advice needed: preventing escalation with family members.

[gentle]

any charge nurses out there, please provide constructive criticism. how do you handle inappropriate family members and keep your cool. this was at the end of the shift. i didn't take well to being called names.

Patient rolls in on gurney from er with broken hip. we settle the patient. No problems. spouse present then goes home, still no problems. patient's family begins calling requesting this and that. spoke on the phone with the first family member who seemed reasonable explaining how particular requests for physician change were handled. Within an hour the second family member calls saying call back immediately. spoke with patient/spouse again explained how requests were to be handled. requested spouse speak with family members. family member calls back. i refused the call, passed it on to the charge nurse. charge nurse turfed call to next charge nurse. per that person, family mad now "coming to hospital" tone of voice inappropriate. i alert house supervisor and get okay to have security make rounds during arrival of family member. family members are not listed on information release section.

Spouse arrives calls me names because family mad. now, i'm mad. house supervisors etc now involved. patient verbalizes grateful for care I provided to the charge nurse. i'm tired of this. this experience went to hell in a handbasket. it's crazy. please pass information on how to deflate these situations in the future before they start. i did document the situation.

[Batman24]

We have one family member assigned as the main contact person to avoid muliple calls on the same matter from multiple people. Ours also have to have a code before we will provide any information. If you don't have the code you aren't authorized to obtain info on the patient.

We aren't to tolerate abuse. We can tell them not to call us names and remove ourselves from the situation and get CN. We are backed up when we do this and because the inmates aren't running the asylum where I work we can concentrate more on patient care and less on the drama. The family members also come to see that their abuse will not be tolerated. If they continue security will escort them out. Usually once they see their bullying behavior won't get them anywhere the stop immediately. It's all about setting appropriate boundaries and following through on them.

[RochesterRN-BSN, BSN, RN]

I'm with you Batman24! Its setting limits as soon as the behaviors begin. If you let then feel like they have frazzled you they seem to only be more difficult I learned.....Being in psych I have gotten pretty used to mad patients and mad families. If you are firm and stand your ground with this is what you asked for this is what we have done and the old, I understand that you are frustrated, however we are doing our best to care for your loved one. I need to ask that you speak to me appropriately or we will need to ask you to leave.

And not acting frazzled.

Well sorry you had to deal with nasty family....they can make or brake the experience you have carring for their loved one. And in the end its usually the patient who gets stuck in the middle!

Good luck!

[Vito Andolini]

I would need to know more, some particulars. Were you courteous? rushed? Did you come across as impatient? What changes did they want? Easily accommodated stuff or the moon?

The way this stuff is handled at Batman's place - now that's the way to fly.

As you know, when our loved ones are sick, we show our bad side - a lot of us do. But abuse and threats should not be tolerated. I don't know, like I said, I'd just have to know more about the particular situation and how you were behaving/sounding. I am NOT saying it was all on you - I'm just saying I don't know.

[Blee O'Myacin, BSN, RN]

I simply tell family members, friends, neighbors, second cousin's dog-walkers that call in that I am unable to give information about that patient, please call XXX. No, I can't give out that number, either. If the tone is set from the beginning that you are only going to talk to the designated family representative about patient care, and stick to it (even if people get angry). You did good with documenting and bumping it up the chain of command.

[Pepper The Cat, BSN, RN]

spoke with patient/spouse again explained how requests were to be handled. requested spouse speak with family members. family member calls back. i refused the call, passed it on to the charge nurse. charge nurse turfed call to next charge nurse

I'm certainly not pointing fingers - but perhaps this was not the best approach.

"turfing" the call to another person makes the family feel that they are not being heard. Perhaps if one person had taken 5 minutes to say "I know you are worried about Pt X, but there are rules and regulations that we must follow.

[CaseManager1947]

I think the issues mentioned by other posters are excellent... we must adhere to HIPPA guidelines, and require that the caller provide that code word... of course you do get the deal where everybody in the world gets the code word passed around. I agree, the patient's spouse or DPOA for health care advocacy should be the spokesperson. I do agree, though, that when calls get "turfed", rather than dealing with issues head on, people feel as though they are not being listened to. Our standard mantra for changing attending is that the family member/spouse or DPOA must find a physician who is willing to assume care, and they must notify the current attending... we stay out of that.

[Ruby Vee, BSN]

i'm certainly not pointing fingers - but perhaps this was not the best approach.

"turfing" the call to another person makes the family feel that they are not being heard. perhaps if one person had taken 5 minutes to say "i know you are worried about pt x, but there are rules and regulations that we must follow.

how many phone calls from how many different family members is a nurse supposed to take while still trying to care for a sick patient? at some point, you have to step away from the phone and take care of the patient. the family was heard during the first few phone calls. enough is enough.

[gentle]

Wow, Thanks everyone. Great helpful responses. I will be using a little of all the above in the future.

Below, I have tried to add a bit of clarity to the situation. Any further responses would be much appreciated.

I would need to know more, some particulars. Were you courteous? rushed? Did you come across as impatient? What changes did they want? Easily accommodated stuff or the moon?

The way this stuff is handled at Batman's place - now that's the way to fly.

As you know, when our loved ones are sick, we show our bad side - a lot of us do. But abuse and threats should not be tolerated. I don't know, like I said, I'd just have to know more about the particular situation and how you were behaving/sounding. I am NOT saying it was all on you - I'm just saying I don't know.

Hmmm, thanks for the questions Vito. This helps me to go back and rethink. Now then, I was busy with another patient at the time the second family member called. Honestly, I was also annoyed at having received a second phone call from same family because I had already told the first person that I would speak to the patient about the concern. I never talked to the second family member. Said person called the floor twice and neither time did I talk to this person. I dealt with the patient and the spouse only.

The CNs took both phone calls with the second family member.

As far as speaking with the patient and spouse, I may have been short; I was definitely direct. I don't think there was anything wrong with me requesting that the patient's spouse relay all messages to their family members. I did not explain the HIPPa thing to the patient and spouse though. This I should have done.

I think the issues mentioned by other posters are excellent... we must adhere to HIPPA guidelines, and require that the caller provide that code word... of course you do get the deal where everybody in the world gets the code word passed around. I agree, the patient's spouse or DPOA for health care advocacy should be the spokesperson. I do agree, though, that when calls get "turfed", rather than dealing with issues head on, people feel as though they are not being listened to. Our standard mantra for changing attending is that the family member/spouse or DPOA must find a physician who is willing to assume care, and they must notify the current attending... we stay out of that.

I'm certainly not pointing fingers - but perhaps this was not the best approach.

"turfing" the call to another person makes the family feel that they are not being heard. Perhaps if one person had taken 5 minutes to say "I know you are worried about Pt X, but there are rules and regulations that we must follow.

I turfed the phone call twice. Once because I was busy with another patient. After I finished I went to talk to the patient and spouse. We have the exact same mantra: we do not get involved with MD changes. The patient/dpha is required to do this. That information was told to both the first family member then the patient and dpha.

I turfed the phone call the second time because, I got the impression from the patient and spouse that this particular family member can be "the boss". I also turfed it because I had already spoken with both patient and spouse. Family is not on contact, info release list. Still very glad that I did. From CN who took the call, family member sounded inappropriate.

In the future I want to transfer over into the ER, ICU, or pediatrics anyway. All information will be very helpful for this transition-which is coming soon . . . soon . . . soon. This is one of the first times that I can remember actually getting really upset in a situation like this. Usually, I am more of the doormat person who thinks that I am causing all the problems. Over the last 2 years, I've grown alot. I'm no longer taking the blame for everything everyone else does. Somewhere along the line I started standing up for myself. I began making me responsible for me and others responsible for themselves. I think when I put the responsibility of the patient's desires back into the hands of the patient and spouse, then made their family their responsibility, things went downhill. Next time, I will simply start off the conversation with the HIPPA mantra.

The two things I didn't do this time were start off the conversation with the HIPPA mantra and let a patient's family bully me. The first a lesson learned. The second, I'm kinda happy for me.

[RN1982]

I've hung up on family members who have yelled and cursed at me over the phone. I don't care. I always say, "Ma'am or Sir, I'm going to end this conversation now if you do not stop swearing at me"...if they continue...click.

[diane227, LPN, RN]

When I have conflicting family members I determine who will be making decisions if the patient is unable to. Spouse, DPOA, etc. I then inform the family that all information will go through that person. I write this on the Kardex and pass it on to each charge nurse. As charge, I prefer to have the staff refer these calls to me in the first place. The nurses are too busy to get tied up on the phone with an angry family member.

When people curse at me I tell them " you are obviously upset right now. I will not accept your language and tone of voice. I am going to hang up now. When you have composed yourself you may call me back" and I hang up the phone.

When the family members are there in person, getting called names gets my back up. I try to remain professional but it is hard, especially if they are intoxicated. Again, I try to redirect them as above but if they don't calm down and they are disruptive to the unit, I call security and have them removed from the floor.