Conflict in the family causing me anxiety

[PerfectlyPlump, ADN, RN]

There is conflict brewing in my patient's home, between his parents. Since they are not married, I think the mom is the one who can legally make decisions about this child's care.

My problem is that I am getting caught between them, and when I do, I experience an irrational anxiety. I feel like one or both parents are going to be angry, and maybe at me. Of course I don't want to loose my job. But it is deeper than that.

I think that family conflict is one of the challenges of this kind of nursing. How can I keep it in better perspective so that their problems, and the fallout, doesn't overwhelm me?

[KATRN78]

can you give us an example of the conflicts you deal with?

[PerfectlyPlump, ADN, RN]

I don't think I should be more specific online. It is just normal stuff.

But the problem is my anxiety. I fear getting onto someone's bad side as a result of standing my ground on a detail of patient care.

There was a good outcome, I am glad to say. I found out that once again, my intuition is really good! Let's hope I can keep that in mind next time, and not doubt myself so easily. LOL. Thanks for listening!

[nursel56]

Been there! In my view, you have two issues. One is the drama that all families have complicated by the stress of a child's medical condition and the other is our nursing judgement vs what a family member wants us to do. If your anxiety is related to being forced into deciding when to stand your ground, thinking about various scenarios ahead of time may lessen that.

When I started in PDN, the DON who oriented us said that home care is different than other environments we work in, and that most families have developed habits over years of taking care of their child that work for them but absolutely not what we would do in a hospital or LTC. She said we have to allow them their autonomy in that regard as long as it is not overtly harmful -- like flushing a G-tube with apple juice (actual example she gave).

However, our primary responsibility is to our patient and that is who we advocate for. When it is an important issue, never let them pressure you into a potentially harmful action or not providing an intervention that is clearly indicated. An example of that would be when my clients tried to insist that I use Vaseline to lubricate a Foley catheter. I flat refused to do that and they didn't insist.

When a conflict situation remains unresolved, call the Case Manager who should be available within 30 minutes time to call you back. If he or she does not, document your efforts to reach them. There have been times when I've needed to stand my ground on an issue of patient safety to the point where I have said they are welcome to request another nurse, but that I could not comply and use unsafe practice.

If your family is endangering their child due to them arguing, fighting, throwing things or if one family member is abusive to another we have an obligation to report that to DPS. I've told people that, too. So far I've managed to avoid dropping a case or reporting family to social services, thank God.

Working as PDN comes with completely unique challenges, and I'd been a nurse for years before I encountered any of it.

[Alex Egan, LPN, EMT-B]

In these situations I usually make it clear I am here to take care of the child and not get involved in family politics. In this situation the mother is the POA so you are obligated to follow her wishes for medical care. If the father had counter wishes express empathy but reinforce that you cannot make changes to meet his wishes. For both parties refuse to speak about the other and rebuff attempts to vent to you. Be consistant. Your the nurse not the friend therapist or clergy. I would keep a personal log of unusual things that happen, concerning, complaints, and who you have notified about said things. Keep it clear of identifing information, to avoid HIPPA issues. The truth is this situation will either get better, or it won't. If it doesn't be prepared to get out of there, I refuse to be drug into family court for he said she said sessions and if it looks like its cursing to there I bolt.