Difficult families....

NoCrumping · Apr 24, 2005

We have parents that say who can and can not take care of their kid all the time. Usually it is because one nurse enforces the rules when others let the parents do whatever they want to do. Of course, there are notes at the desk saying "do not assign baby boy BB to nurse XX per parent request" all the time. SOme patients even have "parents request that only the following nurses be given baby girl GG." Everyone LOVES not to be on that list, because those parents can be so demanding.

I think this is wrong.... what do you think? I mean , unless there are specific legitimate issues with certain nurses, if the families are consenting to care in a nicu, or anywhere, for that matter, means they are consenting to be treated by whomever that facility deems appropriate. Its a hospital. Not a hair salon where you pick the people who do your hair. I agree most of these people need control over a situation where they have none, but I think management should step in here and stand up for their nurses. Its like, the parents are making up the staffing assignments with their demands.

what does everyone else think?

fergus51 · Apr 24, 2005

I completely agree with unfit nurses being barred. That isn't my issue at all. My problem is when what nehkismom said happens: one nurse enforces the rules they should ALL be enforcing and the parents get their way by throwing a fit. I find this completely unacceptable. I've even been asked to change assignments in the middle of a shift to pick up such a family and have told the manager I'll take the assignment, but the rules will be no different with me than they were with the previous nurse.

IMO, the problem is that managers nowadays are more concerned with parent satisfaction than patient outcomes. I am sick of hearing them excuse inexcusable behavior. This "customer is always right" mentality has no place in healthcare. This isn't MacDonald's. Our responsibility goes a lot deeper than that.... OK, rant over carry on....:)

live4today, RN · Apr 24, 2005

If management changes assignments then your coworker should be enforcing the rules the same way the first nurse did. That way the parents get their way, but they don't manipulate the staff. Bring it up in a staff meeting...that you will back each other up in these situations even if you wouldn't normally make the same decision. You should have each other's back.

Great advice! Nurses simply MUST learn to support one another! Deal with your differences behind closed doors, but when you come out to the patients and visitors, keep a united front so "no wolves" cross the line and break the consistency of the unit. This is FOR the safety of THE PATIENTS...not to please the nurses. When will they get it! :rolleyes:

live4today, RN · Apr 24, 2005

I completely agree with unfit nurses being barred. That isn't my issue at all. My problem is when what nehkismom said happens: one nurse enforces the rules they should ALL be enforcing and the parents get their way by throwing a fit. I find this completely unacceptable. I've even been asked to change assignments in the middle of a shift to pick up such a family and have told the manager I'll take the assignment, but the rules will be no different with me than they were with the previous nurse.
IMO, the problem is that managers nowadays are more concerned with parent satisfaction than patient outcomes. I am sick of hearing them excuse inexcusable behavior. This "customer is always right" mentality has no place in healthcare. This isn't MacDonald's. Our responsibility goes a lot deeper than that.... OK, rant over carry on....:)

Amen to all that!!! :) We all know that "the customer" isn't always right, so why treat them like they are when we know they're not. :rolleyes:

Management likes their cushy jobs. If they don't do what admin tells them to do, their jobs are in jeopardy. It takes a really strong and confident manager to stand up for the nurses they manage. If managers do not stand up for the nurses they manage, that only shows they have a weak backbone and are afraid to stand up for what they know to be right and just.

VEVINA · Apr 25, 2005

How to deal with parent who has always gave "sacarstic" remarks and also have preference nurses to nurse their babies? I had this mum saying that to me one of my night duty before she went home: "Nurse, don't fall asleep tonight!" I was so shocked and angry...just because her baby had self-extubated in one of the night. Morever, that was my first time taking care of her baby in that night duty. And, she wasn't talking in a joking manner. I did tell my nurse clinician about this matter on that very night...but to my disappointment, she did not do anything to it. In my ward, most of nurse managers never stand up for nurses' rights, especially towards the demanding parents.

And, just because her baby is premature, she always expect the nurse that taking care of her daughter, to be always in the room. And she will always interrupting the nurse conversation with the other baby's parents, by adding sacarstic remarks... :angryfire

t2000JC · Apr 25, 2005

i would say just be the professional at all times, and don't seem intimidated by her attitude. it may stem from her constant stress of having a premature baby. whenever parents have a sarcastic comment from me it's usually from not understanding the whole situation. (for example, exptecting the nurse to immediately bump up oxygen on a baby versus waiting and seeing if the baby can come up on their own)..maintain that you are the professional nurse who is working on that unit for your patients. t.

mac23 · Apr 25, 2005

All of our babies have a social worker assigned to them and I often get them to consult with the family to see if they can help. Sometimes the out of control families have so much going wrong, they act out when they come to the unit. A lot of times I've found that the issue is they feel they have no control over their baby and that some nurses are too possessive. They feel like the baby will never bond with them and are simply afraid.

We sometimes had problems with families who had a primary nurse that wasn't working and didn't like the way the other nurse did things. I've experienced a lot of times where a primary nurse will let a family bend the rules so they think it's ok. Then when the other nurses enforce the rules, they don't understand why all of a sudden it's not OK to do what they are doing.

Besides social work and just reinforcing how the unit works, we get our nurse managers and the patient satisfaction department involved. At least on my last unit, they were very good about not giving in to unrealistic demands. Because it is an intensive care setting our rules say the we have the right to restrict visitation if we feel it's necessary and at times have done this.

It's been extremely rare and the baby has to be stable but the other option is to have the attending speak to the family and they sometimes give the family the option of transferring the baby out to another facility.

Lastly, our unit had a parent support group of former preemie parents that we tried to refer difficulut families to. Some in the group were difficult at one time or another in thier stay and try and offer the family support throughtout their stay. The nurses who head this group are very good about picking families who changed, and not one's who will justify the inappropriate behavior.

When my daughter was in NICU I did ask that one nurse please not be assigned to my child. He couldn't even put an NG in the right place without getting help. My concern was what if one day he felt he could do things on his own......who knows what could have happened.

When families make inappropriate comments to me, I just remind them that I have the education and training necessary to care for their child and that our goal as a unit is to do what's best for the baby.

LilPeanut, MSN, RN, NP · Apr 27, 2005

No, she never apologized, that I remember. She could have at the moment when she realized that she had made a huge mistake, but I was upset at the time and don't remember Anyway, it doesn't matter, I hope the nurse learned to not jump to conclusions about parents. I'll admit I may have lost my temper a little. In my defense, I had JUST given birth and I was coming off all sorts of drugs, including mag. *blush* I try in general to keep my temper, but medications can screw with your head.

mattsmom81 · Apr 27, 2005

Adult critical care units run into similar problems as NICU...IMO these problems can get totally out of control with open visiting; aggravtyed further when nurses will not consistently enforce visiting rules and common sense boundaries with their family relationships.

IMO this happens cuz: 1) some nurses are codependent and cannot stand for their families to get upset/not like them if they don't get their way and 2) nurses get dysfunctional when the nurse manager won't stand behind them when family gets upset. That combination leads to the type of 'nurse picking' and manipulative, staff splitting behaviors we see.

It all boils down again to nurse solidarity...again. That nurse manager is still a nurse, and that codependent nurse is not above the rules.

Since the institution of 'Above and Beyond' customer service awards in facilities, I've seen more suckazz nurses going to ridiculous lengths to ingratiate themselves in order to get the positive note to administration as well...disgusting IMO.

SarasotaRN2b · Jun 3, 2005

Do NICU's have open visiting hours for parents or specific times?

Kris

LilPeanut, MSN, RN, NP · Jun 3, 2005

Usually, they have open visiting, except for shift changes, when everyone needs to leave to ensure the privacy of the babies when reports are given.

Gompers, BSN, RN · Jun 3, 2005

Yep, usually pretty open. The only time parents aren't allowed on our unit is a few hours each morning when the docs do rounds. We really need to have privacy during shift change as well, but the problem is we even do four hour shifts, so we'd be kicking people out at 7am, 11am, 3pm, 7pm, and 11pm. For now, at least we have privacy to discuss things during rounds.

Other visitors are only allowed in from noon-9pm, accompanyed by the parents.