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This is a discussion on Parents who are controlling in NICU Nursing / Neonatal, part of Critical Care Nursing ... How do you guys deal with parents who want to "micromanage" your nursing care? Lately on my unit we...by obprof Apr 6, '12How do you guys deal with parents who want to "micromanage" your nursing care? Lately on my unit we have parents who want to tell the nurses how to do their job like when and how to wean their child from the isolette, that they want medication for their child because they are convinced they have GI reflux, or that their child is in pain because it is crying (not because it is hungry and wants to eat now), etc? They will also rush in and pick up their baby despite the nurses telling them that it isn't time to do cares yet and their baby needs to sleep to gain weight. It doesn't seem to matter how much patient education we do, either. They are driving me nuts!
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- Apr 6, '12 by umcRNWhen you find the answers please share :-) My NICU is notoriously horrible for allowing micromanaging by parents, not just with the nurses but with the doctors as well. Things don't get escalated until there is a safety concern for the patient. It drives me crazy. Parents are allowed to dictate care, request physician progress notes which is technically against hospital policy and other ridiculous things because the docs just don't want to deal with them so agree to whatever they want just to shut them up. Ugh!
- Apr 6, '12 by bmsrnWe have parents like this. I just tell them the policy and educate them. It's really annoying though because they are the kind of parents that will "fire" a nurse if they don't like what they are told. It sucks that they get away with it- it's the charge nurses and upper management that allow them to be catered too. I've seen doctors cater to parents too- usually it's the parents that are lawyers or MDs. We have a policy for weaning to an isolette, so I just follow that policy- I don't care what the parents say about that. Same with giving pain meds for crying. If their kid is crying in a crib- they usually don't even have pain meds ordered.
When parents come in and wake up their baby an hour before their feeding, then they feed horribly, I straight up tell them "See, this is why we don't wake them up too early before their feedings". I'm pretty straight forward with the parents.
- Apr 7, '12 by Ashley, PICU RNFirst, remember that being a NICU parent is extremely challenging. The longer the child stays in the NICU and the more comfortable the parent becomes with the medical jargon, the more assertive they want to be about their role in the child's care.
If you're a parent, imagine giving birth to your child and feeling totally helpless. You can't even hold your baby, much less feed them, change them, or take care of their medical needs. You feel useless and rely on doctors and nurses to care for your baby. It's a very unnatural and unwelcome feeling.
So I'm sure you can understand, once the baby gets more stable and the parents learn basic care, why the parents feel it's so important to take hold of their new role and start making the decisions. They are the baby's parents and they have been left out for too long. They are tired of feeling useless. Rather than feeling like the nurses know so much more than they do, they now feel like they know their baby better than the nurses. Remember, they are at the bedside nearly every day, where nurses rotate every shift.
It's also possible that the parents do not feel informed about the child's care, making them even more apt to appear controlling. If the parent is requesting doctor's progress reports, it's probably because the doctor isn't giving them regular updates, in person, about the baby's status. These parents have spent weeks analyzing vital signs, amount of feedings, and ounces of weight. They don't like being kept in the dark.
While I don't work NICU, I do work PICU, and it's the same thing. Our patients often come to us from the NICU or have only been home for a short period. We also get a lot of children with chronic medical problems who frequent hospitals. I find that one of the best things I can do is tell them my plan from the beginning of the shift:
"Okay, Mom. This is my first time caring for little Jimmy, but I got a really great report from his nurse last night. Is there anything special you would like me to know about him? (Wait for answer) Okay. Thank you. Now, I see that he is getting fed Neosure 22 every three hours and his schedule today is 9a, 12a, 3p, and 6p. You'll be feeding him? Okay. It's really my experience that babies do best when we let them sleep in between feedings, so unless it's feeding time, I'll try really hard not to wake Jimmy up early, okay? (Here's a hint. When you say that YOU are going to try not to do anything, it's a hint for the parents to try not to do it as well.) Sometimes statement's like, "I agree with you, but unfortunately we have to follow this policy for weaning, just in case something goes wrong. I'd like to move him to an isolate faster too, but the hospital is really concerned about liability, and a few more days isn't going to hurt him." Pass the buck, if you can.
After that I'll ask if the parents have any problems with his schedule, questions I can answer, or specific concerns they want me to bring to the doctors. When I go in the room to do a procedure, I explain why I am there, what I am doing and why I need to do it. Sometimes I ask if there is something special that other nurses have done that make it go more smoothly.
I find that, almost 100% of the time, if the parent understands that you value their role and input, they are much more cooperative. But try to act like you know best, and they get up in arms really quickly.
Of course, some parent just want to micromanage, period, and nothing works. In that case sometimes you have to be frank to the point of saying, "I understand you want to be involved, but your decisions are hurting your son's care. And escalate the problem if you believe the child's safety is compromised.
- Apr 7, '12 by obprofThanks Ashley! That's really helpful!
- Apr 7, '12 by umcRNAshley I will completely agree with everything you are saying, and for the most part all those techniques work well with "difficult" parents. However, I have worked in NICU, PICU and peds CICU. NICU was my first job, my "home" unit so to say and I still love it there. That being said, of the three units for some reason NICU has THE WORST family/social issues. Maybe it's just my unit but I don't know. The parents who want to wake their sleeping baby? Fine, they will soon learn that the baby won't eat well if they do that, I have no problems with them. The parents who INSIST because of some research they have read online that their child should be on methylprednisolone instead of decadron, then get the docs to agree with them, then get upset when the kid craps out from the steroid change and mad when the docs switch them back to dex? That bugs me.
Or I love the ones who when their kiddo was doing well but suddenly develops NEC or something else the parents start screaming at the nurses to get away from their baby, "you're killing my baby!" (luckily I have never been told I was killing someone's baby but I have heard this screach a few times over the past years).
The grandparent who thinks their ex 26 wk now 5 mo old granddaughter should be sitting in a bouncy seat for developmental reasons and won't take no for an answer even as the baby is in the middle of a pulmonary hypertensive crisis, on 100% FiO2, 20ppm iNO, sedated, paralyzed and on pressors and has sats drifting into the 40s and HR into the 70's as we call security to get grandparent to step away form the crib. That's a problem.
The parents who refuse a g-tube for their 7mo old ex 23wkr who is trach/vent dependent, NEVER eaten in his life but otherwise seemingly "normal" but gags & aspirates everytime you stick a bottle in his mouth...hence lives on the unit a few more months because the docs allow parents to dictate his plan. That's a problem.
I could go on. Most of these problems are doctor related in that, like I said before, the docs don't want to deal with the parents so do whatever they want to keep them happy. It puts the nurses in a bad place and makes the day to day care of the patient miserable for everyone. It becomes even more fun when those babies grow out of the nicu and end up in picu/cicu where those doctors are much more stringent on their plans/boundaries and the families get even more difficult because of the culture change.
Luckily these families are only a small percentage of the ones we see on a day to day basis, but there always usually at least one on the unit. And like I said before, unfortunately it ends up giving the nicu a very bad reputation.
- Apr 7, '12 by obprofAmen umcRN!
And I thought it was difficult to work L&D with all of the "natural birth plans" that mothers insist on even if the baby's heartrate is crashing or she's hemorrhaging! (Don't get me wrong, I tried to have as natural of a birth as possible with my daughter. But, I'm not so rigid).
- Apr 8, '12 by Bortaz, RNJust tell them "You ain't the boss of me."
- Apr 8, '12 by NicuGalSometimes you have to let them learn the hard way about certain things...we can tell them over and over not to touch their 23 week baby who is oscillating and on all the drips, etc, but until they see the bad gas and the desats, etc they will do it. Or the ones that wake that baby after it has been sleeping an hour and keep Suzy awake for 2 hours and then Suzy decided eating isn't high on the priority list, then we are brutally honest and tell them this is why Suzy needs to sleep. We do give our parents a great packet on gestational ages and developmental things, but the majority of our client population aren't educated, are teen parents, drug parents, etc.
We also warn parents to stay off the internet....parent boards they go on are sometimes very one sided and that need to know that only certain articles are really evidence bases and others are as old as the hills.
Sometimes, there isn't a thing you can do but grit your teeth and educate them the best you can. And make sure everyone who cares for that baby is on the same page!
- Apr 12, '12 by littleneoRNOne of the unique things about NICU is that in the start, we truly know more about someone's child than they do. That and the fact that we can pretty carefully control this tiny little human and their environment tend to make us fairly anal and controlling. Although this is well-intentioned, I think it also makes us prone to forgetting that this is their child, and they do have the right to be involved in and make decisions about the child's care, even if the decisions aren't always the best ones.
Just like I can go to the doctor for some depression issues but then elect not to start taking anti-depressant medication that they recommend, a parent can seek care for their child but not always follow all of our recommendations. I don't believe we should cater to demands that are inappropriate. For example, the physician is responsible for the meds that they order, so they shouldn't order something that's inappropriate, even if the parent wants it. However, if I tell the parent that I am making an effort to keep things dark and quiet so the child gets a good nap, and I tell them why, they can still choose to wake up their child. I will do everything possible to help them make a healthy decision for their child, but in the end some of these things are their decisions. Don't you all ever ask questions about your doctor's recommendations and even challenge or disagree with them sometimes?
I have found that variations in the way I phrase things can make a big difference. For example, my new little patient's mom really wanted to hold him today. I could have said, "He's not ready to be held." or "He can't handle coming out yet." We say those things all the time, right? Instead, I said something like, "I would love for you to be able to hold him, and I'm sure you're really looking forward to it. I know it would be great for both of you. The actual snuggling part would be wonderful for him, but I am a little worried though about how he would handle the transition between the isolette and your arms. I noticed that when I do small things like turn him in bed, his oxygen levels drop quite a bit. I think it's going to be better for both of you if we pick a time when he is showing that he does really well with activity before we make a big move." This mom responded really well when she saw that I was paying attention to her baby individually and wanting the best for him. I'm not trying to say that I say everything right. I have just paying a lot of attention to my words lately, and I have noticed that parent responses seem to really depend on how I phrase things.
I guess if I was sitting at my child's bedside for weeks on end, I would probably have a lot of opinions (some misguided) about their care too. And I probably wouldn't respond very well to people who were very sure that they knew my baby and what was best for him/her better than me.