Unappreciated by the patient's family

[orangepink]

Hi! I don't know if this is the right forum for my topic so please feel free to move it as the mods deemed fit.

I'm an RN-BSN with around less than 2 years experience as a med-surg nurse. I currently work in a critical care unit with a slightly different set-up than most CCU units. I get 5-6 patients in a shift. When I say that out loud, a lot of nurses (from other hospitals) wonder how does that work? Well, I get 2 critical care patients, 2-3 med surg/tele patients and couple of rehab patients so if one practicies prioritization and time management, you can actually get things done within your shift. Like, give meds to the rehab patients and not worry since PT/OT will be working with the patients all shift long.

Anyway, I said all that to give you guys an idea of what my work environment was like yesterday (my friday). I've been taking care of this rehab patient 3 days in a row this week. This patient (Z) has been in the facility since the start of the year. A lot of nurses have been taking care of him but I've only taken care of him this week for the first time. Even though it's my first time with Z, I see how other nurses take care of him. I don't say anything about it but it's always bothered me that they leave this post-CVA patient lying in a fetal position. He's 60+ years old, alert, oriented but non-verbal, contracted in all extremities and all the other nurses leave him in a fetal position.

So when I had him this week, I stretched out his legs a bit because in the back of my mind, this guy will go home someday and I don't want him to go home looking like this. PT/OT doesn't work that much with him except that OT puts a hand splint on his right arm. Anyway, the thing is the son yelled at me so loud that every one in the nursing station heard him yelling at me even the other patients' and their families heard his yelling at me. He yelled that I'm not gentle with his dad and that I feed him too much (of the pureed diet). I politely replied that his dad his contracted and I wanted to stretch out his legs but he wouldn't hear anything of it. He started threatening me about a lawsuit and my license. When it boiled down to that, I just remained quiet. This son was bigger than me and angry so I didn't want to aggravate things further. As for the feeding, a part of me wanted to tell the son that I'm actually one of the very few nurses who take time out to feed and encourage his dad to eat something. Most nurses in the unit would brush that off to the CNAs and since the CNAs are busy, they just only offer 2 spoons and report that the patient doesn't want to eat. I take time out from my other patients to stand their and feed his dad and coax him to finish at least half of the tray. I coax his dad to at least drink all the thickened juice.

Then the wife complained that for the 2nd day in a row, I supposedly left the tube feeding bump beeping and that I did nothing about it. Well, for the last 2 days of my work week, I had harrowing time since considering my experience compared to the other nurses in that unit, I bore the brunt of the critical care patients. That means, I got the severely ill ones.

Anyway, what I'm saying is that --- I was just hurt that the family didn't appreciate my good intentions and efforts about their dad. I do one good thing compared to the other nurses and I get yelled at. I know I'm supposed to grow thicker skin but sometimes, being unappreciated hurts especially when I, for one, believe in my profession. I was just wondering if other nurses have experienced being unappreciated and if so, how do you deal with it?

[wanderlust99]

One of the hardest things about nursing for me is when you put your heart into it and you care enough to do the right thing...and it goes either unnoticed or just unappreciated by the patient, their families, or by staff. I've come across 2 really abusive people in the last 2 weeks and it's been difficult. One was an abusive patient who had me in tears and another was an angry family member who had me threatening to call security on him. It's where my burnout is coming from at the moment. All you're doing is your job, the best that you can do, you're even going out of your way to care for this stranger in the best way you can, going that extra mile...and you're treated like a piece of ****. I'm just hoping for some nice patients and families this week to get me through it. I feel your pain.

[anotherone, BSN, RN]

i love the just walk out of the room and ignore them. education is a waste on many patients and their family memebers. yes i know they are angry/upset by their situation/diagnosis, but it isn't my fault. let them yell and scream and i walk right out of the room ( has only happened a few times- one of the best parts of working almost all nights!)

I try to not even care anymore, although it is hard. I pretend I am a different person at work, and go in focus on the job while there as my alter ego and leave it all there. The few times i have had eppisodes like this happen to me, they really upset me and i am sick of wasting time on things like that.

[jessi1106, BSN, RN]

Good for you for doing a great job--caring for your patient, feeding him.

No matter what the family said or did --you know in your heart that you had good intentions. That is admirable, be proud. They were lucky to have you and unfortunate to have lost you.

[Vespertinas]

And then the wife complained that I, along with the CNAs, used dirty wet wipes on the patient so I just took the wipes and threw it in the trash and left the room.

Turning around and walking away can be justified as avoiding an abusive situation. Body language with attitude will just be fuel for the fire. I understand you were angry but if your practice is being questioned, don't throw your professionalism on the line too.

So anyway, I left hoping they would leave but I had a medication that was due to give so I came in and explained that I'm giving medication but since the pt's son loudly claims that he can do my job, I politely encouraged him to give the meds and left the room

Careful. I don't want to be the negative Nancy here but you are setting yourself up. You should be observing your patients taking their medications, that's part of administration. If this family is litigious, this situation could go awry in ways you can't imagine. It makes sense that you want to keep your interaction with the family to a minimum but you can still do the necessary work and still keep your distance.

If you don't feel comfortable, you should ask to not be assigned to that patient in the future. Other nurses seem to handle the family okay and the charge nurse has witnessed your problem so she should understand. Hopefully that solution is feasible in your world.

[caliotter3]

Never leave medications in a room and tell the patient's family member to give them. Most families wouldn't need for the light to burst on in order to figure out that you just handed your job and possibly your license to them. That is the type of reaction they were trying to get from you all along, and you fell for their prodding. Next time, don't let it get this far. Request a different assignment.

[VivaLasViejas, ASN, RN]

Families.....sometimes I think my job would be a snap if only I didn't have to deal with them. Some are wonderful, of course, and these are not the ones who give me indigestion; it's the completely unreasonable folks whose default position on everything is hostility, and they attack, criticize, and hound the staff for every real or imagined slight toward their loved ones.......as if we wake up every morning with the sole intent and purpose of neglecting them.

Sad to say, our society has developed an entitlement mentality and until the pendulum swings back the other way, nurses will continue to be unappreciated, and sometimes even harassed and threatened by patients and families alike. We cannot change that. All we can change is how we react to it.

I'm not saying we have to put up with abuse, threats on our lives and so forth. But we cannot afford to internalize verbal insults and other bad behaviors, lest we burn out and leave the profession. So......I visualize a thick Plexiglass wall that I've built, piece by piece, to protect myself from the slings and arrows that come my way so that they collide with the wall and slide harmlessly down to the ground, instead of hurting me.

This is the only way I can deal with these inevitable occurrences. Having a mental health condition that predisposes me to taking things too personally and being too easily wounded by harsh criticism, I survive in this profession by keeping that invisible wall up at all times when I'm at work, and letting it take the hits.

That's not to say that I can't or won't take criticism when it is justified; on the contrary, I thrive on criticism that is offered constructively. But when you've got a patient's daughter screaming at you in front of 50 other people because the doctor's office failed to fax her mom's new orders to the pharmacy after you've called them twice and they've reassured you both times that they've taken care of it.......that's when it's time to duck behind that wall.

[lrobinson5]

Well, my first thought is now we know why the other nurses leave him in the fetal position... There are some people you just can't please.

[wooh, BSN, RN]

I had such a nice group of patients on my last shift. It was a surprise. Usually I'm excited to get one patient/family that's nice.

[orangepink, NP]

i love the just walk out of the room and ignore them. education is a waste on many patients and their family memebers. yes i know they are angry/upset by their situation/diagnosis, but it isn't my fault. let them yell and scream and i walk right out of the room ( has only happened a few times- one of the best parts of working almost all nights!)

It's amazing the lack of patient education re: their diagnoses. I had a pt whose wife kept yelling at the RTs as to why her husband has trouble breathing. Her husband has been a chain smoker since he was 16! He has COPD. The RT and I looked at each other, speechless. Since he has been diagnosed, no one has bothered to explain COPD to her.

[orangepink, NP]

Never leave medications in a room and tell the patient's family member to give them. Most families wouldn't need for the light to burst on in order to figure out that you just handed your job and possibly your license to them. That is the type of reaction they were trying to get from you all along, and you fell for their prodding. Next time, don't let it get this far. Request a different assignment.

Actually, my charge nurse was already aware of this so she gave me a different patient that day (3rd day) but she didn't tell me why. I didn't know they already complained about me that 2nd day. The other nurse complained about the sudden change so I assumed it must have been a mistake so I said yeah we can switch it back to yesterday's run. It was only when this incident happened that my charge nurse told me all the reasons.

In hindsight, I shouldn't have left the medications with the patient's son but he kept bragging about the fact that he knew more about nursing than I did. It got to me, unfortunately. I really tried to mentally distance myself from his emotional outburst but I have limits too. Words do hurt.

And I walked out (mayhap in anger) because I felt that I had other patients who needed me more and I had other important things to do than be yelled. I'm known as the nicest person in the facility to the point of being a borderline doormat but one thing that gets to me is when my work ethic is questioned. Like I said, I believe in my profession.

This isn't the 2nd incident with a patient's family. And please bear with me --- I just want to vent out.

Last year, an 80+ female, dementia patient, s/p fall, sacral wound had a daughter who has been yelling at all the nurses, staff, doctors about patient care. On the first day that I had this patient, I knew that the daughter was going to be coming early so I figured I'd get to this patient first. Give all the meds, get all the orders (like inserting a new IV because the pt pulled one out just at the change of shift) done so when the daughter comes, I'd have more time dealing with her emotional outbursts. Turns out the daughter came during change of shift. Saw a leaking IV site and blamed it all on me. And by "it," I meant all the things that happened since the pt got admitted on me. My goodness. I never met so much anger in my entire life. I stood there, shocked and speechless. In 2 days, she called state to investigate me. Seriously. Sh_t happens to the good nurses.

It's like what Mo. Teresa said, it's between me and God, anyway.

[itsmejuli]

You'll get used to being unappreciated once you're married with children and working full-time.

[Pinkmegan]

I,m not posting a quote from your excellent post due to it's length and as, in my opinion, all the points raised are very relevant.

I work for an independent facility in the charity sector. (Don't know if you have these in US due to the way your health system works with insurance etc..) We care for clients with Neuro. conditions who need high dependency care. We are split into 2 teams, each with one RN and 5 CNAs on early shift, 3 CNAs on late shift & 2 at night. Each team has 18 clients! I work 14 hr shifts, often with only one short break for lunch!

The majority of our CNAs are worth their weight in gold! Any problem with a client, however small, will be reported to me straight away. Very few of our clients can eat independently. As of today there are 8! The rest need help with eating or are on pumps, or both. I try to help with feeding if I can but, with such long drug rounds, this is not often possible. I trust all my CNAs totally to feed all the clients.

But to get to your actual point, relatives! They come in 2 distinct groups! Those who are so grateful & who can't thank you enough and those who constantly complain about everything! As I know, and I'm sure that you do to, all the clients get the same level of care so why does this happen?

My main theory revolves around guilt. The relatives know that they could or should do more to help their 'loved ones'. At meal times some rels. will happily feed the client whereas others will sit and watch the staff do it! Well, it is our job after all!

Others who constantly complain don't appear to want issues addressed. When one complaint is resolved they find another!

One example this week, one client with rels. who are 'serial' complainers, was so obviously well cared for, happy and in good health resulted in them having to complain about something else. On this occasion they highlighted minor cleaning issues; bed table a bit sticky, some splashes of enteral feed on bed rail & wall (we know it goes every where if you'r not careful!) all of which would be resolved when cleaners arrived!

We all have 'down' days relating to this but we need only to remember that we are doing an exemplary job! Relatives won't change and, if we know that we are doing our best, we don't need to either! We get far less complaints than we do compliments, but we tend only to remember the negatives!

Take care, try not to let it get you down as you have many years of nursing in front of you. Concentrate on the comments from grateful rels. I keep some written down to look at when I get home from a bad shift!

Megan xxx