I am struggling with patient families lately.

Ruby Vee, BSN · Dec 31, 2012

Years ago, I read a venting post from a nurse who was frustrated because she had a patient who was fixing to die, and 16 family members were standing around the bed with another 20 or so outside the room, all wailing loudly and screaming in Spanish. The family was so loud that other patients were having difficulty resting and their families were approaching the nursing staff trying to get them to "quiet those people down." The patient died, and the noise escalated while some family members began throwing themselves on the floor to kick and scream, flinging themselves into each other's arms and the arms of innocent passers by and tearing at their hair and garments. The OP was venting because all of the other patients on the unit were suffering through this family's protestations of grief.

I could not believe how many posters wrote in, excoriating the OP for her lack of compassion for the grieving family and telling her that "it's their culture" and "you need to learn to be more tolerant of other cultures" or "you need to find some compassion or find a new job." When I did a little investigation, I found that most of those posters were brand new nurses, student nurses, or wannabes.

Sadly, people with very little experience or NO experience, still feel that they know better than we do how to do our jobs; and the very people who are excoriating us for our perceived "lack of compassion" show very little compassion for us, their colleagues or future colleagues. It's very hard to teach someone who already thinks they know everything; we just have to wait until those posters accumulate a little experience of their own and start to "get it."

Meanwhile, my take on visitors is pretty simple: visiting is a privelege, not a right. If you're not following the rules, if you're hindering the patient's care, getting in the way or making a pest of yourself you clearly do not deserve the priveledge of visiting. I wish more nurses felt that way.

DoeRN · Dec 31, 2012

Why should the family have to meet any expectations of yours??? YOU are the nurse. YOU work for the hospital. Yes, as a nurse, YOU are "expected" to be "on top of" matters regarding the patient. The expectations rightfully belong to them and the patient. Their loved ones' care is in YOUR hands.

Here is a situation for you since we are to please the family.

You get report and you have a patient that isn't doing so well. Her sats are dropping and she wasn't like this last night when you had her. You have another patient in a lot of pain with a really anxious husband. Your in the patient's room who's 02 says are dropping. She stops breathing and there is no pulse.

In the meantime the anxious husband is at the desk complaining about his wife's pain and the fact that the nurse hasn't been in the room. The charge nurse has a full assignment but agrees to look at the MAR to see when she can have pain meds. All of a sudden the code bell goes off. The charge nurse runs to get the crash cart. The anxious husband jumps in front of the crash cart and stops it. He is demanding that the charge nurse gives his wife pain medicine before she runs into the code room. What would you as a nurse do? Please the family because that is your job? Or do you tell him to move out of the way and save the dead patient who is a full code life?

SaoirseRN · Dec 31, 2012

The above is a extreme example, but I think it illustrates the point that OP was making. In that case, no, I'm sorry that the man's wife is having pain, and normally I would be right on that, but right now my other patient is the priority and I will not stop and appease this husband, nor should I expect another nurse to do so either.

I will certainly speak with him after and explain, whether he is receptive or not, but in the moment he is in the wrong because he is not only keeping me from doing my job, but endangering the life of another patient. Pain is not ideal, but death is less so.

(I am in other words supporting the above poster's comments)

martymoose, BSN, RN · Dec 31, 2012

Here is a situation for you since we are to please the family.
You get report and you have a patient that isn't doing so well. Her sats are dropping and she wasn't like this last night when you had her. You have another patient in a lot of pain with a really anxious husband. Your in the patient's room who's 02 says are dropping. She stops breathing and there is no pulse.
In the meantime the anxious husband is at the desk complaining about his wife's pain and the fact that the nurse hasn't been in the room. The charge nurse has a full assignment but agrees to look at the MAR to see when she can have pain meds. All of a sudden the code bell goes off. The charge nurse runs to get the crash cart. The anxious husband jumps in front of the crash cart and stops it. He is demanding that the charge nurse gives his wife pain medicine before she runs into the code room. What would you as a nurse do? Please the family because that is your job? Or do you tell him to move out of the way and save the dead patient who is a full code life?

This is NOT an extreme example! not to mention it is becoming more and more common with the ME ME ME mentality of entitlement.

Sure, after all is said and done, and they fill out their press ganey, who do you think is going to give the bad review- the dead pt, or the ****** who said no one was paying attention to his family member???Press Ganey does not take into account what you were doing at the time.

That is what this is all about. If hospitals are going to continue to reward and coddle the most obnoxious- this stuff is only going to GET WORSE.

What part of "the customer is always right" are some of you not hearing??

Oh, and yes, of course I would attend to the code first. But I would also expect to hear in the next month that "our scores are dismal" and we are all going to get spanked for it.

SaoirseRN · Dec 31, 2012

This is NOT an extreme example! not to mention it is becoming more and more common with the ME ME ME mentality of entitlement.
Sure, after all is said and done, and they fill out their press ganey, who do you think is going to give the bad review- the dead pt, or the a$#@$ who said no one was paying attention to his family member???Press Ganey does not take into account what you were doing at the time.
That is what this is all about. If hospitals are going to continue to reward and coddle the most obnoxious- this stuff is only going to GET WORSE.
What part of "the customer is always right" are some of you not hearing??
Oh, and yes, of course I would attend to the code first. But I would also expect to hear in the next month that "our scores are dismal" and we are all going to get spanked for it.

It's posts like these that make me glad I work in Canada. We still get the ME ME ME ME crap, but we are not expected to take it just to make people happy. Come work up here, nurses!

martymoose, BSN, RN · Dec 31, 2012

Meanwhile, my take on visitors is pretty simple: visiting is a privelege, not a right. If you're not following the rules, if you're hindering the patient's care, getting in the way or making a pest of yourself you clearly do not deserve the priveledge of visiting. I wish more nurses felt that way.

I wish more corporations, I mean hospitals, felt that way

Anna Flaxis, BSN, RN · Dec 31, 2012

DoeRN's example isn't too far off the mark. Although I've never experienced that exact situation, I have had family members come out of the room to request another pillow or warm blanket as I'm zipping down the hallway loaded down with pumps, fluids and meds for a patient who is crashing, only to get a nasty look or comment when I tell them I will get to it when I can. I had a guy with dental pain repeatedly coming out of his room to complain about the wait, while the doctor was in coding an infant. I've had family members get angry with me because I won't feed their pre-op loved one, even though I've patiently explained why they cannot eat.

It's true that people can be blatantly self centered and unconcerned about what else might be going on that just might be more important than a cup of coffee, a soda, or an extra pillow. When you are exposed to that again and again day in and day out, it does affect your attitude. When I worked in the ED, there were days when I wanted to get rid of the blanket warmers and pillows completely.

I'd also like to point out that the "Patient's Bill of Rights" also includes Patient Responsibilities, and most consent forms include a section that states that the patient is aware of their Rights and Responsibilities; when they sign consent for treatment, they are also signing that they are aware of these.

Ruby Vee, BSN · Dec 31, 2012

I met a brand new nurse tonight who views Press-Gainey as the answer to all of nursing's ills. I told her I thought Press-Gainey was Satan incarnate. She's no longer speaking to me. Now where is the butter an salt? I'd love to chomp on that young'un.

martymoose, BSN, RN · Dec 31, 2012

^^^ omg really???? what are these schools turning out now???

Guest343211 · Dec 31, 2012

Family-centered care is appropriate for any patient. The problem I am reading here is lack of feeling support for setting appropriate limits in the healthcare setting in order to be able to facilitate this in a productive way. Now this then becomes a problem with leadership and administration (the crux of most problems in healthcare IMHO). Nurses and physicians need support from administration for appropriate limits and boundaries. Family-centered care and Patient-centered care is not something people can make a blanket statement about in terms of application.

Those family members that are truly problematic must be addressed on a case by case basis, as well the fact there there needs to be as sound policies in place. Of course, then, those policies need to be enforced consistently.

Most of the time, even for my sick loved ones, I have not had to be there overnight, night after night. But here's the thing: often nurses are forced to work with limited staffing, and I have seen very serious things get missed. Therefore, I will continue to advocate for people "being there" to look out for their family members. It doesn't mean people have to move in, as is often the case in pediatrics. When patients are pretty sick and vulnerable, however, they often do need someone that will watch out and go to bat for them. I think this is more of a function of making nurses operate, out of desperation, apart from that of a true advocacy role (often, again, suboptimal staffing).

When I know the nurses in area are strong advocates and have the ability to function in such a matter, I know I don't need to be there so much. Trust me. No family member wants to live at the hospital or stay overnight. The 99% of all family members that do this do so ONLY for the safety and advocacy of their family member.

**Much of it has to do with appropriate staffing, strong and positive communication, and a sense that the people caring for your loved ones are dedicated to the safety and advocacy needs of your loved one. When this can be accomplished, nursing and the institution take a HUGE burden off of the family member/s. Remember that many family member-advocates have their own families and jobs to attend to as well. **

As for people that are just there to be there, it can be a touchy situation, but you have to have the appropriate support of management and administration. You do have to be careful in how you handle it. But there has to be clear parameters and limits in place. And individuals have to kindly, respectfully, yet firmly have to address the family. At the same time, you also have to be humble and honest with yourself regarding your own prejudices re: family-centered/ Patient-centered care. If the nurse has an attitude where she or he are just writing it off as something that "makes their job harder, they have TOTALLY missed the boat. Indeed, one day, they may find either themselves or their close loved one in a vulnerable situation, where there clearly needs to be closer advocacy and support. If the situation becomes severe enough or has been a problem a number of times throughout hospitalizations, individual nurses will change their tune on it--unless it's all just about a job to them, and they have very little ability to empathize with the situation. I have met a few of these nurses while one of my loved ones was very critically ill. I tried to be respectful to one nurse's role, but she just shut me down, b/c clearly her prejudice was set, and in her mind, her control and ease of role was paramount to her. As a fellow nurse, I knew I was walking on egg shells, b/c I understood her side as well as mine as advocate for my loved one. She didn't care. Fortunately, there were other nurses that did, and these nurses made ALL THE DIFFERENCE. So, I ended up not worrying about if that nurse liked me or had an attitude, b/c my primary concern was for my loved one. I did what I had to do, and I don't regret being family advocate. As nurses, patient advocacy is job one. But also, there's a old saying that says, "Charity begins a home"--that is within your own family. So what kind of hypocrite would I have been to be a strong advocate for my patients, but ignore that role for my own close family member? I mean, that would have been ridiculous. So in the end, you do what you have to do. There needs to be a strong measure of understanding regarding what many family members are going through with concern for their loved ones. Don't go through the motions. Try to literally put yourself in their shoes. And don't paint all family members with such a broad brush. Those that abuse the situation need to be dealt with in a firm, but kind manner. Yes, it's a pain in the butt, but the overall benefits of FCC/PCC outweigh the negatives if the philosophy is applied in the right way.

Again, the bigger issues seems to be sub-optimal staffing, lack of education on FCC and PCC philosophies and applications, and lack of consistent and wise administrative support.

It can work and does work. It requires a balance in approach--not a reactionary one.

Guest343211 · Dec 31, 2012

Thank you ruby and palmharbormom and all the other posters who do not think I am a horrible nurse for being annoyed with visitors.
I do believe that I stated enough times that I think that visitors are a beneficial part of recovery.
I can tell you that I am a damn good nurse and would never give my patients (or their families) any less care than I would give my own family.
I came here to vent, not be judged and told that maybe I need to find another line of work.
As for sixela21, I hope that nursing school and your subsequent nursing career is all rainbows and butterflies. But, truthfully, I'll be waiting for the day that you post your own "venting" thread.

Jennilynn,

I am not making a broad judgment about you. I am asking you to review things analytically with some reasonable sense of empathy. I asked you to take what I said in the constructive manner in which it was given--that's it. You are either open to do so, or you are not.

Venting is fine. But you have to understand that people naturally want to offer perspectives whereby problem solving and constructive thinking come into play. Isn't that a big piece of what we do as nurses?

I have no idea if you need to find another line of work. Consider the other side of things, and please don't use such a broad brush over the issue. FCC/PCC can and does work. It needs to be applied in the right way, and as in all things in nursing, problem-solving and empathy are key.

I don't want to share too much of my personal experiences with this issue, beyond the pediatric component (but with regard to very sick adult loved ones), b/c I want to maintain some level of anonymity. If I give too many horrendous details, I risk losing that. Suffice it to say, the times I have had to be in the FCC-advocacy role for my loved ones have been incredibly stressful beyond any words I could relate here. Bottom line, my loved ones, other nurses and docs, as well as my family and myself were glad I took on that role. People have the right to do this, and they should. Those that abuse the freedom to apply bedside FCC/PCC should be addressed by policy and appropriate support from management.

Every one wants to wave a wand and magically problems disappear. The real world and problem-solving doesn't work that way. It is always ongoing. That's part of the problem with management--the incredible lack of insight and fortitude regarding the ongoing processes entailed in application of policies.

I wish you the best in your nursing career, and I simply ask you to consider a different perspective on this. That is to say, please don't necessarily throw the baby (FCC/PCC) out with the bath water simply b/c there are problems with how it is applied in various places.

Take care.

Guest343211 · Dec 31, 2012

Here is a situation for you since we are to please the family.
You get report and you have a patient that isn't doing so well. Her sats are dropping and she wasn't like this last night when you had her. You have another patient in a lot of pain with a really anxious husband. Your in the patient's room who's 02 says are dropping. She stops breathing and there is no pulse.
In the meantime the anxious husband is at the desk complaining about his wife's pain and the fact that the nurse hasn't been in the room. The charge nurse has a full assignment but agrees to look at the MAR to see when she can have pain meds. All of a sudden the code bell goes off. The charge nurse runs to get the crash cart. The anxious husband jumps in front of the crash cart and stops it. He is demanding that the charge nurse gives his wife pain medicine before she runs into the code room. What would you as a nurse do? Please the family because that is your job? Or do you tell him to move out of the way and save the dead patient who is a full code life?

You address the priority issue--the coding patient. Everything else has to wait to be dealt with in the best possible light after the crisis--higher priority issue. "We will get someone is to give the pain medicine as soon as possible." Now, again, if there was proper staffing and strong teamwork, this shouldn't necessarily be so much of an issue. In peds, family members see us running to the code and cracking chests, etc. We try to call out to get someone else to do something such as give pain meds. If someone wants to jump in my place and go into savior-code mode, I am so beyond that at this point in my career, that is fine with me. I am happy to be the runner and pain-med giver. In almost every place I have ever worked, we made it work, b/c most of the folks I worked with understood what it means to put the patients first. And again, most of the family members could see how crazy things were. You have to have people that are willing to work together. No stupidity about who is going to chart the code or get this or do compressions or any of that stuff. People that flow and work together. When I am in the role of a "runner," I do just that--I run my orifice off getting stuff and attending to the needs of other patients. And then there are times when I have to be runner, and then jump back into the code. It's an attitude of making things work and working together. This is absolutely key. If you work with nurses that don't get this, that's when things fall apart. Trust me. Most families understand when there is a code. I have been a nurse in critical care for over 20 years--99.999% of the time--they understand.