My God, these family members!!

[SoundofMusic]

They are just killing me. Why is it that so many of them feel so entitled to sit in their aging parents rooms and just boss us nurses to HELL and back, while they sit there, fully able to do much of what we're doing for their parent, but simply do NOT have the time to do when we have other patients and issues to deal with. i MEAN -- can't they get mom up at least perhaps ONCE during the day? Does it have to be a nurse doing it every single time, ten times a day??

I just came off a shift tonight where I literally waitressed all day long, making and fetching coffee and water and 100 millions cups of juice for these patients (because we're always short a tech) -- and a patient's daughter was literally screaming at nurses at change of shift to come in and do something or other for her mother. It was absolutely NOT an emergency. (She was actually screaming -- "Good thing it WASN'T an emergency!!" These people have been on our unit for over 2-3 weeks, running every nurse on the unit ragged. Their mother is far over 80 years old and is only going to head to weeks of rehab after being on our unit. They want a private nurse -- that is what they want and need. But they can't get that on a floor. I think their call light was on for perhaps five minutes, max.

I am just SO tired of family members not understanding what we do -- and our managers from the floor to the corporate headquarters not backing us up to explain it to them. We are simply to treat everyone as our "family members" and go above and beyond 1000 percent of the time. Who goes above and beyond FOR NURSES??? DOES ANYONE???

We have no private space to do our charting, we are like fish in a bowl for these family members. If they see you at the nursing station -- that's it. They are ON YOU like flies. If they don't have a reason to bug you, they will find one. So, you don't get your charting done on time and are left to stay after a shift for an hour.

I am just so tired of it. So burnt out. Is it any wonder why they can't keep nurses for long? I mean -- come on, management -- take a LOOK at what you are doing to nurses nowadays. Put some LIMITS, please, on these family members. It is OUT OF CONTROL.

[Jo Dirt]

They don't put up with crap like that where I work. The DON tells them with a quickness that if we can't meet their needs Mom or Pop can be hauled out of there in a heartbeat. This doesn't mean we nurses have the easy road, we're expected to stay hopping, but not on account of some unreasonable family member.

[moonischasingme1]

I feel you. For the most part, I just smile and fetch whatever it is that someone wants (cups, juice, crackers, blankets), but then sometimes it is so ridiculous. For instance, I bring a family member in a blanket and as I bring it in, they ask for cups. As I retrieve the cups for them, they remember they want a pillow case. It's like DUDE MAKE A LIST OR SOMETHING!! I don't have time to run around all day being a waitress, but that is unfortunately part of the job it seems.

I actually had an odd experience a few weeks ago. I work on a tele floor, but one week the hospital was full and they needed rooms for hysterectomy patients. So, I had this hysterectomy patient and the gynecologist/surgeon came in to remove the packing. He was an older doctor from Italy. As he was leaving, he said, "Now, I want you to get the tech to do peri care...i don't want YOU TO DO IT, I WANT THE TECH TO DO IT~"

I said, "I can do it, it's not a big deal."

"NO, no, no, no. When I came to America from Italy, i was SHOCKED to see nurses carrying trey's, delivering food, and doing the work of a tech. THAT IS NOT YOUR JOB!"

I told him that I am not above doing anything a tech does. He said I need to be doing other things, like communicating with the doctors and meds, etc. I told him yes, but I don't always have a tech to do some of these things. He was like, "THEN THEY NEED TO HIRE SOME MORE!"

DUHH~!!!!

I was just kind of shocked by this since usually it seems a lot of doctors only think of us as the jobs that techs do. It was kind of refreshing, but I was still taken aback by how adamant he was that I DO NOT DO PERI CARE!

[nursemike, ASN, RN]

I document this type of behavior, in a completely objective manner, of course, focusing only on observable behaviors and not interpretations of those behaviors, and I use quotes. This speaks to the patient's psychosocial status, which is a part of the holistic aspect of nursing care. We have a spot in the chart for psych/soc aspects of the patient with dropdown boxes such as "demanding", "combative", "hostile", "withdrawn". If I make a narrative note about a patient's pain, blood pressure, wounds, IV site, foley, etc., why would it be inappropriate to chart a narrative about their behavior if their behavior is not appropriate? Being hostile or needy, while it may be baseline for that patient, is not really "normal" per se, so it needs to be documented. Completely objectively, of course.

Good point--especially since the behavior might not be baseline. Had a patient who came from ICU on an insulin drip. Dayshift nurse didn't realize he needed Q1H fingersticks, because they weren't ordered. ICU just does them and yells across hall to doc, we usually have a detailed titration order. By the time I came on and got report, pt said he felt hypoglycemic. So I got a fingerstick and his BG was 30. Pt complained because I didn't stop the drip until I had a reading. Well, yeah, he had a point. I could have stopped it, then got the reading, and even if his BG had been 59, or 89, or 312, one minute off the drip wouldn't have killed him. (One minute longer on it didn't kill him, either...but still.)

So, the patient later apologized for getting testy, and all I could say was, I think I might get irritable if my glucose was thirty, too. I don't actual recall irritability being a classic symptom of hypoglycemia, like it is of hypoxia, but it's certainly a classic symptom of feeling crappy, and I hadn't had the guy long enough to know whether he was usually grouchy or it was a mental status change (a little of both, it turns out--we got along great, after that, but he could be a bit demanding from time to time.)

Which doesn't address the OP's concerns, but I do try to consider that people are often not at the best under the stress of a loved-one's hospitalization. A lot of times I'll offer coffee or tea to visitors if they've been there a while. Just feels more hospitable, to me. Or a pillow and blanket if they're sleeping in. I've also had some nightmares like the OP describes, but thankfully not very many. We're only six miles below the Mason-Dixon line, but that's "southern" enough that a lot of people still exhibit "old-fashioned" manners like respect for authority figures (who, me?) and the elderly (well, okay, that may fit me,) and speaking softly. Not meaning any disrespect for y'all Yankees on the board. But I have relatives from Kentucky who couldn't speak up to tell you their bed was on fire, and my overall impression has been that the farther south you go, the less acceptable it is to "cause a commotion." At least until you reach Very South Jersey (aka Florida).

Uh, geez, I'm wandering, again. I've been meaning to ask my MD about a scrip for Arricept, but I keep forgetting to.

Uh, so, two quick points: when management talks customer satisfaction, I talk ratios. Ours is generally 6:1, and pretty acute, so I don't have a lot of time to cater to visitors. Last couple of nights, I only had 4 pts, and I could have gotten in a couple of hands of bridge if anyone had wanted to. At 5:1 and nobody too terribly sick, I can fluff some pillows and fetch some coffee without too much trouble, but if 1 or 2 are "busy," I have to set some limits. Other point: when I am pressed for time, "I'll let your aide know as soon as I can," is one of my favorite replies. Kind of a subtle reminder of why I'm actually there. Also reminding myself that it's okay to delegate (one of my weaknesses when I was very new, but I'm getting over it!) Plus, you know, now they're mad at the aide, instead of me. Cheesy, yes, but we're talking survival, here.

[squeakykitty]

It KILLS me when a family member comes to the desk asking for the nurse of their loved one and when told that nurse is at lunch they get angry and pitch a fit. i couldnt help myself one day and said "did you eat lunch today? it's 2pm and she is just now eating hers so NO i wont call her to come back to the floor. she'll be back in 30 minutes" (it was NOT an emergency..was something stoopid i cant remember now)

I have to ask---what did that family member say to that?

[surfchickRN]

AMEN SISTER!! It is so ironic you write this a few days after I got written up for "talking back" to an elderly patient's daughter because she was being so redic. I work on a busy surgical unit that is chronically short staffed, actually no anymore because I QUIT!! I'm to the point where I don't care anymore and if management wont step in, then I'll take matters into my own hands. I have never felt so UNSUPPORTED, because that is what managers should do is PROTECT THE RIGHTS OF THE NURSES. THERE IS ONLY SO MUCH WE CAN TAKE WITHIN REASON AND STILL DO OUR JOB EFFECTIVELY!! I CANT STRESS THIS ENOUGH. WHAT CAN WE DO?? I TOOK THE ONLY STEP I KNOW, AND UNFORTUNATELY THAT MEANS QUITTING MY JOB. Actually, I didn't quit my job, I QUIT MY MANAGER!!

[LTC - LPN]

Preaching to the choir girlfriend! I think if the management cared about the actual patient...think of this...all the time you're waitressing, how much time are you available for actual nursing? Families have a knack of stealing time from patients, and maybe somehow you can tactfully make them aware of that too. Good luck, we all understand.

[old ICU nurse]

you can never please everyone and some people are unrealistic about the function of a hospital--no, it is not a hotel nor am i the maid. direct discussion and limit setting are the keys. however, being an ass and saying "that's not my job" or ******** about getting a cup of coffee doesn't help. i have taken care of patients with families from hell :angryfire. a lot of that "displaced anger" at the nurses is guilt for being a crappy (son, daughter, husband or wife) for years--we are just seeing what is brought in from home. unfortunately, the critical care area (or any place of the hospital) is no place to resolve dysfunctional familial issues--so try not to get caught up in other people's baggage.

i think there is a happy medium in dealing with visitors. the most important thing is open and direct communication. my hospital's icu has "open visiting" which means families can come and go 24/7 to see their loved ones--this can be a curse as it is like the airport at times. i have found that the best way to deal with families is to listen to their needs as best as possible--but i tell them that my job is to take care of the patient first and foremost. we have a two person visiting rule and i stick to it! i involve families with as much care as they are willing to do (such as mouth care or lotioning skin). most are willing to step out during toileting or bathing without much prompting. i also explain that i have a great deal of charting to do on their loved one--and i explain that if i cannot communicate all of the needs of the patient in my notes--that the doctors, therapists, etc. cannot provide all of the treatments that may be needed. that also helps.

here's what i have found that helps:

if i have a disguntled family member or patient--i turn them over to the nurse manager or third party to discuss their issues. let them go to administration to complain. perhaps that is the only way to get staffing deficiencies corrected. it is crazy to assume that a nurse can have 10 patients without a unit secretary or cna to assist--even if it is getting the phone or answering a call light. our hospital also has a patient grievence process where "unhappy campers" can have their complaints and concerns handled by a third party. it is not the responsibility of the bedside nurse to cure all of the complaints!

find out the root of what is making the family member go crazy--are they sleep deprived? do they not have enough money to go to the vending machines for food or beverages? (the economy sucks and people are poor--spending $5-10 in the cafeteria for each meal is a lot if you don't have it). are they having psychological issues such as guilt, anger or depression about their loved one? do they just want someone to talk to?, i.e. they're scared.

use what resources you may have at your hospital--chaplain, doctors, case managers, nurse managers, dietary--anything that may help. i know i have pestered mds to "talk" to that family about being disruptive. the "old school" mds have no problem telling a family that disrupting the nurses for trivial things is disrupting the delivery of important care to their loved one and the other patients.

i know that these are not the perfect answers--and sometimes you just have families that suck. but for every family from hell--there are more that are thankful and appreciative of the care and kindness that we show as nurses--and those are the ones that keep us sane.

[squeakykitty]

I didn't quit my job, I QUIT MY MANAGER!!

I LOVE this phrase!!!!!

[old ICU nurse]

good post! I added my own. It never hurts to use the golden rule.

Good point--especially since the behavior might not be baseline. Had a patient who came from ICU on an insulin drip. Dayshift nurse didn't realize he needed Q1H fingersticks, because they weren't ordered. ICU just does them and yells across hall to doc, we usually have a detailed titration order. By the time I came on and got report, pt said he felt hypoglycemic. So I got a fingerstick and his BG was 30. Pt complained because I didn't stop the drip until I had a reading. Well, yeah, he had a point. I could have stopped it, then got the reading, and even if his BG had been 59, or 89, or 312, one minute off the drip wouldn't have killed him. (One minute longer on it didn't kill him, either...but still.)

So, the patient later apologized for getting testy, and all I could say was, I think I might get irritable if my glucose was thirty, too. I don't actual recall irritability being a classic symptom of hypoglycemia, like it is of hypoxia, but it's certainly a classic symptom of feeling crappy, and I hadn't had the guy long enough to know whether he was usually grouchy or it was a mental status change (a little of both, it turns out--we got along great, after that, but he could be a bit demanding from time to time.)

Which doesn't address the OP's concerns, but I do try to consider that people are often not at the best under the stress of a loved-one's hospitalization. A lot of times I'll offer coffee or tea to visitors if they've been there a while. Just feels more hospitable, to me. Or a pillow and blanket if they're sleeping in. I've also had some nightmares like the OP describes, but thankfully not very many. We're only six miles below the Mason-Dixon line, but that's "southern" enough that a lot of people still exhibit "old-fashioned" manners like respect for authority figures (who, me?) and the elderly (well, okay, that may fit me,) and speaking softly. Not meaning any disrespect for y'all Yankees on the board. But I have relatives from Kentucky who couldn't speak up to tell you their bed was on fire, and my overall impression has been that the farther south you go, the less acceptable it is to "cause a commotion." At least until you reach Very South Jersey (aka Florida).

Uh, geez, I'm wandering, again. I've been meaning to ask my MD about a scrip for Arricept, but I keep forgetting to.

Uh, so, two quick points: when management talks customer satisfaction, I talk ratios. Ours is generally 6:1, and pretty acute, so I don't have a lot of time to cater to visitors. Last couple of nights, I only had 4 pts, and I could have gotten in a couple of hands of bridge if anyone had wanted to. At 5:1 and nobody too terribly sick, I can fluff some pillows and fetch some coffee without too much trouble, but if 1 or 2 are "busy," I have to set some limits. Other point: when I am pressed for time, "I'll let your aide know as soon as I can," is one of my favorite replies. Kind of a subtle reminder of why I'm actually there. Also reminding myself that it's okay to delegate (one of my weaknesses when I was very new, but I'm getting over it!) Plus, you know, now they're mad at the aide, instead of me. Cheesy, yes, but we're talking survival, here.

[RandeeN]

this is a synario that will reappear forever. Families are there for their family member. they do not know or care what you do, for how many, how tired or stressed you are. or pretty:yeah: much anything you would expect them to know. all they care about is themselves and what they want.They were not educated in hospital process,or how to interact with personnal. it is probably printed clearly in the admission packet,but you know very well, that no one ever really reads or studies that document...God knows they have the time,cause they are there. Perhaps you could direct them to the nurse manager when you have exhausted your first or second line of defense or explanations. Give them a verbal contract on what you will do and when for them..most often, with families like this, nothing will be good enough. Try to include the doctor...When he makes his rounds, go in with him and direct their concerns to him. This may or may not take someof the burden off of you. Take your breaks. try not to multitask a million things at once. Burnout is a progressive and debilitating process, and not to sound like i know it all, but I'm in the process of recovery from it. Encourance your facility to do a burnout seminar. Use what ever resourses you have to relieve yourself of these pressures. Don't give up. Your nursing career will have many challenges in it. Families is just one. Everbody is an individual and needs to be treated as such. Patients/families are a package deal. Don't expect them to know or understand,even thoiugh you have gone over it. Don't expect anything from anybody but yourself and then you won't get disappointed. This is the gospell....God bless you, and pray for the still,will,and the Holy Spirit to be with you in every room you go into. Keep up the good work,and get help when you get frustrated...you need to. :heartbeat

[FireHorseNinja]

Her husband yelled at one of my co-workers one afternoon about how "no one has been taking care of her". I went in the room and told him to google pressure ulcer when he got home and then ask himself how she had been laid up here for 2 months without having one....then see if he still thinks no one's been taking care of her. He must have done it because the next day he apologized and that was the end of them acting like that. Miraculously, without us ever taking care of her, she managed to survive her admission and went back home.

Great strategy!

[nerdtonurse?, BSN, RN]

I will never forget the frequent flyer (diet coke and demerol, q4) who stomped into the middle of a code, demanding his pain med. I mean, pt's naked to the world, I'm doing compressions, resp's bagging him, we're pushing every med we got, and this twit stomps in saying he's been on the callbell for 5 minutes and no one's given him his demerol, and he's going to file a complaint naming all of us. He grabs the ID of the nearest person, who happened to be one of the docs. Luckily, the doc in the room is one of the old war horses at the hospital, and after the code, saw the guy was admitted for "leg pain" and his room was at the other end of the wing. He went in and DC'd the patient home at 2200. Patient goes crazy, screaming, and the doc called security and had him forcibly removed.

Of course, he just went to the ER and got readmitted. But at least he went to another floor.

Only time I've seen a doc stand up for us....