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?

[TDub, MSN, EdD]

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.

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.

End Game RN:monkeydance:

Wow, this is amazing! How do you structure your time? I wouldn't be able to do this for one patient even if I had no family, friends, kids or dog and lived at the hospital. How much of your day is spent going over thses protocols?

[End Game RN, RN]

TDub;

Warning...superlong...

What protocols?????????????????????????????????????????????????? I do what I am...I am what I do....I am a nurse.

Good early morning from Miami, Florida. Uhmmmmm... How do I do this?

Let me also add to my responsibilities...believe it or not....

I not only work twelve hour days, 7a-7p, and do everything I wrote about my typical work day...but on my "days off" I work with our horses, we import, breed, broker Andalusian horses from Spain. And I provide vaccinations, nursing care, documentation of my interventions with our stock. I work with our Vet when it is required, provide wound care, dressing changes on any horse or dog or cat at the farm that requires it. I recently broke seven ribs, right side, #4,5,6,7,8,9 & 10 with #6 & 7 protruding slightly, but painfully near my spine, also had a small anterior pneumothorax. (getting another series of intercostal nerve blocks on Tuesday for pain management) I was thrown from one of my horses, a quarter horse gelding I raised from birth. (Unexpected lighting in a relatively clear sky), this was June 25, 07. Unfortunately I have since been on FMLA, hoping to return to work a.s.a.p, like end of August after f/u CT of chest. My work at the barn is now limited to completing and submitting paperwork for competitions for our Andalusians, for evaluation for elite status for another of our stallions. Lots of hands on computer time, though I don't claim expertise with computers. I was also able to update our vaccine status, especially since herpes encephalitus (Equine) has been detected in Florida, and in our area. This has been identified as a more virulent strain with recommendations of several boosters of Rhinobort- K+1b. So.. you think I'm busy? Due to the injuries I sustained, as described above..I was unable to drive secondary to severe pain and shortness of breath ..when I had to drive..I used a 10lb bag of ice divided into kitchen garbage bags,two pillow cases to pack against my right side and back..and cried the entire time I drove. I drive stick. I even waited another day to go to hospital..my sister in law called 911 'cause I was unresponsive the morning after the injury. packed in 20 lbs of ice front and back and I too was ice cold. So.. like I stated in my introduction, "I can do almost anything"

Actually I do take some mental health days..i.e..being with horses is my "rest" from the stresses in my particular specialty. There are times I actually just hang out with my family/friends for a day, maybe one time per week, and not all day. I have even taken "sleep in" days.

Now..let me address my clinical nursing skills...I do absolutely everything I wrote, easily validated by my co-workers whose only complaints seem to be that I do to much and raise the bar tooo high for the rest of them. I tell them that I am not competing with anyone except myself. I often help my "partners" who are assigned on either side of me. I have changed lines, taken patient's to emergeny CT scans with critical changes in their status along with the "new" nurse, after getting another nurse to cover my assignment for this period of time. I've bathed patients', changed linens, got patients out of bed for my colleagues and still somehow manage to keep my patients and families happy.

Whats the secret? Anyone can do anything with any patient or family or colleague if you maintain an open, friendly, approachable attitude.

Communication is the one main tool nurses can use, especially in an ICU, an believe me we are a huge neurosurgical ICU encompassing a broad spectrum of patients.

I establish a relationship with my assigned patient and family, and I automatically assess and adapt to their needs, balance it out with what I know I absolutely must accomplish for a two patient assignment. I find out who is working on either side of me and assess what their needs, and their patients needs are. I am hypersensitive to body language and vocal tones, especially with our culturally diverse population.

A "time out" where even if I am working aggresively with a critical patient, I have the proxy and/or others in the room with me where I can have them observe and ask questions, still maintaining patient privacy as I don't expose patient's body. I have the medical team come in to speak with the family, I explain everything I am doing in real time and answer questions as they are asked as I work.

Depending on several factors which involve my initial nursing assessment of these peoples' pychological makeup and coping..this can be instantaneous at times. I give my personal cell phone number, name and instruct who ever is representing the patient, to call me anytime during the twelve hours I am working. Its amazing how just this one courtesy impresses the family and equally amazing how this is not abused. I also find this causes the family to "chill out" a bit, even taking food and Cuban coffee breaks. If things get intense, I tell who ever it is leading the group anxiety to go buy me a colada and take a mental health break for themselves.

I would say that immediate introduction, communication, hard work, organization and a compassionate attitude that is real, not scripted, and a direct way to allow family to communicate with me, i.e. my cell phone all serve to reduce family, even patient anxiety.

Since you seemed surprised that I can do this, and I do, each and every scheduled work day..I won't mention the dozen or so other things I do extra for families.

Remember, the ICU, I don't care where you work...you do have some "down time" in the unit where you are not running around.This time should be taken to continue to develop your relationship to your assigned patients and families.

If you take time to teach family how to care for their family member while in the ICU, having them work side by side with you on a patient who requires some level of post ICU care..You end up with happier families and improved patient outcome..i.e. my patients do not return to our unit when their family members learn and demonstrate excellent care. Every situation is different, every family and patient is different, but it is possible to adjust teaching and practice to the level of safety, competence and desire of the persons who are being taught.

I have had families performing trach care, changing the inner cannula, dressing and soft trach collar. They learn to suction the patient via trach, using the ambu-bag on O2, I don not leave them alone performng this care..they must also demonstrate competency in checking the ambu-bag for its peep valve..check the diaphragm for secretions, and if so, Identify the problem to me and tell me what their actions would be to correct the problem, they must attach the tubing to an O2 source and correctly ventilate the patient before and after suctioning. They learn to assess secretions, they perform pej, peg care, they straight catheterize the patient if required. They learn how to turn the patient safely and with good body mechanics, they change bed linen and learn how to care for skin on the physically impaired patient. They learn to get the patient out of bed whether in a wheel chair of some type, or in a Total Lift II chair. Even when getting a patient out of bed to a regular chair.

Not all families want to do this, or any aspect of the patient's care. These people require another way to incorporate them into the reality of the patient's ICU admission. Many times this is by allowing them to observe me at work, and giving them time to formulate and ask questions, none of which requires me to babble incessantly at them. Just let them hang out and you just do what you for the patient.

There are so many ways to provide excellent care to patients and families, and believe me I have had my share of angry,unreasonable and frightened families, to psychotic families. Some you can work with, some require administrative intervention, some require security or Metro Dade Police intervention. Eventually things do work out. at least, in my experience,

...and yes, I have experienced burnout on several occassions..I do back off occassionally, but still try to be caring and supportive.

I also have personal reasons for trying to do my best 24/7 and these reasons will not change, nor will my nursing practice change.

Have a great day!! I'm off to the barn for a mental health break.

Eeka End Game RN

[teeituptom, BSN, RN]

No they dont affect my morale. I refuse to empower them to affect my morale. If I dont empower them, then there is no way they can affect me.

[nyapa, RN]

Affect my morale? Just talking about it affects my morale. This is probably because having suffered physical abuse at the hands of patients (and I know I'm not the only one) that no matter how hard I try to not let it do so, I am always looking out for the next time. I have been working away from potentially violent ppl for over half a year now, and am about to step back into an area where it can occur again. It'll be great to see if the break has helped me...

[Marie_LPN, RN, LPN, RN]

Nowadays, about those types i just think to myself "at least i don't live with 'em."

[penguin2]

No they dont affect my morale. I refuse to empower them to affect my morale. If I dont empower them, then there is no way they can affect me.

This is so true!! They can only affect us if we ALLOW them to.

[twistedpupchaser]

As a nursing student I have heard lots of stories about these patients/families and wondered how I would deal with them. Coming from a very physical background and standing 6 foot 4, I figured that most patients would not try it. How wrong was I?

On one of my rotations I had a patient about half my size chest poke me and heap on the abuse calling me every effin bleeder under the sun. I still don't know why I did it, I chest poked him back and "read his horoscope". My preceptor walked in part way through and let me finish before giving me a stern "talking to".

At morning tea the next day another nurse on the ward came up and thanked me, this patient was behaving himself for the first time!

I havn't dealt with any realy bad families yet but I hope I handle it a bit more diplomatically than I did this particular patient.

:innerconf

[Diahni]

Twisted:

Ah yes, one more story in which a paying customer acts in such a way that you can't believe it! I have often found myself thinking, "Where in the world, except maybe during warfare, is it okay to let it all hang out in the way that some patients and their families do?" And at the same time, nurses are not supposed to react. ALthough I'm so impressed at the character and maturity of people who don't let this kind of thing get to them, I still think there's a real systemic problem. Who made up this rule, and why does it persist? If somebody lays a hand on you, that's called assault. There is nowhere in society, including behind the walls of our own homes, where it's okay to be abusive to other human beings. I go to a store where there's a sign, "Misbehaving children will be sold to the gypsies." - Maybe there could be a more diplomatic sign in hospitals to let people know that employee bashing, verbal or physical is against the law.

Diahni