families with clipboards/notebooks

ZASHAGALKA, RN · Apr 9, 2006

I agree to disagree on this one. When your loved one is facing death - it doesn't matter that your'e scribing a diary, making notes - Nurses/doctors shouldn't feel threatened - why hide your feelings, your writings? In my mind - it's insecurity on the 'professionals' part if they are feeling anxious on seeing people scribing. Respect the patient - respect the relatives.

It doesn't make me anxious, but I AM put off by intimidation tactics. I don't believe what you are describing are meant that way.

But some family members DO use a great show of scribbling to 'intimidate' the nurses.

And it's not normally difficult to tell the motives. I've had lots of people taking notes, asking the right questions, writing down meds so they can look them up later. Awesome! I love involved pts/family members.

But I don't think that was the kind of pt/family member the OP was talking about.

~faith,

Timothy.

Marylou1102 · Apr 9, 2006

Many years ago I took care of an elderly woman. Her son came in from out of state and spent every waking moment at her side. He had a steno book and we would often see him writing in it. As she was discharged from the hospital we found out that he was a famous author, who is still writing today. Was he taking notes of his mothers care or working on his next book? Please don't assume that everyone that takes notes is looking for a lawsuit.

I attended a seminar on the legal aspects of nursing and how to avoid being named in a lawsuit. The lawyers said that the personal relationship between the nurse and the patient/family went a long way toward determining if there was a lawsuit or not. They are less likely to sue someone they like or feel a personal connection with.

ZASHAGALKA, RN · Apr 9, 2006

Many years ago I took care of an elderly woman. Her son came in from out of state and spent every waking moment at her side. He had a steno book and we would often see him writing in it. As she was discharged from the hospital we found out that he was a famous author, who is still writing today. Was he taking notes of his mothers care or working on his next book? Please don't assume that everyone that takes notes is looking for a lawsuit.
I attended a seminar on the legal aspects of nursing and how to avoid being named in a lawsuit. The lawyers said that the personal relationship between the nurse and the patient/family went a long way toward determining if there was a lawsuit or not. They are less likely to sue someone they like or feel a personal connection with.

I completely agree. Especially about the relationship thing.

But then there are the ones, that start their conversations with, "What's your last name, for my record. . ."

And, scribbling furiously:

"It took 6 minutes for you to answer the call button."

And,

"The last nurse got my meds here alot faster, wanna see. . ."

Like I said, most motives are pure. But the ones that play the note-taking game to try to intimidate their nurses, well, they are OBVIOUS about it; that's sorta the point.

~faith,

Timothy.

Nurse Ratched, RN · Apr 9, 2006

Agreed with Timothy that I've definitely seen both kinds of patients/families. The ones that irritate are the ones who insist on referring to "My brother, the lawyer."

ZASHAGALKA, RN · Apr 9, 2006

This reminds me of a similar story.

Many moons ago, I was taking care of this pt (not responsive) in critical care. My manager asked me if it would be ok for his sister to stay all night, even though we had closed visiting. I agreed.

About 2 hrs into my shift, he has an episode of diarrhea. I asked if she would step out while I got him clean. She moved to the doorway, but stop there.

"No", I said nicely, "can I get you to step out to the waiting room; I'll come get you and let you back in as soon as he's clean."

"No."

"I'm sorry?", I said.

"No, I changed his diapers when he was a kid, I'll be fine in here."

"Ma'am, he was a kid FORTY years ago, I think some additional privacy is in order since then."

"I'm not leaving."

"May I ask why?"

"Somebody has to be here to make sure y'all are taking care of him right."

"Excuse me, did you just say that you are here to keep track of my care?"

"Yes."

"Please leave, visiting hours are over. You may visit again in the morning."

"You can't make me leave, your boss said I can stay."

"Then you can take that up with her, but now, I'm afraid I'm going to ask you to leave."

My boss had been called by the house supr and both her and the DON were up there at midnight. They reached an agreement that was fine with me (they couldn't DEMAND that I deviate from hospital policy): she could stay for 15 min at the top of every hour. She did so once, and never came back.

Which goes back to one of my previous comments. I readily bend rules to be an advocate but not if you are going to try to intimidate me: then I stick to the rules.

~faith,

Timothy.

SFCardiacRN · Apr 9, 2006

I consider "taking care of the family" as part of patient care. Sometimes limits have to be set and sometimes the families can be unruly. Usually these families have had a bad experience with another nurse but can be put at ease by being professional and using the same "healing voice" one uses with patients.

TazziRN, RN · Apr 9, 2006

I have never had a family member takes notes in front of me but I did have a doctor do that once. He kept a little notepad in the breast pocket of his shirt and was always whipping it out, scribbling notes. I didn't think much of it (we all hated him and he was incompetent) but after the hospital's contract with his MD group was over I was called in to the boss's office with my union rep. He was taking notes on ME. He cited about 15 cases where I was supposedly incompetent and sent them not to my boss or the DON, but to the medical chief of staff. I had to go back and research every pt in those charges and write up a rebuttal, which took several days. There were no grounds in any of them but it created a huge amount of wasted time for me.

When my great aunt was in the hospital and my cousin called complaining about the care she was not being given (by the doc, not the nurses), I told her what to say and who to talk to and told her to record the times that she talked to someone and the time when the doc finally responded.

I have had disgruntled pts or relatives ask me for another nurse's last name, and I've told them that our last names are not given out for our own physical safety.

burn out · Apr 9, 2006

If the family insisits on staying with a patient thet is not dying I just bite the bullet and tolerate it, however, they do not get anything more than to sit inthe room. unless the patient is deemed incompetent I must respect their right to privacy therefore I can not tell the family what medicine I am giving or anything else about the patient..if they want to know ask the patient or doctor.

Roy Fokker, BSN, RN · Apr 9, 2006

Which goes back to one of my previous comments. I readily bend rules to be an advocate but not if you are going to try to intimidate me: then I stick to the rules.
~faith,
Timothy.

:yeahthat: :yeahthat: :yeahthat:

As the cliche goes "It takes two to tango". If you want to be prickly about rules and proceedures, well so can I

I've had some patients keep notes because they wanted to try to stay on top of the myriad things being done to their loved ones. Sometimes they'd write dows patient education stuff - we'd explain it and they'd write stuff down in their "own way" so that they could understand and execute it --- I didn't really care, so long as they were able to demostrate that they could provide competent care upon discharge, I could care less if they called a Foley "the pee tube".

I've never had one of 'em "you best better be careful or it's a lawsuit in the morning" types so far, thank goodness. Trust is a major part of nursing care - it's hard to deliver 100% care when you know that you're being treated like a suspicious, incometent thug than a trained professional.

yellowlablover · Apr 9, 2006

I have cared for both of my parents in the hospital and I would tell you that in all cases, my sis and I took notes and kept a notebook of everything that was done to them and for them, mostly for our edification and to be able to recount to the next doctor what had been happening. Unfortunately, we learned through quite a few hospitalizations with both parents and with my sis's family, you really do need to monitor the care of your loved one. It is not because I believe nurses (especially) are deliberately acting in an uncaring or even abusive way but that the circumstances that face many in the healthcare field today dicate a reduction in patient care sometimes. I tell friends and family today that if they want to be sure their loved one is getting what they need while they are hospitalized, it would behoove them to have a family member present at all times. Again, not to get ready to sue someone but more to act as an aide and help out when they can or get appropriate medical attention when it is needed.

My :twocents: !

DC

Daytonite, BSN, RN · Apr 9, 2006

i am a first year nursing student (3rd quarter) and have been recently warned against taking care of patients whose families have clipboards and take note of everything you do. previous quarters there wasn't much of an issue because we typically didn't run into visitors/family, but we are at the hospital for an extended time this time around.
so, are these families just looking to file a lawsuit? how do you feel about caring for the patient, does it make you nervous?

:lol2: Had a couple of these while I was both a staff nurse and as a hospital supervisor. Where are you going to run and hide to? :lol2: Look, there are two reasons they might be doing this: (1) to document what is going on for their own medical record. Keeping track of the tests and treatments being done is a legitimate reason to document. Maybe they're keeping track of what's being billed. Maybe they're making a list of medical documents to request for their own medical record file. That is just plain common sense. (2) they're nuts and trying to intimidate the staff. What a great way to make friends and influence people!

With people like these I understood that there was a psychological game afoot. The best thing you can do is to attempt to be as friendly and placative with these kind of people as you can. They don't expect that. Part of what they are doing is putting distance between them and you, so don't let them do that. Don't let them see you are afraid of them. It's all a ploy! It's childish. It's the only way they know how to try to get an upper hand in a situation where they have been rightfully or wrongfully made to feel like they've been wronged or taken advantage of. So, don't make that same mistake and allow them to pull you into their game and intimidate you. Go out of your way to be extra nice to them. If they question the way you do a certain nursing procedure, just smile sweetly and ask how they prefer it done. If if doesn't violate rules of aseptic technique or sterility I never had a problem with it. It is a mistake for people to believe that they can be sued successfully for anything. As long as you follow hospital policies and procedures you are not going to get into trouble. Use instructors, managers and supervisors for backup--that's what they're there for. But, above all, remember that these people are trying to suck you into a head game. You are the only one who controls whether you make yourself a player in their game or not. These kind of people are one reason why you had to study some psychology. More specifically, what they are doing is game playing as a way of trying to get an upper hand in a situation while making everyone else feel insignificant. There has been a great deal of research done on this kind of behavior.

lannisz · Apr 9, 2006

some people are chronic note takers - like my mother - she takes notes on any phone call, even when she's on the phone with me! kind of OCD if you ask me. And some of my elderly pt's have spouses who take notes simply because they are trying to be good caregivers and know they can't remember everything.