How do you deal with overbearing family members?

Catch22Personified · Sep 19, 2012

Deal with them with a smile, address their concerns, and move on. Honestly, when I've pulled: "I'm in the middle of something, we can walk while we talk" usually makes the conversation briefer but there is that risk of HIPAA violations.

Some have the best of intentions.

A lot of them I've noticed never cared for their loved one UNTIL they were hospitalized and are overcompensating. I honestly had enough of overbearing family members after one of them was screaming bloody murder at me while I was doing chest compressions just because their precious little snowflake was constipated.

Esme12, ASN, BSN, RN · Sep 19, 2012

Try to be careful about frequently calling the doctor to "talk to the family". I would recommend using that option sparingly. There are some doctors who are willing at most any time to talk to their patients or the family members and may even prefer you to call them to let them know if there is a problem, others- not so much.
Doctors make rounds and many of them expect that the patients or family members will discuss their needs or concerns at those times. If it is an urgent or emergency situation, then it should be fine. If it is an annoying family member who is questioning every little thing, I would use caution. Sometimes I might tell them that I will call and ask the physician and then when I am on the phone with the doc, ask him if he would like to talk to the family. If he says no, then I haven't told them ahead of time that they will get to speak with the doctor and then be faced with returning to tell them that they cannot.
I know that it's their job and it's what they get paid the big bucks for and all that, but remember, if this family is driving you nuts, they are probably driving him nuts, too. Also, sometimes after being very defiant and demanding with you, they get on the phone with the doc and all of a sudden, "Oh, it was nothing". Now, you feel like an idiot. This has happened to me before on several occasions. If it was not an emergency or critical situation, I would try to educate them and handle it to the best of my ability and then tell them very matter of fact that this is something we can discuss with the doctor when he makes his rounds in the morning or later today, etc... You can also tell them, I will leave a note on the chart with your questions and he will address it when he makes his next rounds.
I guess I always tried to decide on a case-by-case basis. If it's really important, then by all means, call the doctor. If not, try to encourage them to discuss issues with the doctor during rounds.

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Agreed.....some doc's are good with families and others avoid them like the plague. I would answer what I can and divert the rest by having the family write the questions down I would let the family know when the MD makes their usual rounds....I would let case management/supervisor know that the family is being over bearing. I would leave a huge note on the front of the chart that the family wants to be called or needs a family meeting. If the family remains upset....call the supervisor and then call the MD.

Remember families are allowed to ask questions and are not being purposefully obnoxious....although some are just being pains in the behind.........seek help form your charge nurse/supervisor/manager. You will get better as time goes on.

imintrouble, BSN, RN · Sep 19, 2012

If I called any of the MDs on my shift (nights) about why they made med changes I'd be yelled at. I'd expect and deserve it too. A family who is that concerned, that involved, should have asked those questions of whoever made rounds that day. They can ask the MD in the AM. I'm sorry. I'll call the MD about alot of things, but just to satisfy their curiosity about a pill...not a chance.

I encourage pts and famillies to write down what they want to ask an MD. I provide paper and pens. I'll place a note on the chart for the MD to address those issues with the family during rounds. I'll search the progress notes and try to determine why the MD made changes. But I won't call an MD after 7P for something so minor.

I guess it boils down to the facility, the time of day, and the MD.

CoffeeRTC, BSN, RN · Sep 19, 2012

Overbearing family member here. Last week my sister was told (by her surgeon) that her gallbladder was, "Rotten. Not only did this scare her, but it also made her feel as if she was something to be hauled out and thrown away.
She was put on 02 several times during her hospital stay because her sats were low. She was not given an incentive spirometer to use after her abdominal surgey. She was not taught to splint herself when she coughs. This afternoon she called me up (from several states away - I wasn't there during her surgery) and said, "I can't cough hard enough to clear the gunk out of my lungs because it hurts too much. And oh, buy the way, is it normal not to be able to take a deep breath and feel like the air won't go all the way down in your lungs after surgery?"
Hooray for "overbearing" family members who look out for their loved ones. I wish I had been with my sister last week to protect her from the professionals providing her care.

This is something entirely different that what the OP was asking. You had every right to question things in this situation and what you describe is poor or lack of nursing care. The OP was making every effort to (we can assume) meet the family's needs and get in touch with the doctor.

CoffeeRTC, BSN, RN · Sep 19, 2012

I get this alot, but work in a different setting were the docs don't come in daily.

In LTC we have a few docs that round and will call the family to speak with them. This is awesome and cuts down on the questions that the familys may have.

If they don't and I'm there and taking off the orders, I call the family and let them know the doc was in and what changes they have made or what is new. If they have further questions, I direct them to call the docs office and ask to speak with them.

In your case, I would call the doc if I had a question about the med changes but if it was with the family questioning. couldn't you let them know that the doc will be rounding at xyz time and it would be best to ask him or her then?

maelstrom143 · Sep 19, 2012

You handled it as best as you could under the situation. Being new and having to deal with people hanging over your shoulder all shift can be rather intimidating. As you go along and get used to the common admission diagnoses, you will become more comfortable and begin to see a pattern of behaviors from doctors in response to different situations/diagnoses/patients.

Getting to know the most frequent admission diagnoses really helps.

Know:

Proton pump inhibitors: given as prophylaxis in ICU/PCU as stress ulcer prophylaxis (I tell them it is used to protect the patient's GI tract from all the meds and stress due to acute illness and decreased ability of the ill body to deal with things)

Anticoagulants: given to decrease risk of developing DVTs r/t while hospitalized

SCD's: help w/circulation to decrease risk of DVTs

I/S: decrease risk of developing hospital acquired pneumonia (very easy to not breathe as deeply as normally and even normally we have dead spaces; decreased mobility and pain can increase risk of atelectasis, bases becoming "sticky" from insufficient lung expansion)

CHF protocol: acute exacerbation vs chronic issue and possible need for change in meds/dosages in acute phase; become familiar w/beta blockers, diuretics, antihypertensives, etc...

COPD protocol: chronic vs acute/exacerbation: corticosteroids, breathing treatments, anxiolytics and how they can assist in decreasing anxiety and easing breathing in COPD patient

Mucomyst: given to as Tylenol antidote; however, it is also used to protect the kidneys; with increased renal function panel, docs may place patient on mucomyst for 24-48h PO (mix w/Coke to mask taste/smell) before undergoing any procedure that might involve contrast dye.

Diabetes protocol: esp important to know some hospitals will automatically withhold PO meds and start insulin protocol; metformin and need to withhold when patient has received/will receive any procedure using contrast dye (i.e. cardiac cath)

being familiar with common admission diagnoses and protocol may help when dealing with questions.

When dealing with repetitive questions, I try to keep it simple, letting the family know that often, meds will be changed or dosages altered after the doctor has reviewed the home meds list. Some meds may be restarted, others may not...it depends on the problem is and how the doctor decides to manage it.

For repetitive questions: give them paper and pencil/pen, and let them know how important their questions are and that if they write them it will be easier to address the issue when the doctor makes rounds without forgetting anything.

Frustrated family members who have missed doctor during rounds: have them choose one person to be the primary person and either call the doctor w/that family member's phone number and request for an update. Or, attach phone/name to chart w/request to call with update.

Family members who want to see doctor before he/she has done rounds: I do one of several things: if you have a white board, write that family member's name on the board very prominently with a phone number and request for the doctor to call and discuss POC, address questions.

If your hospital has the capabilities, give the family printouts of any new medications, admission diagnoses.

Sometimes, no matter how much you do, you may still have things that come up at the end. It is a 24h job. A professional taking over the shift from you, would do better to say, "we will write it down and place it on the chart for the doctor to see. Thank you for the information," rather than point out that it could have been done earlier.

Worse case scenario (a family that is just not happy no matter how far you go), let them know the charge nurse, director, patient advocate is at their disposal and you would be more than happy to let them know the family wishes to see them. This way, they do not get more and more angry/frustrated, and you have done all you could within your scope of practice. Remember, be assertive, do not let them monopolize your time. If in the middle of med rounds, let them know you have patients in cue for pain meds/critical meds, but that you will be back when you are done taking care of these issues.

Finally, I always let my patients know, I will answer your questions to the best of my ability. If I do not have an answer, I will find one or place a note on the chart so the doctor can address the issue next time he rounds.

Sorry; this is lengthy, but just wanted to share some of the stuff I do when in that situation. So far, it has worked for me :cat:

liveyourlife747 · Sep 20, 2012

^^thanks so much. The advice helps a lot.