Do patients/families that are hostile, rude affect your morale?

SarasotaRN2b · Feb 8, 2006

For the most part, I try to put myself in family members' places because I know that it can be stressful, BUT sometimes (like tonight) there are some families that just seem to push your buttons for the most trivial things. Just take a deep breath, excuse yourself and regroup.

I know that it is not easy sometimes, but this too shall pass.

Kris

smartynurse · Feb 8, 2006

Thank you for your response. Actually, I am not in the throes of a patient/family conflict. This is just something that I have an interest in. After 11 years in nursing, I have observed this kind of problem in different work sites. I feel that it is something that is not addressed by the hospital/facility, and that it may affect nurse retention. It is something that I may decide to research, as I am in school at this time. I have seen nurses call out sick so they would not have to face a particular patient/family the next day, I have seen nurses not be supportive of one another, nurses who feel bad about themselves because of this treatment. Of course, family stress and concern is not avoidable, but my interest lies in what resources (and rights) nurses have to protect themselves emotionally, and possibly legally, in face of these situations. I feel that for the most part, nurses do not have the professional support, education to deal with this in a way so it does not wear them down to the point that they just leave. Also, being that we do not seem to have much of a voice in regards to this type of borderline harrassment or interrogation (at times), how many nurses are advising their children or others not to go into nursing...I also wonder if the newer, younger generation of nurses will have a different perspective and will choose to leave these work environments instead of staying in them. So, I am very interested in gaining some informal, anecdotal info from my fellow nurses about these issues. Thx

live4today, RN · Feb 9, 2006

Do patients and families affect your morale? Have you encountered situations which left you feeling demoralized, insecure or denigrated? For example, how many of you have had family members write down everything you do, from the moment you come in to the room? Do you feel harassed? Are there resources available to you such as debriefing programs, one on one counseling, unit meetings or managerial back up? Does the nursing staff provide support for one another? Or do you just "suck it up", being that the "customer is always right" ? Have you left a facility due to these type of experiences? Do you think this is a problem in the nursing profession?

Yes, this is a MAJOR problem in nursing. I have left jobs that allow such behavior to be taken out on the staff. Sometimes I "suck it up" depending on what the patient is going through. Other times when the patient or family/visitors are simply being mean natured for no reason except they think nurses are there for their every bark........I choose not to suck it up, but to move on if nothing is done about it.

UM Review RN, ASN, RN · Feb 9, 2006

Do patients and families affect your morale? Have you encountered situations which left you feeling demoralized, insecure or denigrated?

Yes, they do. Yes, I have. Though I realize on an intellectual level that most of these people are just generally mean, unpleasant, or rude in normal circumstances, it's just hard too deal with on an emotional level. Especially if you've really been going all out for a patient and then a family member accuses you of shirking.

For example, how many of you have had family members write down everything you do, from the moment you come in to the room? Do you feel harassed?

I've had that happen quite a bit. Some people do that to try to intimidate the staff and thus, they feel that they get "better" care as a result. What they don't realize is that we cave to their demands, but they don't get what they necessarily need because they're too busy plying us with nonessentials. For instance, I had one patient's family keep me from looking over the patient's orders because they kept calling me into the room every couple of minutes to ask questions that certainly could've waited. The result was a delay in treating their loved one, not "better" care. But because I kept running in there and talking to them, they thought they were getting my best. They couldn't have been more wrong. I could hardly concentrate on getting the patient's meds out on time, when if they'd just let me do my job, the patient would've gotten the needed meds that much sooner.

Are there resources available to you such as debriefing programs, one on one counseling, unit meetings or managerial back up? Does the nursing staff provide support for one another? Or do you just "suck it up", being that the "customer is always right" ? Have you left a facility due to these type of experiences? Do you think this is a problem in the nursing profession?

Usually if a patient or a family member is regarded as a PITA by one nurse, another will take over the assignment the next day. We call it "sharing the joy." :clown:

Again, this works to keep the nursing staff sane, but it's really not of benefit to the patient, who would probably get more out of continuity of care. But we value our nursing staff, and if a family or a patient gets too far out of line with their demands we always give them the bottom line, straight up:

"You need to understand that we have priorities for care and we have treatment standards. We are doing all we can for you/your loved one and we are providing you with the best care that we can. If you choose not to follow the course of treatment or you choose to continue to harass the staff, we need to remind you that you are free to go to a different hospital at any time."

Thankfully our management does consider that patients are customers whose perceptions have been altered by illness. They're reasonable, but not butt-kissers.

I haven't left a place due to that, but I do work nights because of it. I'll do just about anything to stay away from toxic people at this point in my life; I have enough problems of my own.

This is would be a very interesting research topic. I'm sure that every nurse can recall a difficult patient or family member that caused problems with the staff. Get enough of them, and it can make you ask why you keep coming to work every day.

annmariern · Feb 10, 2006

Oh had my share of PITA relys this week. Squeaky wheel syndrome. Having been on both ends of the situation, and having been firm when it mattered and letting the rest slide, I see both sides. Sometetimes its cultural, my Korean man whose family were hunting me down for every little thing. My ill-tempered (chronic pain patient) and her hubby who called the surgeon's office because her breakfast tray was held because she was questionable surgery. Not fast enough. We all have em. I guess I try and remind myself, that in that designer hospital gown, is a scared human being and if they are lucky enough, a Rottwieler relative to give a damn. Now sometimes its a control freak issue. Good management, when called as they will be will draw the line. My boss shocked me to death lately when in dealing with an emergency, the patient in the next bed complained the charge nurse was rude to him. He called for a nurse she went, he shouted at her, she basically told him not to. He started the "I am calling my attorney" crap. The boss, told him that was his right. Go ahead, but the nurse was dealing with a more serious issue and if she seemed abrupt, it was not intentional. End of story. Patient was fine after realizing, hello, we are doing the best we can, if your going to scream crap at the nurse who came to help you , not acceptable. I hate when management comes in and just says "oh so sorry, etc" without any regard for the nurse. We don't have to take crap off people, jobs hard enough and yes, sometimes I find myself avoiding a room, because of PITA family. So they are adversely affecting care. But apart from better staffing levels ( never going to happen), sometimes it is entirely the fault of management drawing the line. Yes, we do not provide your friends coffee, or diapers, or checking their B/P, we are busy taking care of actual patients. Oh maybe your used to be being 2 years old and throwing tantrums at home for your wife/husband, not here. I am doing the best I can do. Sometimes I know its not good enough. And sometimes having them there , I realize, this is someones dad and not just another hospital gown, demanding my attention. And sometimes that's a wake up call. Like I said seen the other side, and the squeaky wheel pays off; I was so polite about it too, but when it comes to the end of life of a loved one, don't tell me they don;t need pain meds, because their confused and say they have no pain and they are struggling for each breath and the resps are 40. Make them comfortable. This wasn't a 90 year old, it was my 36 year old brother, who suffered enough. So like I say, sometimes it helps to step back a little from the "tasks" and see the person. And sometimes, when they are a PITA, somebody needs to say so. Thats my 2 cents anyway!

leslie :-D · Feb 10, 2006

working in hospice, i deal with plenty of anxious, angry, frustrated, ambivalent families. one moment i'm medicating the pt., the next moment i'm trying to kill them!! and yes, there have been times when i've implemented firm limit-setting with good effect. often, the families just don't realize how they come across. i'm pretty darned patient with most of the families but there are those few that i've had to sit down and reorient. they're usually pretty apologetic once they recognize their anxieties are out of control. after this type of interlude, i can then resume my job w/o any interference. all is good after 'that' type of confrontation.

leslie

DutchgirlRN, ASN, RN · Feb 10, 2006

After 30 years of dealing with patients and patients families I just had to get myself out. Over the years the problem has gotten progressively worse. I think part of the reason is that they are more informed than ever and want to ask questions (which is a good thing) but then they don't understand your explainations or they think they know it all. They get bolder and ruder by the year. I have been doing HH and have found all the patients to be very gracious and friendly. I think being back in their home enviroment has alot to do with it. They've been just wonderful and I'm enjoying my job once again. I do miss the work at the hosp, the co-workers and the docs.

RN34TX · Feb 10, 2006

I thoroughly share and agree with Angie O'plasty and Dutchgirl's comments.

My last LVN job got so bad with out of control family members and an administration who's attitude was always "What did you do or fail to do to make them so mad" that I nearly left nursing altogether because I was struggling through my RN program wondering why I would want more education in this field just to take more abuse and be treated like someone's servant.

Many will shoot me down for this but I don't care.....

My biggest goal as an LVN getting my RN was to be able to work in some area where visitors were severely restricted if not banned altogether and I have now met that goal working in the recovery room and in a strictly locked ICU. Both jobs I could never have gotten as an LVN.

It was either that or leave nursing period because I've had enough abuse from family members.

It's funny because in the beginning people always warned me about doctors treating me like crap, but 9 years later I can honestly say that doctors have been the least of my problems.

Even though I'm now rarely subject to family member abuse, it still angers me to often read from my own fellow nurses on this BB the same trite, repetitive, worn out phrases whenever this subject comes up:

"Put yourself in the family members shoes." - As if those of us who dare to say that families are out of control have never experienced the hardship and heartbreak of having a sick or injured loved one in the hospital. So what?

I never used it as a license to abuse the staff and create drama on the unit for my own selfish purposes. It goes on every day and many of us nurses flat out encourage it.

"My patient's families never abuse me because I can gain their trust by keeping them informed and involved."

That one is often used by new grads and others who have yet to be burned.

As if I've spent my nursing career keeping everything top secret and tried my darndest to keep family members as out of the loop and confused as possible keep them from knowing what's happening.

I guess they are throwing fits, screaming, cursing, and degrading me because I refuse to let them be involved in their loved one's care and never tell them anything. Baloney.

I agree with the previous comments about people keeping a notebook, writing down your every move, and calling on the call light every two minutes for pillows and juice.

I've seen many near mishaps and plenty of things not getting done like labs and meds on time because the nurse is forever in search of approval from a family that just cannot be satisfied because they simply cannot and refuse to accept that their loved one is dying and/or will never be the same again.

Again, that's not an excuse and/or license to abuse the staff caring for your loved one.

We all have to deal with human tragedy in this life, it's part of being a grown adult.

Why do we as nurses continue to accept immature, childish behavior from grown adults when their loved one is in the hospital?

I dealt with it maturely long before I was a nurse, and I think I should be able to expect the same of others.

DutchgirlRN, ASN, RN · Feb 10, 2006

I thoroughly share and agree with Angie O'plasty and Dutchgirl's comments.
It's funny because in the beginning people always warned me about doctors treating me like crap, but 9 years later I can honestly say that doctors have been the least of my problems.

:yeahthat: :yeahthat: :yeahthat: :yeahthat:

YOU GO GIRL !!!!!!

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 10, 2006

I hate when family keeps a notebook and writes down everything you do, every staff member in the room and a physical description of each, at what time and what they did, what meds, what times, etc. But a one time they (family) said why they were doing it which shocked me. Some were just taking down names of meds and treatments and procedures so that when they went home they could research the meds and stuff themselves since staff seemed so busy all of the time. I hate when family things we are intentionally withholding information from them. What benefit would I get by doing that? The joy of watching people become more anxious? I think not. It does put us in a bad spot though when lab work did come back, and the doc did not get to review it or go over it with the patient yet and they are asking about the results. Families think they get better care by being demanding and rude, but I find myself going in the rooms as little as possible for those patients which isn't good. So in reality, they would have gotten better care from me if they weren't rude and demanding 8 chairs at 0300.

OliveVinesRN · Feb 10, 2006

It does seem to lower my morale. I mean, I went into nursing for the opportunity to make a difference in my patient's lives at a troubling time for them. And for the family member or patients to be rude or condescending is beyond my belief. If they had an ounce of understanding of how much we put into taking care of their loved one and that most of only look out for the best interest of the patients, then they wouldn't dare be that way. I mean, we often put our patients' needs before our own even when we or our family member are sick themselves. And not to mention that we put our license on the line everyday by working in some tough conditions at times.