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| No. 20 | 
Oct 11, 2009, 10:42 PM
 Re: Do family members know how annoying they can be? Originally Posted by zofran 
The pt told me "That is ridiculous! I am going to write a letter of complaint to the CEO of the hospital. The doctor said I could go home in the morning and he is not here to discharge me. What is wrong with you people!?" Family agreed, all yelling at me, telling me "we have things to do today, we were told she would go "in the morning.".
What I've said to those kind of pt is: "Okay, let's pretend for a second it's your mom in the ER, having a heart attack or a stroke. Would you want the doc to leave your mom to come discharge someone when it takes him 30 minutes to do a discharge?" If they've got a soul, they have a reality check. If they keep screaming, I give them an AMA form and tell them "You have two choices: wait, or AMA. Pick one." And then I call the charge nurse and admin rep so they know we've got an idiot on the floor.
 | | Advertisement Sponsored Links | | | | No. 21 |
Oct 11, 2009, 10:50 PM
Re: Do family members know how annoying they can be? Originally Posted by wherehastimegone She is on a dozen meds and has asked me many times if she can just stop taking them as she is truly 'done living'. I never know what to say. She is in her 90's, had a great life and is now lying in total misery in a bed in a small room in a facility. She has lost her mobility, her independence, her home, her belongings, her husband...she has a strong faith and she is ready to cash in!
Get the family on board and tell her yes. Get the doctor to write that she is terminal and get hospice in to manage her pain and the facility.
Good luck.
| | No. 22 |
Oct 11, 2009, 11:07 PM
Re: Do family members know how annoying they can be? Originally Posted by zofran Although I don't work in LTC, I really feel for you guys. I work at a hospital and the families/patients are just as bad. Luckly, my demanding pt/famlies do not usually stay for too long.....We d/c these unreasonable people and they end up at your facility. (so sorry)
Today I had a 65 year old lady, admitted for CHF exas, demanding to be discharged. The doc told her last night that she would most likely go home "in the morning." So at 8am she is out at the nursing station demanding to leave.
I told her that the doc would have to come see her first and determine if she is truly ready for d/c. I told her I would call him by 1000 if he didn't show up to see her by then. So at 1001 she's out at the nursing station again, family members in tow, to demand discharge NOW.
I text paged the poor doc, told him this pt is super anx for d/c, family is here to drive her, etc. He calls back, says he is in ICU dealing with a really sick person, and that he would get to her as soon as he could.
I explained to the pt/family that the docs here usually go see the really sick people in ICU and CCU before they come discharge "stable" people home. I told them that there are people DYING up there and that the docs will assess those poor individuals first, and then come see the pt's ready to go home.
The pt told me "That is ridiculous! I am going to write a letter of complaint to the CEO of the hospital. The doctor said I could go home in the morning and he is not here to discharge me. What is wrong with you people!?" Family agreed, all yelling at me, telling me "we have things to do today, we were told she would go "in the morning."
So these people are going to complain that the doc would assess DYING PATIENTS before discharging this woman. I honestly could not believe how selfish this pt and family were. It makes me physically sick at times......
Just know I feel for you all.....working in LTC, taking all this BS with a smile day in, day out...Keep your heads up nurses.....LPN's, you included. Don't let pt's or families take away from your skill and experience. RN's at my hospital appreciate you more than you would ever know.
Whenever I have patients like that, I do not bother mentioning what the doctor is doing or how long it will take. I usually respond with something informative, "the doctor told me he will see you as soon as he can." and leave it at that. I don't explain what he's doing or why. Self-centered people DO NOT CARE and it is always about them.
So, when the family or patient gives me a hard time, I just go into a repetitive mantra. Me: "The doctor said he will be here as soon as he can..he didn't say what time. I know..it's annoying. Patient: "What???blah blah blah blah blah blah sue you blah blah blah call the nurse manager...blah blah blah blah...!!!!! Me: "The doctor said he will be here as son as he can.he didn't say what time..I know..it's annoying..." Patient: "I already heard that!!!!!! I want him here NOW!!!" Me: "The doctor said he will be here as soon as he can...he didn't say what time. I know..it's annoying." Patient ( is now upset because I AM NOT UPSET) "I want to see the Manager NOW!" Me: "No problem, Ma'am. I will go and get her." Nurse Manager: "Ma'am can I help you?" Patient: "I want my doctor now and your nurse here keeps telling me he's going to show up when he wants to. I'm annoyed that I have to wait!!! I want something done." Me, looking at my Nurse Manager, shrugging: "Yes, the doctor will be here as soon as he can.. Patient says: "IS THAT ALL YOU CAN SAY?????" Me, looking at patient:"I spoke with the doctor and he said he would be here as soon as he can."
Nurse manager repeats mantra (she is the bomb, our NM): "Ma'am the nurse said the doctor will--"
Patient: "I HEARD HER."
As she huffs and puffs back to her room..........
I don't let the situation annoy me, or allow them to escalate. They can't do anything, and neither can I.
IT IS WHAT IT IS. C'EST LA VIE....GET OVER IT....
Smile. Smile...Smile....     :re dbeathe    | | No. 23 |
Oct 11, 2009, 11:25 PM
Re: Do family members know how annoying they can be? Originally Posted by SuesquatchRN Honestly, I have been both, and never heard that from anyone except one DON who didn't last very long.
One thing that gets me is that most of me residents should be on comfort care, not being treated for their HBP/ CVA/ dementia/ with restorative PT. We eke out another 20 minutes of life for them - feh. Get rid of the meds, hire more people, and treat them as they want to be treated. Let them sleep late, let them salt their pureed diet.
AMEN to that!!
There is a family at my ICF right now that's pushing their mother to go on dialysis. She is age 86, diabetic, blind, in heart failure, and she's been utterly miserable since her spouse died a year ago. She's also alert and oriented; if she's told me once, she's told me a hundred times that the only thing that would make her truly happy would be to join him in Heaven. She's lived her life, she says, and she's not afraid to die---the only thing she fears is going on like this.
So why in the name of all that is reasonable do these folks want to put her through this kind of agony and prolong a life that to her is no longer meaningful? I'm fairly close to them, and I've delicately attempted to negotiate this minefield by explaining what dialysis really entails and suggesting that perhaps they may want to get a second opinion, preferably from a nephrologist who doesn't have a financial interest in the local dialysis facility. But they seem determined to keep Mamma alive as long as possible, and she's not strong enough to put up much of a fight, especially with all of them standing together. It's a shame.........I love this woman heartily and it'll kill my soul when she does pass on, but if she were my mother, I'd want her to be comfortable and let nature take its course.
Sad.......so sad.  | | No. 24 |
Oct 12, 2009, 12:11 AM
Re: Do family members know how annoying they can be?
I understand that everyone needs a place to vent thier frustrations, but the distrust in LTC personnel is not unfounded. Many of the reasons that are given as to why you are frustrated would make me uneasy to have you take care of my family member. I have had many experiences with LTC centers and have never been impressed. The nurse to pt. ratio stated in an earlier post in itself leaves a very bad taste in my mouth......
| | No. 25 |
Oct 12, 2009, 12:43 AM
Re: Do family members know how annoying they can be?
There are techniques to building trust with families so that when you cant solve all their problems, they know you have done all that is humanly possible. I learnt some from my husbands seminars and they really help.
It's a matter of knowing what to say and when.
It starts with the admission,: explain from the start " There are hours when I cant be accessible for explanations as I will be providing essential care and cant be distracted, the doctor as well. But here is my personal cellphone number and I will call back as soon as I can". Follow this up with investing time when you can and repeating as often as possible,: " Your mother (or whatever) is important to us, it is in our best interest to keep her healthy and happy so you can depend on that.." or something of the sort. And mean it.
It is showing the families from the start that we are doing all we really can to make this part of their mother's life as good as it can be.
A nice touch is when you do something good ( e.g. like remembering that the pt loves the tomato soup and bringing her seconds of it ) and the patient is happy you should follow it up and say to her/him "You know we love you". and mean it.
Then when you dont have the time to talk you can briefly say " I am busy right now we can talk in half an hour(or tomorrow)"- and keep your promises.
If the doctor cant be available to sign off a discharge, apologize and explain nicely to the patient and her/his family. Not everything is in our hands.
If you have built trust, they will understand- they will be disappointed but so would I be in that situation.
Try to remember that from their perspective, we dont spend enough time with each patient, we are not gentle enough, the food we serve (mind you they blame us not the cook or facility) is garbage, it is our fault that the beds are not as comfortable as those at home, we are to blame it the TV is not set to their mothers favorite soap opera even though we gave the family the option of bringing their own TV and THEY said it was enough for Mom to watch on the public one in the Dayroom where the majority decide what channel is turned on etc.
Don't be afraid of referring appropriate complaints to your DON or SW or MD or Administrator. Or approaching them for help with extremely difficult patients or families. In such a case it is good to have a unit meeting and decide uniformly how to deal with a particularly difficult case.
This doesn't have to be a problem, and complaining here is a good outlet but trust me , we can do better!!
| | No. 27 |
Oct 12, 2009, 02:30 AM
Re: Do family members know how annoying they can be? Originally Posted by wherehastimegone I agree wholeheartedly. My grandmother is in severe chronic pain due to numerous issues, none of which are severe enough to end her life. She is on a dozen meds and has asked me many times if she can just stop taking them as she is truly 'done living'. I never know what to say. She is in her 90's, had a great life and is now lying in total misery in a bed in a small room in a facility. She has lost her mobility, her independence, her home, her belongings, her husband...she has a strong faith and she is ready to cash in!
I had to fight to get her her salt shaker...she super salts her food and so they took it away...if she wants salt - give her salt! And the PT started coming in..it was agony for her as the sessions were very painful..the PT kind of said no pain no gain...ridiculous...they stopped that too! I know they are trying to be 'helpful' but still, common sense. Thankfully they haven't taken away her walker even though she falls...and somehow never manages to break anything! They'd have a battle on their hands taking that walker!
You could always tell her the truth: She has the right to determine her quality of life. As a resident, she isn't required to take her meds. The facility can't *force* her to do anything. She (or her representative) could always advocate her MD to discontinue her meds. That way, the facility won't nag her anymore. Same thing with the salt shaker. Is she DNR? That's important too.
Bottom line, there still is a lot she can do to advocate for her care.
| | No. 29 |
Oct 12, 2009, 03:52 AM
Re: Do family members know how annoying they can be?
Originally Posted by wherehastimegone View Post
I agree wholeheartedly. My grandmother is in severe chronic pain due to numerous issues, none of which are severe enough to end her life. She is on a dozen meds and has asked me many times if she can just stop taking them as she is truly 'done living'. I never know what to say. She is in her 90's, had a great life and is now lying in total misery in a bed in a small room in a facility. She has lost her mobility, her independence, her home, her belongings, her husband...she has a strong faith and she is ready to cash in!
I had to fight to get her her salt shaker...she super salts her food and so they took it away...if she wants salt - give her salt! And the PT started coming in..it was agony for her as the sessions were very painful..the PT kind of said no pain no gain...ridiculous...they stopped that too! I know they are trying to be 'helpful' but still, common sense. Thankfully they haven't taken away her walker even though she falls...and somehow never manages to break anything! They'd have a battle on their hands taking that walker"
Have you tried approaching the DON and SW? Who is the POA? Have you signed a DNR?
The nurses cant give her her meds by force and if she wants salt and understands that her doctor recommends against, but wants it anyway- they have to give it to her.
HOWEVER Please try to understand the staff whose jobs it is to encourage her and give her the meds as per MD order.
You can call the state and report the facility ( even anonymously).
I hope your grandmother feels better quickly
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