Difficult patients and families

Nurses Safety

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This is something that I don't see discussed in much detail here, and I am thinking to myself that maybe I am just a b***h, but do you ever get really irritated by your patients and/or their families? Do you ever feel that your hospital should be putting postcards in their patient info packets as these people act like they are on some all inclusive vacation and that the "H" on top of the building stands for Holiday Inn or Hilton? Please respond and let me know that I am not the only "evil" one who thinks this way sometimes.

After reading the most recent posts, I had to chuckle. When I worked in a hospital I had a pt who expected me to be his handmaiden. I was CNA at the time, but in nursing school. We had our class that I remember well: The nurses' job is to get the patient so he/she no longer needs a nurse. (I know I probably don't recall it as the instructor said it, but I am sure you all get the idea.) Maybe we should have that printed on the admission papers they sign. LOL, just a comment. NA

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I think my job title reads nurse AKA maid. LOL I just love the patient that screams and hollars for pain meds but when you leave the room they are laughing and having a great time. Then when you do bring back the narcotic they will tell you that it's not the right kind and they want _______drug in a certain dose....oh and they will also tell you how many pills of it that they want. Some of these people live for drugs and sitting on the call bell. I love the yell "Nurse" can I have a bath now, it's 2100 and you have just offered a bath an hour earlier, hefore you started passing meds.

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It never fails to amaze me what will come out of patients and families mouths. I work in a busy CCU and the other day I admitted a patient who had failed TPA and came back from cath lab very unstable and bleeding like a stuck pig. As I hung my fourth vasopressor the wife said " I've been waiting to get something to drink and the nurses downstairs said you would get me anything that I needed " (note to self kill cath lab RN) I said very "sweetly" that when I got done saving her husbands life I would see what I could find her to drink. It shut her up for a while and made me feel better!! By the way I am still looking for that cath lab RN

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Occasionally, I've wanted to go in with a restaurant order pad and say"May I take your order, please."

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Once I told a patient who had this long list of stuff for me to do for him (even though his wife was right there) "Why don't you put this stuff on your list for Santa?". I then laughed my head off but he didn't think it was very funny! Some people!

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The hospital I work at is very "customer service" oriented. I understand that these days patients are really clients and they can choose where they decide to go for care-

If they aren't happy they wont come back.

BUT! Where is the limit? On a recent customer satisfaction campaign everyone was commissioned to respond to every request with,

"Certainly, my pleasure." Oh, please.

Our secretary used to announce over the call system when the meal carts arrived- "Nurses, put down your stethescopes, and put on your aprons"

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It is very difficult with families when you have so many patients.I can be more empathic with a difficult patient but a family member who hounds me is another matter.They just do not understand all that we do.

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Smitty! That makes me puke! Certainly, my pleasure! May I kiss your butt while I'm at it sir? We get these monthly "customer service focus" notes up all over the place and they make me sick! One of them dealt with speed. As in hurry to do everything. Like we don't already run like chickens with our heads cut off? No siree, I had been leisurely strolling, delighting and taking my time and secretly laughing when patients would ring their call bells frantically telling me they needed to go to the bathroom, just seeing how long they could hold their bladders and bowels. Until that memo came out I didn't know there was any need to be quick! Give me a break! And the sickening part is the money that's put into these customer surveys! Why not take that money out of the toilet and spend it on staff! Then you wouldn't need consultants to conduct a survey because you'd know you were doing it right!

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Hi bunky - one of the areas of dissatisfaction on a recent survey was the IV stick. They hurt! Well, duh. No kidding.

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Why would a survey include such a ridiculous area of complaint? We are paying megabucks for these consultants to come in and do these surveys. What a waste of money!

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Originally posted by Nancy1:

This is a touchy issue no matter which area of nursing you are in. I work in long term care and have had a family member say "I don't want to hear you have 25 other patients, when I,(notice I) put on my husband'd call light I expect you to drop everything and answer it." This was to the nurse, she did not consider a nursing assistant answering the light.

The management gave us some tools to use: 1) Say: "In order to provide care to all our residents on an equal basis, I needed to finish what I was doing, what can I do for you, now?" 2) Always ask if there is anything else the patient needs? Again focusing on the patient and that we are not here to care for others. 3) If it was too unbearable the manager would step in.

I think that some family members are so fixated or perhaps guilty about this person needing nursing care that that they lash out at the nearest and most visible person "THE NURSE."

Now that I am in management I have given these tools to my staff along with one more, ask "Would you like to speak to Nancy?"

I am not saying this is any magic formula, because I still have family members telling my boss that I was rude, but I am woring on those relationships.

The issue about asking the nurse to change an infant's diaper has me puzzled. I wonder why the family would expect that, unless some other nurse saw the child fussing and offered to help with the child.

The coffee issue again, if the patient is very ill, my staff will offer coffee or to have a meal sent up, but again this is a kindness at usually an end of life issue.

I am not sure if this helps. But ask your management for an In-service on dealing with difficult people.

If you like, I will check my files at work, I think I have something that may help. I will be back with it, if I find it. Good Luck. NA

Nancy,

Granted, some families can be unreasonable. I fully agree that the patient should always be the focus. It is absurd that family members would make personal requests to the staff. However, is some of your frustration really more the result of understaffing and overworking? Are the families concerns appropriate? We have advocated for a relative since '93. In the course we have dealt with hundreds of nurses, doctors, cna's etc... As a result their are some common behavior patterns we have noted.

1) The adminstration of a facility sets the tone for the "cultural" attitude that the staff has towards families.

Many facilities present themselves as hostile and aggressive towards families and reacts towards them as though they were interlopers. This immediately puts everyone on the defensive. This establishs a prison like atmosphere. Where each question and concern is fielded as a hostile aggressive act. Where, when appropriate concerns, (i.e. a patient laying is feces for an hour or so ), are brought to the attention of staff, they are treated as unreasonble and unrealistic requests for care

A few facilities consider the families to be a part of the care plan and actually garner there involvement ( and I don't mean just lip service). Sometimes as a set of hands, sometimes as an extra pair of eyes. This fosters a relationship of trust and flexibility, such that on those occassions (which tend to be more rare in this type of facility) when needed care cannot be given in a timely manner, it is more easily understood.

2) When families see (they are not blind and can count) that understaffing is the norm, they naturally and appropriately have less confidence that their loved one is not being neglected on a routine basis. After all, "if this is what happens when I am here, good Lord, what happens when I'm not!" Clearly, this type of situation makes everthing more difficult for everyone.

3) Almost without exception, in our experience, the reason that some individual healthcare providers consistently resent the involvement of families can usually be traced to a lack of confidence or lack of real ability on the part of the healthcare worker. They tend to act more defensively and at the very least, behind the families back, deride their involvement.

4) The numer one answer that you site, and I quote:

"In order to provide care to all our residents on an equal basis, I needed to finish what I was doing, what can I do for you, now?"

...is a fairly good answer, however, if it is a common one, there is definitely a problem.

(probably understaffing -- clearly, if you alone have 25 patients, your understaffed.) Particularly if you toss in an emergency or two.

same with "Would you like to speak with Nancy?" , if this is with regard to an "A" typical situation it is an excellent answer. However, if it is in regard to routine care, and has to be resorted to a number of times in a short interval, it would be clear that talking to Nancy is not working, and therefore a more creative approach would be necessary.

I know that you have a very difficult job. I cannot convey to you just how much, good nurses are appreciated, and valued, by many families. Part of good nursing incorporates good people skills -- how could it be otherwise? We have met and dealt with some truly wonderful, caring, human beings. But the equation does have some uncomfortable aspects. I hope you will not think some of my words too harsh. But as you are in a management roll, you have even more of an opportunity to make a significant difference. It's really up to you. You set the tone.

Thank You

Lee

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I AM a hard stick, three or four times worth. The idea was that "It hurt", but so much of what we do, does hurt! I can't see the logic in including such a thing on a patient survey unless it is dealing with do you feel that the nurses treated your pain, which is an entirely different matter.

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