. I dunno. I took really good care of this lady and tried probably in vain to heal her sores. I hope that this lady doesn't have to go home to this care. I did exactly what I was supposed to do and the family is not satisfied. Had to vent too.
  4. by   ClaireMacl
    Oh I had a similar experience recently, though it was the patient. She was referred with a possible/probably DVT at 3pm and turned up at the hospital at 5pm. Being helpful, after assessing her, I explained that after 5pm we could not do doppler ultrasounds and most likely she would be called back the next day. She went completely crazy, screaming that if she died on a PE it would be all my fault, this went on and on, before I could get a word in, she stormed out, before I could explain that she would be given clexane as a precaution. I was just about tearing my hair out at the end of it, because she had refused observations and all I was doing was explaining hospital protocol.

    She didn't die, she was given Clexane and apparently did come back the next day, but why shoot the messenger, argh.... sometimes now I think twice about explaining the procedures incase this happens again!!!!!!
  5. by   ortess1971
    This summer, I was in the position of the family member. I'm going to play devil's advocate here and pose the possibility that some family members are overprotective because they have experienced poor nursing care in the past. My 89 year old grandmother went into the hospital for 3 days of tests and to treat a minor infection. She passed away on 8/14 and she received some of the worst nursing care I have ever seen. Went up to visit her one day and the room was extremely hot(windows were closed,fan was not on and her jonny was stuck to her. She had CHF and had an order for oxygen in her chart. She had no oxygen on her. She also had a stroke some years ago and was supposed to receive a pureed diet. Needless to say, she had been receiving non-pureed food. Her mind was fine but because she was old and spoke english with an accent, they thought she didn't know any better. They ignored the fact that she was having chest pain.(they said that "elderly people get confused at night") I admit it, I threw an absolute hissy fit and I would do it again in a heartbeat. It took me insisting on speaking to the doctor(I waited 3 hours) before they did an EKG and labs. She had a heart attack. What this whole experience taught me was that family members have to advocate for their loved ones.We all know that there are those among us in the nursing profession who are apathetic, incompetent or a combination of the two. I did not get upset because I was feeling guilty either. My grandmother was cared for by us at home and putting her into that hospital was the worst thing that could have happened. She had her stroke 9 years ago and she was doing well. I think family members have an absolute right to be present whenever they want to be-if we are doing are jobs well, it shouldn't be an issue. Of course, this is assuming that they are reasonable, polite people!:uhoh21:
  6. by   Town & Country
    I don't think anyone minds families being present, or being overprotective.
    What I do mind is the stunningly idiotic behaviors that nurses are so constantly exposed to!
  7. by   Nurse-o-Matic
    Tonight....
    Patient in room with severe chest pain getting prepped for emergent cath lab, meanwhile family insisting patient lips are dry- when can he get some carmex? He's hungry- hasn't eaten all day, when are you going to feed him? Just look at his toenails! When will you trim those? Louder....Where is that carmex? Family insisting I should tell them where to find the *&#!# carmex in the clean utility since I'm too busy piddling around with patient's drips and meds and consent form. Then, during all the riff raff, family of patient next door pokes head around curtain wanting fresh ice for thier family member's creatine clearance container (which had half-melted but was still plenty cold!)
    YIKES!
  8. by   LeahJet
    While it's all warm and fuzzy to talk about putting yourself in someone elses' shoes and to be all therapeutic..... there are some people that are just JERKS.

    I have kind of an off beat way of dealing with people like that.

    For instance, one night while in the ER, a co-worker asked me to go and try to start an IV on a very obese dehydrated diabetic woman. She had only tried once and couldn't even see anything else to stick. The minute I walk in the room, the daughter goes off on me. "Well lets see if YOU know what you are doing...you only have ONE try....I don't know WHERE you people learned to start IV's..." Just on and on ......
    I looked her right in the eye and say, "Well aren't YOU a sweet thing?" with my southern accent and a sweet smile. The taken aback look on that woman's face was priceless. She had no idea how to respond. She just shut up right then and there.
    See, the secret is to say things that would make the person look absolutely ridiculous if they tried to report you. "That nurse said I was a sweet thing!!"
    This is good for me because I get to get my point across and have fun doing it with a minimal risk of being complained about. I used to walk out of the rooms fuming...now I have a satisfied smile.
  9. by   Night Angel
    Dear LeahJet
    /thankyou, thankyou, thankyou!!!!!!! I really needed that~ I deal with those "very sweet things" on a daily basis. I applaud your way of handling the situation with grace and tact.:chuckle :chuckle Thankyou very much for the insight that I needed to handle situations like that. Hats off 2 U!!!!!!!
    Quote from LeahJet
    While it's all warm and fuzzy to talk about putting yourself in someone elses' shoes and to be all therapeutic..... there are some people that are just JERKS.

    I have kind of an off beat way of dealing with people like that.

    For instance, one night while in the ER, a co-worker asked me to go and try to start an IV on a very obese dehydrated diabetic woman. She had only tried once and couldn't even see anything else to stick. The minute I walk in the room, the daughter goes off on me. "Well lets see if YOU know what you are doing...you only have ONE try....I don't know WHERE you people learned to start IV's..." Just on and on ......
    I looked her right in the eye and say, "Well aren't YOU a sweet thing?" with my southern accent and a sweet smile. The taken aback look on that woman's face was priceless. She had no idea how to respond. She just shut up right then and there.
    See, the secret is to say things that would make the person look absolutely ridiculous if they tried to report you. "That nurse said I was a sweet thing!!"
    This is good for me because I get to get my point across and have fun doing it with a minimal risk of being complained about. I used to walk out of the rooms fuming...now I have a satisfied smile.
  10. by   ShayRN
    Heres one that happened to me the other night. We had a 93 year old patient with a junction rythm in the 30's. We gave him Atropine and put on the LifePak paddles to externally pace him. (His wife wanted EVERYTHING done, which is ofcourse her right.) We were prepping him for an emergency external pacer when ER brought up a patient and her sat was in the 60's. So we had a code in one room, an RRT in another and half the staff working in either room, with me running up and down the halls to make sure everything that was needed was in the rooms. A patient's sister was standing in the hallway watching all the commotion and I heard her say to the LPN at the desk (who was waiting for permits) YOU COME HERE NOW! So she went in the room to be told, MY SISTER HAS BEEN WAITING FOR PAIN MEDICINE FOR OVER 30 MINUTES AND YOU NEED TO TAKE CARE OF HER. The LPN explained that we had two emergency situations occuring and that the entire staff was tied up at the moment. Her response? "I don't care about that, she is still YOUR patient and you WILL take care of her NOW!" This patient was the mother of one of our doctors. When everything calmed down, I called him and explained the situation to him and he promised me it would be addressed. But, I really like the idea of a Visitors Code of Conduct. I may have to bring that up at my next committee meeting, hmmm.
  11. by   RN34TX
    Quote from Bonnie Nurse
    You know Dutchgirl, I do think the PACU nurse should have ASKED the patient if he needed pain medication prior to transfer. The whole situation may have been different if she did.


    I agree. BUT patients in PACU should not have to ASK. What would happen to most patients in PACU if we waited until they asked for pain meds? Not a pretty picture. Round the clock pain control is essential for reduction of complications post op. There may be facts of which i am unaware, but no pain meds post op seems ridiculous.
    I can tell from you, Dutchgirl, and Dusktildawn's comments, that hearing from someone who actually has PACU experience is in order here.

    Not everyone in PACU needs additional pain meds while in the immediate recovery period. You can't just push pain meds just because they've had surgery.
    This way of thinking could cause the patient to need to be re-intubated.
    It's a tricky and unstable period of time right after anesthesia and waking up. BP, Resp. and O2 sats drop easily during this time.


    Stretcher rides, transferring from stretcher to bed, and let's not forget how many patients suddenly put on the "crocodile tears" and drama once they leave PACU and see their family asking them if they are hurting.
    You can't push narcs right before leaving and them zoom them out the door to the floor to prevent the discomfort of transferring and stretcher rides. It's not safe.

    The condition of the patient when they are in PACU is completely different than when you get them on the floor.

    And this is coming from a nurse who is all for maximum pain control.
    PACU is just not the same.
  12. by   DusktilDawn
    Quote from RN34TX
    I can tell from you, Dutchgirl, and Dusktildawn's comments, that hearing from someone who actually has PACU experience is in order here.

    Not everyone in PACU needs additional pain meds while in the immediate recovery period. You can't just push pain meds just because they've had surgery.
    This way of thinking could cause the patient to need to be re-intubated.
    It's a tricky and unstable period of time right after anesthesia and waking up. BP, Resp. and O2 sats drop easily during this time.


    Stretcher rides, transferring from stretcher to bed, and let's not forget how many patients suddenly put on the "crocodile tears" and drama once they leave PACU and see their family asking them if they are hurting.
    You can't push narcs right before leaving and them zoom them out the door to the floor to prevent the discomfort of transferring and stretcher rides. It's not safe.

    The condition of the patient when they are in PACU is completely different than when you get them on the floor.

    And this is coming from a nurse who is all for maximum pain control.
    PACU is just not the same.
    I had a patient come to the floor post op colon resection. PACU had told me that he had not asked for anything for pain. Within minutes of being on the floor (I'm sure the stretcher ride didn't help) he was writhing with pain. I quickly gave him 6 mg of Morphine IV.
    BTW at one facility I worked at I received patients that have told me that they requested pain medications in PACU only to be told by their PACU nurse "They will give something for pain when you get to the unit." This happpened because at this particular facility, if the PACU nurse had given them analgesics they would have had to monitor them an extra 15 minutes according to that facilities policies. It was not all PACU nurses at that this place that did this, it was only 1-2. I repeat: it was not all PACU nurses at this place that did this, it was only 1-2. I'm well aware that patients are supposed to met a certain criteria before they are considered stable enough to be transferred from PACU to the unit. In regards to my response to Dutchgirl's post, the pt had not asked for analgesics in PACU, the patient was writhing in pain on the unit after a colon resection, I question in this instance whether the PACU nurse based her decision in regards to analgesics on the fact that the patient did not request them.
    Stretcher rides, transferring from stretcher to bed, and let's not forget how many patients suddenly put on the "crocodile tears" and drama once they leave PACU and see their family asking them if they are hurting.
    I would expect that the patient would find some discomfort/pain during the transfer process. I don't expect them to arrive writhing in pain. Some patients may even be stoic in regards to pain, doesn't mean that they're not in pain, they may not be telling you that they are in pain.
    You can't push narcs right before leaving and them zoom them out the door to the floor to prevent the discomfort of transferring and stretcher rides. It's not safe.

    The condition of the patient when they are in PACU is completely different than when you get them on the floor.

    And this is coming from a nurse who is all for maximum pain control.
    PACU is just not the same.
    No one said push narcs and zoom them out the door. If your all for maximum pain control, then does it not make sense that part of the criteria that patients meet prior to transfer to the unit be adequate pain control. Please tell me that as PACU nurse you assess pain in the recovery area and base that assessment on more than whether or not the patient's requests analgesics. The condition of the patient should not be completely different when you get them to the floor. Their condition should still be stable although the patient may experience addition pain and discomfort due to the transfer process.
    Originally Posted by DutchgirlRN
    I had a patient come to the floor post op colon resection. PACU had told me that he had not asked for anything for pain. Within minutes of being on the floor (I'm sure the stretcher ride didn't help) he was writhing with pain. I quickly gave him 6 mg of Morphine IV. A few minutes later his elderly mother comes to me and asks me how I dare give her son Morphine. She said I know you people only give people Morphine when they are ready to die. I know people who have received Morphine just before they died. I tried to be kind and explain it to her. She just wasn't buying it. I took her back into the room and explained it to her again and also to her son. He told his Mom to sit down and be quiet. I gave him a wink and with that I was out of the door. Gees, leave the work to the professionals. I wanted to ask her where she got her degree but I didn't want to be disrespectful.

    Originally Posted by DusktilDawn
    You know Dutchgirl, I do think the PACU nurse should have ASKED the patient if he needed pain medication prior to transfer. The whole situation may have been different if she did.

    Our facility is planning on implementing a "Visitors Code of Conduct," some people just get way too out of hand.
    This is Dutchgirl's post and my response. I'm not seeing where I said push analgesics in the immediate recovery period just because the patient had surgery. Perhaps I should have been more excruciatingly specific and stated "I do think the PACU nurse should have ASKED the patient if he needed pain medication prior to calling report, or at least within a reasonable time prior to transfer."

    Sorry RN34TX, I do still question whether in this instance the PACU nurse fully assessed this patient's pain control or based her judgement on the lack of request for analgesics from the patient. "The patient didn't ask for pain medication therefore their pain must be controlled" shouldn't be the attitude of ANY nurse in regards to adequate pain control for our patients.
  13. by   SmilingBluEyes
    Our PACU is just EXCELLENT about not sending up patients in too much pain. I really should thank them next time I see them----they have the PCA all set up and everything. I feel they are a real team of professionals and really do take care of our patients. I rarely get patients on my unit from PACU in much pain at all!

    Yep a thank you is in order.

close