Can nurse ask family to wait outside while doing treatment

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I work in a LTCF and we have a resident whose family is terrible. These people are never satisfied and blame staff for any and everything wrong with resident. This family attempts to micromanage everything. We have MD orders that tell us to call family and ask them if it is ok to give prn meds. Now this family wants to be present any time a treatment is done on their family member. My question is do I have the right to ask these family members to step out while Im doing the treatment?

Specializes in Ortho, Case Management, blabla.
Call the POA and the POA only for every little thing including in the middle of the night until they get the message that some time they're going to have to trust the nurses' judgment. Can we turn him now? Should we give 3 or 4 ounces of juice? How small shall we cut up his meat? sheesh.

I think the approach you are suggesting is kind of passive aggressive. I don't really think it would get anywhere except pour salt into the wound of the problem.

You know, honestly, I think therapeutic communication in these kind of situations is completely underrated. Dealing with families can be as easy as saying, "You sound really frustrated with the care here, what's going on?" It sounds silly, but validating can really make a huge difference. Then again, I work in acute care so I don't have to deal with families on a long term basis :D

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Specializes in Trauma, Teaching.
I think the approach you are suggesting is kind of passive aggressive. I don't really think it would get anywhere except pour salt into the wound of the problem.

You know, honestly, I think therapeutic communication in these kind of situations is completely underrated. Dealing with families can be as easy as saying, "You sound really frustrated with the care here, what's going on?" It sounds silly, but validating can really make a huge difference. Then again, I work in acute care so I don't have to deal with families on a long term basis :D

Yes it is :coollook: that's why I said I was being sarcastic. :)

But it sounds like they've already gone past the point of validation from the OP's comments. I would in reality keep all decisions on the POAs plate however, the rest of the family should not be allowed to veto things or demand the right to make decisions.

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Specializes in Peds HH, LTC.

You can't refuse to do the treatment, but maybe you can get the time that it's done changed. Hopefully there should be at least SOME period of time when no one is there with your resident, (first thing in the a.m., at bed time, somewhere in between), and try your hardest to go in then.

I've had to do this. So and so's family comes in at XXXX time everyday, so I better get in now if I don't want an audience. :)

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Specializes in ICU/Critical Care.

Make sure you document and you have copies of them. Things disappear especially if your DON doesn't back you up.

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Specializes in ICU/Critical Care.
I think it is kind of funny when people do that. I act professionally and work within my standard of practice ("What would a prudent nurse do?").

I actually enjoy reading a good complaint about the care I give. I've actually only had a couple, but they don't bother me. I'm more prudent than George Bush Sr.

I had a written complaint that singled me out BY NAME that went something along the lines of;

A) I pushed pain meds too fast and made the pt sick

B) I used a writing utensil to push some gauze somewhere on the dressing

C) I caused an IV to go bad by not having IV fluids running

D) I didn't keep her postop pain under control

E) I can't remember E, but there were like 6 complaints after that. And that I'm such a terrible nurse and I should be fired blablablabla

So I wrote a written rebuttal to my manager to these accusations...I even did bullet points, just like the patient did (I don't even remember this patient at all, I actually had to go back to their chart for all this).

A) I never pushed any IV pain meds, so this point is invalid (I checked the MAR, I didn't).

B) I took care of her for 5 hours before she even had surgery, and never had her postop, so there was no dressing, no gauze, etc. So this complaint is a mystery to me.

C) I may have saline locked her to go to the bathroom or something, but according to the documentation the IV was still running to the same site at the time she went to surgery. And they continued to use this same site throughout the surgery. And for a day afterwards (apparently its my fault that I saline locked her 2 days ago to go take a leak and they had to start a new IV on her per hospital policy when the old IV expired).

D) I did not take care of this patient postoperatively, so I had no comment on this complaint.

E) you (allnurses) get the picture.

Basically they took it all out on me. Whatever. Sue me.

I also had a patient complain because I refused to give her evening dose of metformin despite the fact that she hadn't eaten all day and her blood glucose was 82 and she was NPO @ midnight. She literally complained all the way up the chain to the vice president of nursing.

To hell with em, I say..The number one thing in my mind is that my patients COME TO NO HARM. Customer service is number 2. If they complain then that is the way it is. The best thing I can do is keep my mind at peace.

So after your rebuttal what did your manager say? I hope they backed you up. I had a patient's family member complain that I was rough with the patient. The patient's sister was in the room and I was removing silk tape from the patient's arm, he said ouch and she called her aunt to complain and her aunt called my charge nurse. My charge backed me up. The patient wasn't mad at me or anything. The sister ended up apologizing for possibly getting me in trouble.

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Specializes in Ortho, Case Management, blabla.
So after your rebuttal what did your manager say? .

I never heard anything else about it. Even if I hadn't written it I probably wouldn't have heard anything about it anyways. What are they gonna do? Write me up for doing my job? The only comment my manager had was, "sounds like they made a mountain out of a molehill." Believe me, if my manager made a big deal out of something like that I'd transfer off the unit faster than adenosine stops SVT

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Care conference, care plan and back up!!!!!! Call the ombudsman too.

How long is the family there? I would plan and get care done before they come or after they leave. Change dressing times if you can.

If they don't want to leave, they don't have to.

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Specializes in CVICU.

Families like this are so annoying. I recently dealt with a wealthy patient. His wife is a doctor. She got her way and didn't follow any of the visiting hour rules (or most of the other rules either). In any case, she was present most of the evening and was there every night. She would watch me perform all my cares and would ask about meds when I was giving them. Eventually she learned to trust me after she realized I knew what I was doing. She finally stopped watching me like a hawk, too. However, she would continue to stay the night in the patient's room until he was discharged. Our normal visiting hours end at 0100.

Depending upon your facility's rules, you may have to let the family stay unless they are in your way and preventing you from doing essential cares. Even if I have a family like the lady mentioned above, I will still insist that they leave the room if 1) the patient asks; 2) a sterile dressing like a PICC or central line change must be done. This is for the patient's safety. Otherwise, I will allow them to stay, even if we are doing something gross.

Most of the time, if we are doing something nasty like cleaning up a steaming pile of poo, they will figure out that they don't need to be there and get out of your hair. I also ask these types of families if they want to help by participating in simple patient cares like bathing and feeding. Some of them like this idea, others do not. I also enforce visiting hours (the above situation was different as the manager let her stay). I give them info on when they can be there and how they can reach me so that they might feel a little better and feel more comfortable knowing they can reach me at any time.

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you know...I forgot to mention what the PP said. Try including the family in as much care as you can. Most of the issues is about trust or maybe they had a bad experience before. Yes...families like this are sooo frustrating, but something must have made them the way they are.

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Specializes in LTC, case mgmt, agency.
my thought is if they want to manage everything the patient has going on ...then maybe they should take the patient home....i hate families like this

has anyone suggested taking the patient home and hiring private duty nurses, cna's, etc? in the meantime, document everything you do and if possible have a second staff member present. good luck.

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by prn i mean our facility protocol for apap,immodium, tussin dm, mom, or bisacodyl. our order from the md is to call family and ask first. nobody has a good report with this family. at one point we weren't allowed to change his foley because the family only wanted the don or adon to do it. the order even went so far as to say if no output send to er. well we did that a couple of times when resident was agitated and pulled on his foley. the local hosp er wasn't too happy about that but we told em it wasn't us it was the family. funny you should ask about the care plan meeting...they just did it yesterday..thatwhere the i wanna be in the room everytime there is a treatment done came from. along witha list of complaints about staff that they observed while they were here. it was amazing what they saw or heard being as they were only in his room. what they don't see is that as long as we have had this resident he has been bedfast and he has not had any skin breakdown. i don't even work that side unless they short and i cover down but somehow they complained about my ipc skills and i haven't covered down in 3 months. go figure

So, what are the family's skills in assessing the need for various prn meds? Can they assess for pain, agitation, fever, etc from home?

Thoroughly document your assessment, communicate the assessment in detail to the family, then ask the family on what basis they don't want the med given. Document that, too, then throw it to your DON or charge nurse and specifically ask if you should follow the protocol or the family wishes. Do some further CYAing by informing the physician of your assessment and the family wishes.

Go back to the schedule and document that their complaint against your skills is baseless, since you haven't been there for 3 months.

You want to do everything you can to form a record of how unreasonable, incompetent and downright dangerous this family is to the patient's well-being.

I wonder if this family doesn't have a long history of neglect of the patient, and are now trying to assuage their guilt over that by these tactics. Wouldn't be the first time it's happened.

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I say yes! It is terrible that well meaning families can actually reduce the amt of care that their loved ones recieve. In my case, sometimes I am reluctant to spend time with a pt if tons of family is in the room.

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