Families and the "ICU culture"

fergus51 · Nov 18, 2004

Geekgolightly, I think you're talking about 2 very different scenarios. Any mother who wants to be with her baby and do best for that child is welcome at the bedside whenever it's possible. And sometimes it isn't. If the policy is you can't sleep while holding your baby, the nurse does not have the power to change the rules and say "Well, no one else can do that, but in your case I'll make an exception" unless they want to lose their job. If parents want to kangeroo and the baby likes it too (cause some kids don't tolerate it well) that's not a problem either.

The problem, and it's a big one, is parents who are difficult or manipulative or excessively demanding. I actually saw one mother get completely irate because the nurse wasn't there as soon as she walked in to pick up the baby and hand it to her. She didn't think she should have to pick the baby up herself. The nurse at the time was doing chest compressions on a baby who had a pulmonary hemorrage and died about a half hour later. I have seen parents tell outright lies about the staff. I have seen parents do things that are not in their child's best interest. I've seen parents who have no respect for NICU rules (had a mother who would try to eavesdrop during report about other babies!). I have had parents who want to wake the baby up because visitors are there to see him (never mind the fact the baby just went to sleep after 8 hours of fussing, they'll wake him up and leave him with me to calm again). THOSE are the parents who frustrate us. I admit, when I first started NICU nursing and heard nurses talk about those families I thought they were exaggerating and being harsh. Then I saw it with my own eyes!

geekgolightly, BSN, RN · Nov 23, 2004

Geekgolightly, I think you're talking about 2 very different scenarios. Any mother who wants to be with her baby and do best for that child is welcome at the bedside whenever it's possible. And sometimes it isn't. If the policy is you can't sleep while holding your baby, the nurse does not have the power to change the rules and say "Well, no one else can do that, but in your case I'll make an exception" unless they want to lose their job. If parents want to kangeroo and the baby likes it too (cause some kids don't tolerate it well) that's not a problem either.
The problem, and it's a big one, is parents who are difficult or manipulative or excessively demanding. I actually saw one mother get completely irate because the nurse wasn't there as soon as she walked in to pick up the baby and hand it to her. She didn't think she should have to pick the baby up herself. The nurse at the time was doing chest compressions on a baby who had a pulmonary hemorrage and died about a half hour later. I have seen parents tell outright lies about the staff. I have seen parents do things that are not in their child's best interest. I've seen parents who have no respect for NICU rules (had a mother who would try to eavesdrop during report about other babies!). I have had parents who want to wake the baby up because visitors are there to see him (never mind the fact the baby just went to sleep after 8 hours of fussing, they'll wake him up and leave him with me to calm again). THOSE are the parents who frustrate us. I admit, when I first started NICU nursing and heard nurses talk about those families I thought they were exaggerating and being harsh. Then I saw it with my own eyes!

fergus, I know the nurse can't let me break rules, I was venting baout the state of NICU's today and the attitude of this NICU, which was not parent friendly, despite the 22 hour/day visiting allowed. Level II nurseries (the one I was in) need restructuring to accomodate parents, and NICU nurses need constant updating of information. Like I said some of those nurses *****ed about my kangaroo care, trying to dissuade me from using kangaroo care at all! They were old school... had no clue about the latest information/studies and tried to guilt me out of holding my baby.

I also know how frustrating families can be, so I understnad any nurse's need to vent. I just wanted to be clear that there are lots of parents who feel unwanted in NICU and want desperately to be with their baby and involved in the care as much as possible.

Also, I would think that maybe some new parents would be incredibly intimidated by all this fancy equipment and feel as though they were not allowed to touch their babies without the nurse handing the baby to them. i felt out of place and like a bull in a china shop, and I am a nurse myself. It might help to inform all new parents that they are allowed to pick the babies up and show them how and explain the equipment, show how to change the baby, etc. etc. That way they can visit and feel as though they can care for their baby themselves. Frees you guys up for babies who need more help.

**canoehead, BSN, RN** · Nov 23, 2004

It never fails that when someone needs to blow off steam, someone, somewhere, wants to make sure they "understand". If the poster truly didn't understand or didn't care they wouldn't get so upset.

FYI I think that I will copy this post, and let's see how many times I get to use it in the course of a year. Taking bets- I think...at least weekly.

akcarmean, LPN · Nov 23, 2004

My first born was in NICU for 70 days. The nurses were wonderful. But we were also understanding parents. If we were asked to leave while an major procedure was going on with another baby in the room we understood waited and then we were let back in. I would get a daily report and write it down in a book. If I had questions I would ask the nurse but tried not to tie up her time b/c we knew she had other babies. Parent or family involvement does help speed up healing. (Just from what I have seen) BUT I can fully understand how difficult some parents can be. I seen it during our stay and would tell my husband how can those parents act like that. They are doing their job and doing the best to care for these babies as possable. Some parents and family can be very rude, demanding, and really not understanding about the care of their loved one. My goal is still to be working in NICU. The best nurse we had was one who had been through the experience and knew what to explain to use and to tell us what we were allowed to do and not allowed to do. Which made us feel like we were doing some care for our son and we were not as fearful of him and the machines. We learned what to do when he stopped breathing and how to stimulate him. We were allowed to do that and then reset the alarm. Which saved the nurse a trip or some little extra time. The machine recorded all the data. I am very grateful for my experience in NICU and that is where my decision to be a nurse came from. I am really not sure what this world is coming to. Everyone is so much more aggressive and angry and very unpatient. There needs to be some major changes in society but we as nurses can't do that. It needs to start at home with the very young children. I am for letting family see the patients but I also think that the family needs to respect the times for visitation. If a patient is very upset and wants to see a family member maybe it might help them calm down (not for sure havn't been in that situation) In NICU if the baby is crying and has been crying for a while and the parents are there and it's not visiting hours maybe the family mom dad might be able to calm the infant and free up the nurse. Maybe visiting hours could be added to the already scheduled times to allow a little more visitation. But I do feel that if you need to work with the baby and it is something that the parents can't participate in or will be in the way that it is right to ask them to leave the room while you do what you need to do. I guess I am just a understanding person and can see and have seen both ways. Well sorry for the rant. Just putting my 2cents worth in.

SarasLPN · Nov 23, 2004

i am new to the site and a nursing student...my daughter has a congintial heart defect. so far she has had to open hearts. we have been in the pcicu enough. the way we were treated was wonderful. parents can come in at anytime they wish all nurses were wonderful(minus 1) and helped explain all that was going on. you could sit bedside all night if you wished unless another paitent was going home or coming in or out from the or or er. or something like that. this is at a childrens hospital though and i am afraid that you will find if you want to work in peds then you will be involved withthe family. if they weren't there you would be mad too right? at a childrens hospital it is different than a regular hospital with a peds floor at least i thnk so.

fergus51 · Nov 23, 2004

fergus, I know the nurse can't let me break rules, I was venting baout the state of NICU's today and the attitude of this NICU, which was not parent friendly, despite the 22 hour/day visiting allowed. Level II nurseries (the one I was in) need restructuring to accomodate parents, and NICU nurses need constant updating of information. Like I said some of those nurses *****ed about my kangaroo care, trying to dissuade me from using kangaroo care at all! They were old school... had no clue about the latest information/studies and tried to guilt me out of holding my baby.
I also know how frustrating families can be, so I understnad any nurse's need to vent. I just wanted to be clear that there are lots of parents who feel unwanted in NICU and want desperately to be with their baby and involved in the care as much as possible.
Also, I would think that maybe some new parents would be incredibly intimidated by all this fancy equipment and feel as though they were not allowed to touch their babies without the nurse handing the baby to them. i felt out of place and like a bull in a china shop, and I am a nurse myself. It might help to inform all new parents that they are allowed to pick the babies up and show them how and explain the equipment, show how to change the baby, etc. etc. That way they can visit and feel as though they can care for their baby themselves. Frees you guys up for babies who need more help.

I completely agree that parents need to feel welcomed and involved in their child's care. I actually only know one nurse who is parent-unfriendly. The vast majority I work with are not (and that could have to do with the fact that we are a level 3 and part of a children's hospital). I even usually get along with the families that have been labelled as being a little difficult and we do encourage them to participate in care. Parents can change diapers, take temperatures, do baths, help with weighing, feed, change leeds and pulse oxs, etc. I joke with some families that they should start collecting a paycheck from the hospital for doing my job. Parents should and NEED to be involved in their infant's care because it's their infant. Us nurses and docs are just visitors in their life for a very short time.

I just don't want you to think that because a nurse says something bad about individual parents means that they are not welcoming to all families. That's why I separated my post into 2 paragraphs, because they are 2 completely separate issues (parents as opposed to destructive parents). The mother I mentionned who became irate when the nurse didn't hand her the baby had been there for months and did know how to pick him up. She just didn't feel she should have to "because that's the nurse's job". It's hard to admit and completely un-pc to say, but there are some parents out there who will never be happy with anything the staff does and who don't seem to care as much about their child's welfare. That does not mean us nurses shouldn't try to do everything in our power to try and make them happy or make all parents feel welcome. It just means that sometimes we complain and I hope you can understand that.

fergus51 · Nov 23, 2004

It never fails that when someone needs to blow off steam, someone, somewhere, wants to make sure they "understand". If the poster truly didn't understand or didn't care they wouldn't get so upset.
FYI I think that I will copy this post, and let's see how many times I get to use it in the course of a year. Taking bets- I think...at least weekly.

Do you mean my answer to geekgolightly's post? I didn't mean to be intrusive, but the last bit of the post was a question. If it was meant to be rhetorical I misunderstood.

**canoehead, BSN, RN** · Nov 24, 2004

No fergus, not you. I just meant that in issues like visiting, pain control or frustrating patients we usually start out with someone needing to vent, but then someone else comes along to make sure we all know how hardhearted the OP was.

It's a pet peeve of mine.

fergus51 · Nov 24, 2004

OK, thanks for the clarification:)

SarasLPN · Nov 25, 2004

I feel like all of you are talking about a few instances. Are there really that many demanding selfish parents whose children are in ICU

I like to work with families, but man, there are just some days when the unit is on the verge of self destruction that I wished we didn't have ANY visitors! Some parents think they are entitled to everything and every minute you have and become very, very nasty when you aren't at that bedside every minute of your shift. I have even said to parents, you know, you are very lucky to have a baby that just needs to gain and grow and doesn't require one to one nursing. Usually, they see the light after that. I have a really hard time with the ones that don't listen to you when you say, I am so sorry, but please leave your baby be until feeding time because he/she just fell asleep after crying for 8 hours...scenarios like that. And usually it is because they have visitors and want to show off the baby....not do what is best for their baby.
I have to say...sometimes having lots of families at the bedside can be deceiving....sometimes they are the ones that are accusing staff of negligence, etc and want the supervisor down there everytime their kid makes a peep and no one comes over to see what is wrong. Ugh. We have a unit full of them this month....I wonder if I'll have any hair left by next month :chuckle

SarasLPN · Nov 25, 2004

I mena did you guys ever think that the parents are stressed, over tired, angry? All this waiting on their newborn and then wam! Something happens and the babys in the hosptail for months or weeks? I know we were 7 hours away from home. Some odd 300 miles or more! We werent' resting and i knowall the other at the RMH weren't either. Just think about what they are going through not what they are making you do extra its YOUR JOB!

**canoehead, BSN, RN** · Nov 25, 2004

Any nurse that didn't explain all the tubes and wires every day would be booted from the unit in a New York minute. Someone that didn't make an effort to understand the stress families are going through, and to cut them some slack, and ease whatever burdens she could would be out of the profession- if they made it through nursing school at all. the attacking you feel is inappropriate is EXACTLY the tone you are taking with people that are stressed and need to vent to a trusted colleague. Go away.