Families and the "ICU culture"

Specialties NICU

Published

Hi all! I am currently a nurse in an adult ICU, and I've been considering a move to a neonatal or peds ICU. (Gotten some great advice on that in this forum; thanks!) One of the reasons that I feel a need to move is the attitude toward families in the ICU I work in. I came from an ICU with a pretty open visitation policy and families were seen as beneficial to the care of the patient. Many of the nurses in the ICU that I'm in now regard families as intrusions. Even the new grads will give me the "OHH NOO! NOT THE FAMILY!" complaint when I give them report. So jaded for only having been a nurse in ICU for two seconds! Anyway, I'm wondering if it really is different in a neonatal or peds ICU. My idea of a childrens ICU is that family centered care would be very important, if not necessary. Am I wrong? Any info would be helpful. Thanks! Dana

Zoie's mom, it is my job to explain things to parents and be understanding of them. We understand that they are scared and stressed (you'd probably be surprised at how many former premie moms we have as nurses). We know we need to orient them to the unit. We know they want to be near their children and they should be.

BUT when they get to the point that their behavior is out of line, we need to tell them that too. It isn't my job to put up with abuse and it certainly isn't my job to cater to parents to the point where it endangers the babies I am looking after. It is NOT my job to provide one to one nursing care to a feeder grower baby, I have to look after three of them. In the end, my main responsibility is to the baby and I'm sure most parents agree that's the most important thing to them as well. Are the majority of parents crazy, demanding nutcases? No. Are there enough of them out there that I sometimes come to a nursing board and vent? You betcha. And no one needs to try to make me feel guilty about it. Just as you think we should walk a mile in your shoes before talking about parents, maybe you need to spend some time working in my unit before writing me off as a horrible person for complaining about some parents sometimes.

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Zoie's mom, it is my job to explain things to parents and be understanding of them. We understand that they are scared and stressed (you'd probably be surprised at how many former premie moms we have as nurses). We know we need to orient them to the unit. We know they want to be near their children and they should be.

BUT when they get to the point that their behavior is out of line, we need to tell them that too. It isn't my job to put up with abuse and it certainly isn't my job to cater to parents to the point where it endangers the babies I am looking after. It is NOT my job to provide one to one nursing care to a feeder grower baby, I have to look after three of them. In the end, my main responsibility is to the baby and I'm sure most parents agree that's the most important thing to them as well. Are the majority of parents crazy, demanding nutcases? No. Are there enough of them out there that I sometimes come to a nursing board and vent? You betcha. And no one needs to try to make me feel guilty about it. Just as you think we should walk a mile in your shoes before talking about parents, maybe you need to spend some time working in my unit before writing me off as a horrible person for complaining about some parents sometimes.

Totally agree. No NICU "graduate parents" need feel like we think this about all families. The only families I have a real problem with are, as you have aptly described, so self-absorbed that they find it impossible to put their baby's needs ahead of their own wants. They want to touch and pet their baby even after you have professionally explained why that might not be in their child's best interest AT THIS TIME; they cannot wait, they cannot put their own desires aside. And so they prevent their baby from having some uninterrupted sleep time, and then are nowhere to be found when it is time for "hands-on" care. They come in and throw a big fit if there is some saliva on their baby's lips instead of getting a cloth and wiping it off; (or just leaving it alone) acting as if this proves that their baby "isn't getting good care", even though their baby is a 24 weeker that is now a 28 weeker. Can't get those 4 weeks without "good care", IMO.

Sorry to sound so sarcastic; just got off work and we have some prime examples right now. We also have some absolutely wonderful moms and dads who exemplify parenthood, selfless and perfectly loving, wanting only what is best for their child. These people are a joy to work with and watch.

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Specializes in NICU, PICU, educator.

I agree...I don't think you have the right to judge any of us. Walk a day in our shoes. People think that because they are babies they are easier to take care of, but the opposite is quite true.

As for the "parent" issue....most parents are wonderful to work with, but it is the ones that complain every moment, demand that you do everything for them (but it is YOUR job to take care of my baby), don't listen to you when you tell them try to tell them what is best for their baby ( please, your baby desats to the 40's when you touch him, so you need to leave him be today....He is MY baby and I will do what I want...then junior has to go way up on vent settings and then the parent is really irate), the ones that want one hundred visitors at the bedside and throw a fit when they are told they have to follow the rules, the ones that come in with a cold...KISS the baby even after we told them the dangers of it and then become irate when junior comes down with RSV or adenovirus and has to be isolated, reventilated. Do you see the point now? And try having 3 of them at once. Then they feed off each other..that is even more fun.

We give our parents a very good orientation to the unit. We have the rules printed out for them. We tell them that if you don't see us jumping at every alarm, then try not to worry. We welcome questions and give reassurance often. We even go way out of our way for many of these kids and families, but it is the minority of the ungrateful ones that ruin it. I work in the inner city and there is the attitude of entitlement from many of these parents, try dealing with that for up to a year. I am not their to cater to the parent, the baby is my first and upmost concern. If I hurt your feelings by telling you what is best for your baby( such as not sleeping with baby while sitting in a chair), I'm sorry, but it is my butt on the line if something happens. And you had better bet your boots that same person would be on the line with a lawyer faster than I could blink if they dozed with junior and he fell and cracked his head.

So...maybe you should go to the NICU or PICU and shadow someone for a day. In the adult ICU's they don't have 24 hour visitation like we do...we don't have any downtime to finish tasks, we are in demand 22 hours out the day...we only have time to give report to the next person. It is very hard to change lines, etc with a bunch of people standing at the bedside. You should try it sometime.

So, don't judge us unless you walk in our nurse's shoes for a while.

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Specializes in LTC.

All I was trying to say is that this attitude stinks! I will walk in your shoes one day, I will be the best Peds Critical Care Nurse I can be because I have been there. See thats the thing I will walk in your shoes but will you ever walk in mine? Will you ever see your first born at barely 4 lbs swollen with her chest still open after what will only be her first open heart operation? Will you ever be there, I certainly HOPE NOT! But you can't tell what these parent s are going through...you dont' have a clue and its unconsiderate to call them selfish when you DONT KNOW!

Sorry its a subject close to my heart for a good reason. Sorry to make anyone feel like they don't have the right to vent I just think you can say tell them to walk in your shoes, well you imigine to take a walk in theirs....I am sorry to piss everyone off .sara:crying2:

I agree...I don't think you have the right to judge any of us. Walk a day in our shoes. People think that because they are babies they are easier to take care of, but the opposite is quite true.

As for the "parent" issue....most parents are wonderful to work with, but it is the ones that complain every moment, demand that you do everything for them (but it is YOUR job to take care of my baby), don't listen to you when you tell them try to tell them what is best for their baby ( please, your baby desats to the 40's when you touch him, so you need to leave him be today....He is MY baby and I will do what I want...then junior has to go way up on vent settings and then the parent is really irate), the ones that want one hundred visitors at the bedside and throw a fit when they are told they have to follow the rules, the ones that come in with a cold...KISS the baby even after we told them the dangers of it and then become irate when junior comes down with RSV or adenovirus and has to be isolated, reventilated. Do you see the point now? And try having 3 of them at once. Then they feed off each other..that is even more fun.

We give our parents a very good orientation to the unit. We have the rules printed out for them. We tell them that if you don't see us jumping at every alarm, then try not to worry. We welcome questions and give reassurance often. We even go way out of our way for many of these kids and families, but it is the minority of the ungrateful ones that ruin it. I work in the inner city and there is the attitude of entitlement from many of these parents, try dealing with that for up to a year. I am not their to cater to the parent, the baby is my first and upmost concern. If I hurt your feelings by telling you what is best for your baby( such as not sleeping with baby while sitting in a chair), I'm sorry, but it is my butt on the line if something happens. And you had better bet your boots that same person would be on the line with a lawyer faster than I could blink if they dozed with junior and he fell and cracked his head.

So...maybe you should go to the NICU or PICU and shadow someone for a day. In the adult ICU's they don't have 24 hour visitation like we do...we don't have any downtime to finish tasks, we are in demand 22 hours out the day...we only have time to give report to the next person. It is very hard to change lines, etc with a bunch of people standing at the bedside. You should try it sometime.

So, don't judge us unless you walk in our nurse's shoes for a while.

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Zoie'smom, do you really think there isn't a single selfish parent out there? That they are all just stressed and all want the best for their children? I wish I still believed that and if you do, I hope nothing happens to change that. If there's one thing I've come to believe it's that being a loving parent does not come naturally to every person. It's a choice. I learned that the first time I saw a parent come to the unit high.

The interesting question I'd ask is how much does stress excuse in a hospital setting? Obviously everyone in there is stressed, that's the nature of the beast, but most people are able to remain civilised. Should families or patients be allowed to do anything (yelling, swearing, disturbing babies, etc) because they are stressed?

I would argue that excusing all their behavior is doing them a diservice. Every parent will probably freak out once or twice, but they need to be reminded that such behavior is not helpful to them or their child and have that energy redirected into something more positive. This is especially true for the feeder grower baby's families (their children aren't that sick, and the parents energy needs to go into learning to care for them).

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Hello,

I think, honestly, what is going on here is miscommunication. Nurses have a right to vent, and parents have a right to vent as well..we will never be in each other's shoes, but maybe when some pple start working they will understand what the nurses' mean.

I have been a nurse for 5 years, almost all in the NICU. I can honestly say that when I care for a patient, it is the patient that is my priority-above lunch, above parent's concerns, above anything else. There have been days when i haven't eaten since 2 p.m. (coming in at 630AM) because I am trying to save a babies life! And, some days, the parents of that baby that I ran around for all day, come in right when I am not there at 2 p.m. and become irate! My priority is the baby, I want the baby to do well, to grow, to go home! I want the parents to feel secure in the care. If it is best for the baby, I will try to do it. (although one must realize that barring extreme circumstances a person has to eat to do a good job!)

I have seen some babies stuggle with kangaroo care (it originated in areas where we don't have the technology-incubators, etc. -we do now; like anything else, it should happen on a case by case basis) including temp instability which leads to poor feeding or even needing oxygen. I have seen some babies thrive. (and lest you think I am uneducated on this subject, I did a research paper on it at an ivy league university)

Yesterday i had some parents who were upset that when they came I was at lunch. But, when I came back, I taught them to check the temp, change the diaper, and hold the baby. I also disussed behavioral states of the premature baby and why it helps to visit during feeding time and let the baby sleep and conserve calories. They expressed a much nicer attitude after that.

My bottom line is if a parent has a concern about a baby, I will always listen, because it is their baby and they are intuitive. Some units are not good at educating parents on why they do what they do, and they should.

My other bottom line is...these are BABY intensive care nurses in a BABY intensive care unit! I think they must know what they are doing! There is no need to always feel so suspicious or parents to assume they know what is best because they read it in a book or on the internet.

I always tell my parents, if you have concerns, verbalize! Maybe they are mad because their nurse isn't at the bedside, but maybe it's because that nurse is taking another baby off the vent and working with grieving parents. I have had parents Refuse to leave the area when another baby was literally DYING. Their baby was sleeping in a crib peacefully.

I think when you work in healthcare you see the best of the human personality and the worst. To me, it's another day at work, to others, it is the most bittersweet day in their life. If we all communicate, we may understand that we have the same goal after all--taking care of the baby with compassion and dignity. t.

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All I was trying to say is that this attitude stinks! I will walk in your shoes one day, I will be the best Peds Critical Care Nurse I can be because I have been there. See thats the thing I will walk in your shoes but will you ever walk in mine? Will you ever see your first born at barely 4 lbs swollen with her chest still open after what will only be her first open heart operation? Will you ever be there, I certainly HOPE NOT! But you can't tell what these parent s are going through...you dont' have a clue and its unconsiderate to call them selfish when you DONT KNOW!

Sorry its a subject close to my heart for a good reason. Sorry to make anyone feel like they don't have the right to vent I just think you can say tell them to walk in your shoes, well you imigine to take a walk in theirs....I am sorry to piss everyone off .sara:crying2:

Sara,

It's just my opinion but I think you are taking people's statements too personally. I don't know how you feel because your feelings and reactions are unique to you, but I do know how I felt having had my baby born at 23 weeks and being very very sick. It was like nothing I've ever experienced in my life. I think you're taking your personal experience and thinking that every parent in these situations will react how you reacted; feel how you felt; parent how you would parent. It's just not how it is. I can't walk in any one else's shoes because even if I could I'd probably do things differently than what they would. I'll tell you, I had to learn very quickly that just because I'd been through what some of the families have been through it didn't always translate into knowing what would be appreciated by that family. What I mean is, there were times I'd so something that I really thought a family would appreciate because it's what I appreciated when my daughter was in the NICU, only to have them react the opposite way. For a long time I took it really personally, thinking, my goodness when my baby was in the hospital I would have wanted the nurse to ...................

Just think about everyday situations. There are times when people do things and you just shake your head thinking, when that happened to me I didn't act like that or when that happens to me I'd never do that. It's no different with patients in the hospital. You'd think ALL parents want what is in the best interest of their child but it's not always the case. In fact, parents behavior is what lands some kids and babies in the hospital in the first place.

Just try not to take it too personally. Its not an attack on you personally or to invalidate your experience. It hurts to hear some of these stories because you are personally invested in the subject, but unfortunately the things described do happen.

.

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Specializes in LTC.

I know it is too close to me..I just never met or saw anyone acting in this rude and crazy way that you guys are talking about parents acting! Sorry. That is why I guess I have to wonder why would you not consider the parents it just doesn't seem like many have. I don't know anything about experencing the problems of premies..Zoie was full term but premie size her problems were heart and feed related. I just know that my experience was good and as many times as we were in this hospital that the nurses I made friends with who shared a great deal with me being i was a fellow going to be nurse...anyhow I will no longer be posting on this thread...I will go away like some one suggested!

Sara,

It's just my opinion but I think you are taking people's statements too personally. I don't know how you feel because your feelings and reactions are unique to you, but I do know how I felt having had my baby born at 23 weeks and being very very sick. It was like nothing I've ever experienced in my life. I think you're taking your personal experience and thinking that every parent in these situations will react how you reacted; feel how you felt; parent how you would parent. It's just not how it is. I can't walk in any one else's shoes because even if I could I'd probably do things differently than what they would. I'll tell you, I had to learn very quickly that just because I'd been through what some of the families have been through it didn't always translate into knowing what would be appreciated by that family. What I mean is, there were times I'd so something that I really thought a family would appreciate because it's what I appreciated when my daughter was in the NICU, only to have them react the opposite way. For a long time I took it really personally, thinking, my goodness when my baby was in the hospital I would have wanted the nurse to ...................

Just think about everyday situations. There are times when people do things and you just shake your head thinking, when that happened to me I didn't act like that or when that happens to me I'd never do that. It's no different with patients in the hospital. You'd think ALL parents want what is in the best interest of their child but it's not always the case. In fact, parents behavior is what lands some kids and babies in the hospital in the first place.

Just try not to take it too personally. Its not an attack on you personally or to invalidate your experience. It hurts to hear some of these stories because you are personally invested in the subject, but unfortunately the things described do happen.

.

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