Conflict w/ a patient or family member?

mattsmom81 · Oct 29, 2003

When I first started my nursing career back in the '70's, people in general were more mannerly and respectful. Facilities also had set visiting hours, we were staffed better, and our managers were more apt to be managing effectively.

Today's facility can be a free for all: and even in the ICU angry entitled visitors can make a nurses' shift miserable. The general populace is less respectful, more demanding, show their tempers quickly, and have a Burger King mentality. Management supports this as 'the customer is always right'.

Our nursing leadership's response to this situation has been to embrace 'family centered care' and unrestricted visiting as 'its best for the patient.' Despite all their studies, I take issue with this, because in the ICU, a patient's comfort level due to continuous family presence should NOT outweigh the critical care nurse's ability to provide safe nursing care. IMO it goes back to Maslow's hierarchy of basic needs. When family is in my way, interrupting constantly and diverting attention away from my ability to provide critical care, how is this helpful to the patient??

Our pleas to our manager to set some visiting times have gone on deaf ears.So...nurses are voting with their feet; quitting and transferring to more nurse friendly environments.

I love doing my agency shifts in local ICU's that still lock down...and restrict visitors to set times....where our sickest patients are actually allowed to be our priority. What a concept! :eek:

Nurse Ratched, RN · Oct 29, 2003

Had a pt family that in truth was just mad at the situation *and* the pt - young college student who didn't mention his medical problem to the family until he got 500 miles away back at school and then family was frustrated at trying to "help" him from a distance. Truth be told, after meeting and speaking with the family, they were so overbearing I think I understand WHY the pt didn't tell them. I did enlist the family's aid in encouraging the pt to followup re: his condition.

It was also one of those situations where the family member didn't think you were competent unless you had a pair of testicles, but that's another thread .

fergus51 · Oct 29, 2003

I think there is a big difference between difficult (as in high maintenance) and rude. I don't mind the families who want to ask a lot of questions and will even get the doctor to talk to them if I am too busy. I also like them to be involved in the care of the patient as much as possible.

There are some families who are just plain rude and it is not appropriate no matter how stressed they are. Swearing at nurses is not allowed, thanks. I find therapeutic communication works great with the high maintenance families, but with the rude ones, it's better to just end the conversation and ask them to direct any concerns to the charge nurse. Then DOCUMENT!

sanakruz, ADN · Oct 29, 2003

The CUSTOMER is NOT always right

Just remember that we as nurses see many people at their WORST with it all hanging out;) ....Too many families have unhealthy boundries and are emeshed in the emotional lives of their loved ones. And you get to see it all!

cannoli · Oct 29, 2003

This is probably something I'll get flamed for, but sometimes when these people get ticked off at us or me for whatever reason, and they can get you in a lot of trouble, I think they (the public) are damned lucky that there are people that are willing to do this (nursing).

I know they are under stress, etc. , etc. but sometimes it hits out of the blue and there is entirely no need for it. The customer is not always right and we shouldn't have to take it, we certainly don't get paid enough to get used and abused but it happens everyday.

fergus51 · Oct 29, 2003

I don't even like the word customer to be used in healthcare. Maybe it's because of being a Canadian, but no one here pays any more for health care than the next guy. My money is paying for their care too, so they are not the customer as far as I am concerned.

cannoli · Oct 29, 2003

Yes, I agree with you, but in the hospital everyone is our (the nurse's) customer. The nurse is nobody's customer.

sandyth · Oct 29, 2003

:roll In the LTC situations; the family members are worse than the pts. As much as they "know" they should be MDs.. lol :rolleyes:

Chaya, ASN, RN · Oct 29, 2003

Oh, yeah, it's pretty common to be slammed by family. I give them certain allowances- they are scared, they may not know how things work on the floor, etc. but some are just plain jerks. I try to answer their concerns but often tell them I'll have to look something up in the chart or ask the MD or whatever and get back to them and then I do. This gives me some breathing room and gets their concerns dealt with. If they are of the "just plain jerk" variety, I try to remember to separate my reaction to them from my interaction with the patient, who like as not is just appalled at how their family is treating me!

Dinith88 · Oct 30, 2003

Wow..good thread.

If you practice nursing for any length of time, you're bound to experience patient and/or family-member-jack-asses...

It's a fact of life in healthcare(esp. nursing!)...

I used to get bothered and all worked up...but no longer.

Usually, i push the line and get mouthy(sarcastic) right back at the person...be they pt, family, md, whatever..

I think it comes with experience. As you become more comfortable/confident in who you are and what you're doing, you'll find it much easier to deal with these people. (It's funny when people who DONT KNOW JACK about nursing/healthcare attempt to critique, insult, or ridicule you or your work)

OK,OK, people are stressed and in crisis mode and deserve a little understanding...to a point. But come-on! Being rude, obnoxious, or ass-facey ...is the mark of a serious jerk...

And i have little time for Jerks!!

twarlik · Oct 30, 2003

What great advice you all are providing. Thanks so much!

It definitely sounds like I'll just have to grow some thicker skin. I usually don't let people get to me. The problems arise when I'm already having a bad day and someone starts pushing my buttons. It happened the other day at my current position. (I work in an office environment.) Well, things got a little ugly. I came out unscathed, but I can see that it's something I need to work on. Thanks again for all the advice.

drewpy · Oct 30, 2003

Todd

Yes, family members do question quite a bit. How they question is a different matter. If they are questioning for their own education and know how, that is one thing. And as nurses, imho, we must embrace and encourage that. Education to the family can oftentimes be the best prevention. Sometimes its also better to remember where they are coming from or to put yourself in their shoes. You will find though that as you gain experience and knowledge that your confidence grows. Even though you may not know it, that confidence and knowledge is sensed by your patient/family members. You will also find that with experience we learn how to handle some of those questions better.

Remember as well that if a family member sees a student taking care of their loved one, and this is true of any health care dicipline (RT,PT,Med student) they are more cautious and question in order to be sure that you know how to take care of their loved one. Especially if they have been burned before.

It will get better. . .Just keep with it!!