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

[smartynurse]

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?

[nurseJLoo]

so true!! thay make them think they are going to have a private duty nurse at theyre beck and call!!

[nurseJLoo]

I like to piss off rude family members with the HIPPA law if they are not the RP you dont have to tell them shat!

[End Game RN, RN]

Hey everybody; this is my particular talent. I practice nursing in a multicultural, multiethnic, multilingual community with a large variety of religious practices. Needless to say, it is important to know and understand the community where you work, I was born and raised here which gives me a head start.

I work with critically ill neuroscience patients'. This population includes brain and spinal cord injuries secondary to trauma, the trauma patients many times have associated orthopaedic injuries or associated soft tissue injuries, some extensive, requiring complex wound management and dressing changes. We have patients with neurovascular problems of the brain or spine. Our facility receives patients from the entire State of Florida if complex care is required, even from the Carribbean, Central, South, Latin America, the islands off Florida, and tourists from many different countries who suffer trauma or neurovascular disorders while on vacation in these areas of the world, particularly Mexico or Jamaica. You might say we are the emergency room to this part of the world.

Because we are a central receiving facility for all of the above patients we have had to learn how to communicate effectively with a very diverse patient population. I have found just being friendly, introducing myself to the patient, but usually family and friends if the patient is severely injured or has complications of surgery or diagnosis requiring supportive measures such as intubation, ventilation, supportive medications..etc...Within a twelve hour shift, I can, without too much difficulty, take nearly every family, every patient and make them an integral part of his/her or the patient's care. I first assess them as a group, single out the ones most likely to manage the other family members and visitors, get social worker to get the Health Care Proxy done. I always defer to the Proxy and/or others the Proxy wants with them when receiving information from M.Ds or me. I invite them to actively participate in the patient's care, or to observe me performing care by myself or in some cases with one of my friends who is the assigned PCT for my area. I explain everything I am doing and why, I explain safety measures taken when caring for the patient. Our PCTs all speak two to three of the common languages in South Florida and are an integral part of my being able to communicate and teach my patients and their families.

I insist that a family must bring writing material. legal pad and pen, and to take notes when I am educating them. I also insist that they go onliine and read/study the patient's diagnosis, treatments, surgery, complications of diagnosis and surgery. I give a list of medications needed to support the patient, then they can look them up. When I have established a SOLID foundation of trust, even love, I tell the person assigned to a specific area of study that if the "homework" isn't turned in, I won't let them visit...surprisingly I end up with a lot of "homework" assignments that I follow up with a discussion of what was learned and how the research related to the patient. This last is somewhat limited to people who can actually do this, i.e. have the education, interest to do this successfully. I find this works with this group of people. I check their notes and correct the spelling or provide the correct terms for them.

Other families require a different approach based on education, literacy, their ability to visit and participate in support groups, etc...I always find a way to incorporate patient care and education with a diverse group of people who come with that patient. Again, I insist they take notes and/or keep a running diary from day to day.

Once we have established a relationship, usually because I invite them to share Cuban coffee with me in the unit (not with milk, I like it strong!!) I sometimes bring simple treats to share or sodas, bottles of water to hand to the family and sit them down and tell them to ask any question, make any request, take this time to express concerns to me about anything related to the patient or their personal situations that might require a social worker to evaluate later, I give the primary person, Proxy, my personal cell phone number and tell them to call during my shift and I will speak with them, if I can't speak at that moment, I will call them back A.S.A.P!!

I listen to them, making time for each patient or patient's family this first interaction. Remember at this time I may be taking a patient to CT, Neuroangio, Specials, OR, hanging a variety of drips on the two assigned patients, maybe getting ready to place lines on a patient, while communicating with both families or with patient if the patient is able to communicate in some way.

Even if I am crazy busy, I always take that second to give a hug and kiss (culturally acceptable) to family members or to the patient who is not requiring such intensive nursing at that time. I always reassure them that I will have time to speak with them..and I always keep my word. I am fortunate in that our staff will help fill in when I am somewhere else. Our PCTs are OUTSTANDING!!! and our patient population, their families really appreciate them.

Yes, sometimes I get a very angry, aggressive, accusing family or patient, but I find that I eventually have them smiling, laughing with me while working with the patient, again, teaching them at the bedside. I honestly don't know how do it, except I make myself available to them more than most staff can seem to manage. I deflect criticism of other staff and redirect anger and frustration just by listening, touching gently and looking directly at the person who is speaking to me. I have simply walked into a room, smiled at what appears to be an angry person, nudged playfully the arm of this family member, handed a coke to them and got a smile and an interesting conversation follows. (I buy all the food and drinks myself from places on our campus).

By the end of the first or even the second interaction with my patients and families, the two families end up talking to each other, since they see that I am working with both patients. Sometimes this has ended up as a friendship that may or may not become permanent. Many patients and the families come back to see us and share rehab and personal family stories with us.

This is only a summary of what I do every single day!!! It is challenging, sometimes frustrating, and it is impossible to be successful with everyone, but I have a great track record so far. I would say I am 95% succcesful practicing critical care nursing this way.

I have practiced this way since the beginning..I am contiuously adapting and improving my clinical nursing and communication skills to meet the extremely diverse patient population we serve. I have been burned out many times, but stiff upper lip and all that..I have been able to return day after scheduled day and do what I do over and over again. I love my profession. I have been "ridden hard and put away wet" as the saying goes a thousand times or more.

No one said this was an easy profession. its easier to bend, to adapt, to grow. Its a joy to love and admire people you just met. Its a challenge to absorb grief and give back just a bit of your soul to help heal someone who is grieving.

And many times, this can be a thankless profession. But who cares? As long as you know you did your best.

End Game RN:monkeydance:

[reesern63, RN]

Yes, they do. As much as I try not to let them get to me, sometimes I get so discouraged. Our "Satisfaction Surveys" are really bad right now--big surprise! We're horribly stretched, and it's affecting pt. care. It hurts, because I know how hard we all are trying. Rest assured, it will be our fault, not the fact that we are understaffed.

I think pts. and families have gotten much ruder over the years. I remember as a new nurse when I was treated with a little more respect by the public. Now people feel they can walk all over you, and I am not exactly the type of person people normally walk all over.

[reesern63, RN]

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

Are you suggesting that older nurses do not have the courage to challenge or change an abusive job environment? May I remind you who paved the way for this much vaunted younger generation?

[DutchgirlRN, ASN, RN]

Yes, patients and families that are hostile definately affected my morale. This lead to burn out, which led to me leaving the hospital. I found the patients in HH both thankful and appreciative for the care they received in their homes. The families were still occasionally a problem but no where near as bad as in the hospital setting. The majority of patients I work with now are outpatients and the vast majority of them very pleasant. There's always one in every crowd no matter what business you're in but I think the hospital settting has more than it's fair share.

[GLORIAmunchkin72]

All I can say is: WOW! You seem to be a very thorough and caring person. Your patients are lucky to have you.

Hey everybody; this is my particular talent. I practice nursing in a multicultural, multiethnic, multilingual community with a large variety of religious practices. Needless to say, it is important to know and understand the community where you work, I was born and raised here which gives me a head start.

I work with critically ill neuroscience patients'. This population includes brain and spinal cord injuries secondary to trauma, the trauma patients many times have associated orthopaedic injuries or associated soft tissue injuries, some extensive, requiring complex wound management and dressing changes. We have patients with neurovascular problems of the brain or spine. Our facility receives patients from the entire State of Florida if complex care is required, even from the Carribbean, Central, South, Latin America, the islands off Florida, and tourists from many different countries who suffer trauma or neurovascular disorders while on vacation in these areas of the world, particularly Mexico or Jamaica. You might say we are the emergency room to this part of the world.

Because we are a central receiving facility for all of the above patients we have had to learn how to communicate effectively with a very diverse patient population. I have found just being friendly, introducing myself to the patient, but usually family and friends if the patient is severely injured or has complications of surgery or diagnosis requiring supportive measures such as intubation, ventilation, supportive medications..etc...Within a twelve hour shift, I can, without too much difficulty, take nearly every family, every patient and make them an integral part of his/her or the patient's care. I first assess them as a group, single out the ones most likely to manage the other family members and visitors, get social worker to get the Health Care Proxy done. I always defer to the Proxy and/or others the Proxy wants with them when receiving information from M.Ds or me. I invite them to actively participate in the patient's care, or to observe me performing care by myself or in some cases with one of my friends who is the assigned PCT for my area. I explain everything I am doing and why, I explain safety measures taken when caring for the patient. Our PCTs all speak two to three of the common languages in South Florida and are an integral part of my being able to communicate and teach my patients and their families.

I insist that a family must bring writing material. legal pad and pen, and to take notes when I am educating them. I also insist that they go onliine and read/study the patient's diagnosis, treatments, surgery, complications of diagnosis and surgery. I give a list of medications needed to support the patient, then they can look them up. When I have established a SOLID foundation of trust, even love, I tell the person assigned to a specific area of study that if the "homework" isn't turned in, I won't let them visit...surprisingly I end up with a lot of "homework" assignments that I follow up with a discussion of what was learned and how the research related to the patient. This last is somewhat limited to people who can actually do this, i.e. have the education, interest to do this successfully. I find this works with this group of people. I check their notes and correct the spelling or provide the correct terms for them.

Other families require a different approach based on education, literacy, their ability to visit and participate in support groups, etc...I always find a way to incorporate patient care and education with a diverse group of people who come with that patient. Again, I insist they take notes and/or keep a running diary from day to day.

Once we have established a relationship, usually because I invite them to share Cuban coffee with me in the unit (not with milk, I like it strong!!) I sometimes bring simple treats to share or sodas, bottles of water to hand to the family and sit them down and tell them to ask any question, make any request, take this time to express concerns to me about anything related to the patient or their personal situations that might require a social worker to evaluate later, I give the primary person, Proxy, my personal cell phone number and tell them to call during my shift and I will speak with them, if I can't speak at that moment, I will call them back A.S.A.P!!

I listen to them, making time for each patient or patient's family this first interaction. Remember at this time I may be taking a patient to CT, Neuroangio, Specials, OR, hanging a variety of drips on the two assigned patients, maybe getting ready to place lines on a patient, while communicating with both families or with patient if the patient is able to communicate in some way.

Even if I am crazy busy, I always take that second to give a hug and kiss (culturally acceptable) to family members or to the patient who is not requiring such intensive nursing at that time. I always reassure them that I will have time to speak with them..and I always keep my word. I am fortunate in that our staff will help fill in when I am somewhere else. Our PCTs are OUTSTANDING!!! and our patient population, their families really appreciate them.

Yes, sometimes I get a very angry, aggressive, accusing family or patient, but I find that I eventually have them smiling, laughing with me while working with the patient, again, teaching them at the bedside. I honestly don't know how do it, except I make myself available to them more than most staff can seem to manage. I deflect criticism of other staff and redirect anger and frustration just by listening, touching gently and looking directly at the person who is speaking to me. I have simply walked into a room, smiled at what appears to be an angry person, nudged playfully the arm of this family member, handed a coke to them and got a smile and an interesting conversation follows. (I buy all the food and drinks myself from places on our campus).

By the end of the first or even the second interaction with my patients and families, the two families end up talking to each other, since they see that I am working with both patients. Sometimes this has ended up as a friendship that may or may not become permanent. Many patients and the families come back to see us and share rehab and personal family stories with us.

This is only a summary of what I do every single day!!! It is challenging, sometimes frustrating, and it is impossible to be successful with everyone, but I have a great track record so far. I would say I am 95% succcesful practicing critical care nursing this way.

I have practiced this way since the beginning..I am contiuously adapting and improving my clinical nursing and communication skills to meet the extremely diverse patient population we serve. I have been burned out many times, but stiff upper lip and all that..I have been able to return day after scheduled day and do what I do over and over again. I love my profession. I have been "ridden hard and put away wet" as the saying goes a thousand times or more.

No one said this was an easy profession. its easier to bend, to adapt, to grow. Its a joy to love and admire people you just met. Its a challenge to absorb grief and give back just a bit of your soul to help heal someone who is grieving.

And many times, this can be a thankless profession. But who cares? As long as you know you did your best.

End Game RN:monkeydance:

[Diahni]

All I can say is: WOW! You seem to be a very thorough and caring person. Your patients are lucky to have you.

End Game:

I don't have time to read all your post right now, but I did see the part about writing materials for families, so I am looking forward to reading the rest of it. I suspect that whatever the issues, the stuff brewing beneath the surface in a family explode in the open when a family member is ill. I wish there was more training in nursing school about this kind of stuff, which is crucial. Briefly, when I raised my hand during a nursing class discussion about dying patients, the teacher rolled her eyes and said, "I don't have time for this." What I said was that I noticed that it always was the most errant of siblings that comes forward with all the demands about the sick parent. I thought is was a good observation, but it tells you volumes about the atmosphere of nursing school. I look forward to taking in your post!

Diahni

[sticknurse]

I'm with you, it's a huge white elephant in most nurse's lives. I have left jobs as a result. I wish things were different. We are expected to be so patient, so understanding, so nurturing....but we have to take so much crap. I don't want to be the "thing" people beat on with words or intimidation. I'm a person too. I firmly believe alot of nurses have a high tolerance for crap. It's unfortunate we don't know how to set boundaries on the people around us. Why don't they address the toll it takes in school??

[Diahni]

Feeling very lucky that in the OR, my patients are unconscious and the families are in the waiting room. Don't know how the nurses on the floors deal with some of these people. As far as I'm concerned, you deserve medals. I would get written up my first week on the floor for telling them where to stick it!

HA! I second the motion for medals for all nurses. I would say that not only are administrations indifferent to the difficulties of nurses dealing with the public, it is obvious that putting up with so much is considered part of the job. I would question how this situation came to be, but a film I saw in a nursing class about the history of nursing spells it out. Is there any other job/profession that would tolerate this? It is a question worth asking. I have heard countless stories, (and have some of my own,) that illustrate the general consensus that nurses should be able to take as much as patients and their families can dish out. Well, we are all human beings, and people can only take so much abuse without psychological harm.

Diahni

[Diahni]

I'm with you, it's a huge white elephant in most nurse's lives. I have left jobs as a result. I wish things were different. We are expected to be so patient, so understanding, so nurturing....but we have to take so much crap. I don't want to be the "thing" people beat on with words or intimidation. I'm a person too. I firmly believe alot of nurses have a high tolerance for crap. It's unfortunate we don't know how to set boundaries on the people around us. Why don't they address the toll it takes in school??

Sticknurse:

Actually, nursing instructors do address it. They treat you about as badly as your favorite PITA in order to give you a taste of what's to come! When I started nursing school, so many people said, "OOO, I could never be a nurse." While I know what they meant, i.e., some people don't have the stomach for body fluids and smells. Yet there is so much worse. I am in such a quandry, as I believe I'm going to bail. While I do have all the right instincts and qualities for the job, one thing I can't do is take you-know-what. This syndrome, CTS (can't take the aforementioned you-know-what, is a real liability for me.

Diahni

[busy-bee]

I do believe this is becoming steady worse for nurses. Families and patients such as this have the ability to make you wish you never met them. When I come across these people, which is often, I do my job and nothing more. I find most are looking for a lawsuit, looking for someone to blame, etc.