Hard to handle family members

Nurses Relations

Published

Specializes in ICU.

Over the past few weeks it seems like we have just had an above average amount of "strong personality" family members. One has been staying bedside 24/7 trying to bully and dictate her fathers care. She even has a list of staff members that are and are not allowed to care for her dad. I am usually a very passive person, not one who does fantatstic with confrontation so often give in to her requests. This left me clocking out at 22:00 the last time I had her because I still had 2 blank flow sheets and had not gotten to chart except 2 patient notes all day. My shift SHOULD have ended at 19:15.

Wondering what your best but respectful ways are for enforcing boundaries are. How do I not get run over by people like this?

Thanks for any input!!

Up Vote Up Vote ×

Develop goals with her (presuming the father is unable to make decisions) for the shift/day and then periodically remind her of those goals. Let her know how often you will be in the room and what you will and will not do. Like with a child, make a schedule and establish boundaries.

Should be simply provide resistant to all interventions then involve your chain of command to help intervene.

If you provide examples of how she is "difficult" we may be able to provide you with more pertinent advice.

Up Vote Up Vote ×

Yes, an example would be helpful.

Up Vote Up Vote ×
Specializes in Critical Care, Education.

This is one of those classic 'conflict management' scenarios that are introduced in nursing school. Going back to the basics will help. Try to separate the 'issue' from the 'content'.... Many families are overcompensating for feelings of guilt because they perceive that they should have been more attentive or caring - now they're trying to atone. Another common thread is compensation for loss of control by trying to control everything. I have often found that families of gravely ill patients seem to be experiencing anticipatory stages of grief ... and you're on the receiving end. Maybe they're just scared stiff because they've heard all the horror stories about hospital stays or they have had bad experiences in the past.

I agree with PP - engage the family & make them part of the process if possible. Make sure they are in the know about what is going on at all times. Each shift, you should make it very clear that you have other patients to care for... and how you plan to divide your time. Work with her to develop a tentative schedule of events - and then let her know if you have to deviate, and why.

If all else fails, can you get a psych nurse to consult? They could help you come up with a realistic behavioral mod plan.

Up Vote Up Vote ×
Specializes in NICU, ICU, PICU, Academia.

This is an issue for your manager to deal with. It's their job.

Mine has actually established contracts for difficult families, and that whole 'not allowed to care for patient X' is strictly not allowed without remarkably extenuating circumstances.

Up Vote Up Vote ×

It is very easy to "not get run over" .

The "boundaries" are not up to you, or the facility to decide. There are no boundaries when it comes to getting the best care for your sick and helpless loved one.Answering the patient's and the family needs are what we are here to do.

Listen to the family concern. Have a five minute conversation with the family .. where you LISTEN to them.. acknowledge their needs and...

let them know you understand what they want for their loved one.

Problem solved.

Up Vote Up Vote ×
Specializes in NICU.
It is very easy to "not get run over" .

The "boundaries" are not up to you, or the facility to decide. There are no boundaries when it comes to getting the best care for your sick and helpless loved one.Answering the patient's and the family needs are what we are here to do.

Listen to the family concern. Have a five minute conversation with the family .. where you LISTEN to them.. acknowledge their needs and...

let them know you understand what they want for their loved one.

Problem solved.

Yeah, not so easy when family members are difficult and WONT listen. And yes, there definitely need to be boundaries. Yes we need to listen to their concerns and what they want for their loved one....but as the nurse we know what is BEST for their loved one. And when a family member is dictating who can and cannot care for their loved one, what the nurse can and cant do....that not only means the nurse cant provide the best care they can for the patient, but other patients' care is jepordized because the nurse cant get to what they need to do. Personally I don't think things like this should be accommodated unless its a legitimate concern. Of course we need to be mindful of what the family is going through, but we also have jobs to do.

I have a friend who had an extremely prematurely born son (25 wks), and she would always dismiss what the doctors and nurses said and blow off the care they suggested for him because she said she knew what was best for him and they knew nothing. Sure, you might know what is best on a personal level but last time I checked you didn't go to school to learn the medical aspects of things and what is best for their medical care.

Up Vote Up Vote ×
It is very easy to "not get run over" .

The "boundaries" are not up to you, or the facility to decide. There are no boundaries when it comes to getting the best care for your sick and helpless loved one.Answering the patient's and the family needs are what we are here to do.

Listen to the family concern. Have a five minute conversation with the family .. where you LISTEN to them.. acknowledge their needs and...

let them know you understand what they want for their loved one.

Problem solved.

I would agree that we are here to serve the patient and their family but we must establish professional boundaries.

Up Vote Up Vote ×
I would agree that we are here to serve the patient and their family but we must establish professional boundaries.

I guess that would depend on what the definition of boundaries are in this case.

In all of the facilities I have worked in lately, the patient and families call the shots.

Unless they are being extremely loud or threatening we are doing the "please them at all costs" dance.

OP .. This is the time for your manager to intervene. NM will surely handle the situation if it is causing overtime.

Up Vote Up Vote ×
Specializes in ICU, Postpartum, Onc, PACU.

I have a "cold heart" I guess when it comes to this type of stuff. Unless the patient is on comfort care, it's 2 visitors at a time. When family members protest and I've tried to explain nicely, sometimes it comes to me asking "If I need the room, what would you rather have in the room? A crash cart or an extra couple of people?" and that usually works as our rooms are obviously on the small side.

I try to answer questions and things to the best of my ability and try to accommodate, but it just doesn't work with some people. The ones who sit at the bedside and write every little thing down because they're going to sue over the smallest thing are irritating, yes, but it's part of the job (nowadays especially!).

Also, I've gotten "fired" a few times in my 5 years as a nurse and it's usually a positive thing because I'm not having to deal with a difficult family member (the patients are hardly ever the problem in my experience) and they get a different nurse they might jive better with. The 4 times I've been "fired", once was a total shock because one of the daughters had thanked me for the care I gave her mother and another time, the patient apologized when she saw me again because she felt bad!

You can't please everybody and in this profession, if you try, you'll go nuts! ;-)

Up Vote Up Vote ×
Specializes in ICU.

Thanks for everyones input. Yes, this was the family member who took notes on who came in the room, what was done. With other nurses photos were taken with her cell phone which is grossly against hospital policy although to my knowledge nothing was done. It almost seemed like management had taken an appease her in everyway possible so she doesn't file a frivolous lawsuit...... which I am almost positive a supoena will be coming my way sometime in the future. Probably the entire floor, anyone who placed hands on her dad. Luckily (?) I was one of the few she liked. Probably because I put off all charting and anything else to put her dad first. Which would be why I left at 22:00 that day. She reported Dr's, nurses, anyone and everyone to the higher powers. Some of which were very good Doctors, but she didn't like something they did or said.

We have since sent the pt to a rehab hospital. She was not a happy camper since they don't allow family to stay bedside 24/7 and stonewalled us anyway possible in delaying the transfer.

Up Vote Up Vote ×
Specializes in Telemetry, Med-Surg, ED, Psych.

Call the nurse manager and let them deal with these lunatics. I am not paid to be a patient relations officer or an administrative compliance director.

The minute I see the notepad come out, the names being jotted down and the demands called out, I excuse myself and get the big boys involved. Other people need my care more and frankly, I am in no mood to be on the defense while trying to provide care.

My advise : Stay cool, Smile, Pretend you give a crap, and get the powers that be involved.

Problem solved

Up Vote Up Vote ×
+ Add a Comment