Family members and Visitors telling me HOW to do my job!!!

[abbaking]

Have any of you had those pain in the butt family members and visitors TELLING you how to do a dressing change or how to start an IV? The past shift, I had a gentleman telling me and all the other nursing staff how to give PO meds, change the dressings and how to "Properly" use the accu-check. Meanwhile, His tone was that of explaining domething to an idoit ---Talking S-L-O-W-L-Y and annunciting every word......I find this behavior VERY insulting and irritating. I am not a child....I am a trained and educated medical professional - Sometimes with people like this I want to go to there Jobs and do the same thing ----see how much they enjoy it. Its very insulting....it make the patient fell tense cause her or she may think I am imcompetant.....The gentleman proceeded to rip off tape from already fragile skin.......That was the last straw....I said ---(to my co-workers in the room assisting me) "The last thing she needs is a skin tear and yet MORE skin breakdown".

[Vito Andolini]

Some things never change and this is one of them. Back in the day we called these visitors "helicopters"...they hoover over the patient and attempt to direct the care of the nurses (not the doctors). Now I am in hospice. I love it when a family member knows more about the patient's dressing change than I do...that means that they are going to perform the task while I watch and observe the wound. Wouldn't you just love to do that in the hospital setting? If they are particular about how that trach is changed and they do not trust me, then I encourage them to change the trach and I will observe. Same with the foley or whatever. If this is technology or a procedure that they are providing when I am not there, then they may provide it while I am there. It is that easy for me. If a family member (or the patient) does question why I am doing something the way I am I will pull up the basic procedure on my laptop and use it to reassure them about my process. I talk to people throughout the procedures, I engage them, validate their knowledge and expertise, ask them questions. This is MUCH easier to do outside of the hospital, no question. When folks are in the hospital they lose control over a wide variety of things. Nurses see the impact of that loss of control in a variety of ways...this is one of them. That coupled with the fact that some people are just annoying know-it-alls.

Of course, a nurse can make a mistake and a family member or patient really can know better than some nurses, docs, et al.

[JeanettePNP, MSN, RN, NP]

I'm sort of in the opposite situation. I'm a student nurse and I still feel like I'm playing nurse when I go into a patient's room. Yet so far patients and their family members have responded to me with respect as if I were a "real" nurse.

[belgarion]

I totally agree that a caregiver who has been dealing with a patient with a chronic conditions has insight and experience that no one else can match. My wife suffers from a wide variety of ailments and has paradoxical reactions to a number of drugs and standard procedures. I can't count the number of battles I have fought with nurses and doctors who have never seen her before but refuse to give any credence to what I try to tell them. On at least two occasions this stubborness has resulted in extended hospital stays.

I tend to cut a lot of slack for patients and members of the immediate family who are only trying to help by sharing what they know. I do, however have my limits and when someone gets TOO overbearing and all-knowing I can usually quiet them down with the same look I use on my kid.

[Woodenpug, BSN]

I agree that this sort of stuff can be really annoying. But what about the patients with chronic conditions that have seen their wound dressed every day and been educated about it, who know how it's done, who then have a nurse who they've never seen before and whose never done their dressing before show up and start on it...? The patient really does know how best to do their dressing in this situation. The nurse could certainly learn from them! I hope that this attitude doesn't hold you back from learning form your patients now and then.

They see an exact procedure. Something step-by-step. The patient focuses on the ritual, not the reality. I still focus on the fact that the most important member of the health care team is the patient and family. The patient doesn really know how best to do their dressing change in this situation, because the patient does not have my physical limitations or abilities. I double glove most of the time because sterile gloves two sizes too small slide on easier. That does not mean that the best way to do a sterile dressing change is to double glove.

[BunnyRN]

This is the reason, I ask them to step out of the room. Provide patient privacy. However, there are some family members that you can't easily avoid, or they are known to the staff, as "troublemakers". Sometimes I pleasantly welcome them to participate in the care.

I appreciate family members sometimes. But there are times they are very annoying, preventing nurses from doing their jobs. Just be pleasant, and not let it get to you. When they see your vulnerability they will work harder to make your life difficult.

[misswoosie]

"Yeah, but she threw the gloves in the trash so I have to use cotton swabs today"

A simple explaination of the facts regarding why the nurse the day before was using gloves and why the one today is using Q tips would have been far more useful,rather than a patronising sweet smile and clever ass (but completely uninformative) repsonse.

Personally-I would have reported the nurse for being downright rude.

[misswoosie]

I totally agree that a caregiver who has been dealing with a patient with a chronic conditions has insight and experience that no one else can match. My wife suffers from a wide variety of ailments and has paradoxical reactions to a number of drugs and standard procedures. I can't count the number of battles I have fought with nurses and doctors who have never seen her before but refuse to give any credence to what I try to tell them. On at least two occasions this stubborness has resulted in extended hospital stays.

I tend to cut a lot of slack for patients and members of the immediate family who are only trying to help by sharing what they know. I do, however have my limits and when someone gets TOO overbearing and all-knowing I can usually quiet them down with the same look I use on my kid.

How generous that you "cut them a lot of slack" even when they are helping you to do your job. Quiet them down with the same look I give my kid! Which category of nursing does that fall into?

[diane227, LPN, RN]

I try to listen to these patients, especially when they have been dealing with a chronic illness for a long time. If they have a special time that they take a certain medication I try to give it at their preferred time. If they come in with a dressing that they have been changing at home and they know how it is supposed to be done, I let them walk me though it. If someone has written a new order for the dressing change I will explain it and work together with them to incorporate the change. Many patients get very anxious about making sure that they get their medication and treatments on time. When they are anxious I will usually make a copy of the MAR for them and give it to them and explain it, noting the times their meds are scheduled and letting them know that we have a one hour window, 30 minutes before and after the time to give the medication. They really seem to appreciate being included and it does a lot to decrease their anxiety. They are so fearful that someone is going to forget their medication, it helps them to know that they are getting the right medications. Our medications often do not look like the one's they take at home.

If they are diabetic and they want to do their own fingerstick and draw up and give their own insulin I let them (under my observation of course). They are not allowed to take any meds brought from home unless we have a physician order.

[belgarion]

[/i][/b]

How generous that you "cut them a lot of slack" even when they are helping you to do your job. Quiet them down with the same look I give my kid! Which category of nursing does that fall into?

I think the real point was missed here. I guess you have never had a family member rushed off to ICU for a couple of weeks because the doctor or the nurse totally blew you off for three days when you were trying to tell them something about your family member (who you see every day) seems wrong. I would guess you haven't had some one sent home from the ER in spite of your trying to tell the doctors and nurses that the treatment they used on your family member has never worked in the past so why do they think it will work this time? And then they give the "I don't understand what happened " speech when your loved one is brought back two hours later in an ambulance. I have had this happen.

Yeah, I listen when patients and family try to tell me something. There is always the chance that some little grain of information will will prove to be critical to the patient's care. Since they see the patient every day I tend to listen when they tell me "something isn't right". When they tell me about a treatment that has been used in the past I ask how it worked then. I short, I try not to blow off someone who is trying to give me info that might, just maybe, keep that patient from becoming a statistic.

Do I allow abuse or interference in my job? No way. I give respect and I demand it in return. Just a little holdover from my days in the management world. As far as giving "the look", I don't think it falls into any category of nursing. I do believe that it falls into the category of "get out of my face". When used properly it is as effective on a hardheaded family member as it is on a stubborn kid or an arrogant company vice president.

[Batman24]

I do listen to family members when they say the patient doesn't look right, something is off, etc. Usually they know the signs as they have seen them before so it always bears checking into. I also try to give meds on their regular schedule as it cuts down on their anxiety quite a bit and that's best for the patient. These things don't bother me at all. Family members who are there to help out are a blessing to us. I appreciate the extra hands and set of eyes.

The ones who are there for themselves more than the patient are the prob. They need boundaries set from the start about what it appropriate and inappropriate for the patient. It isn't a party and the patient's needs always come first. Making that clear in a firm and kind way often does the trick.

[caliotter3]

This happens to me often in home health. I really like it when those that you can barely understand and who never went to a college anywhere, talk to you in that manner and write instructions in illigible and impossible to understand "English". What is really appreciated is that authoritative, condescending tone! Ha, ha. :chuckle

[mamason]

I once had a woman disconnect her dad's chest tube so he could get up and go to the bathroom. He was on bedrest and confused, mind you. She was a nursing student and knew "everything." Yeah....that was a really fun day!