family requests and time management

[lalalalexi]

I am pretty new to nursing and lately I have been experiencing a lot of family requests that seem to really set me back as far as time management goes. I am wondering how to deal with this and also wondering if it's ever appropriate to just say no to them.

For example, yesterday I had a husband probably in his mid-30s call me in to rearrange the chairs in the room. He wanted the recliner next to the bed so he could sit next to his wife and then dictated exactly how he wanted all the other chairs arranged in the room for other family members. I told him that "this is your room while you're here. You and your family can rearrange the chairs however you want them, you don't need my permission." He told me he "felt uncomfortable" doing this. So I moved the chairs, while the family watched. The same night (of course it happens to be a night when we're over census and short one tech so everyone is running around like crazy), the wife of a patient calls me in and is sitting in a chair reading a book. She says "You know, I'd really love a warm blanket and a cup of tea". The pt was sleeping and SHE had pushed the call light. I just wanted to tell her no, I'm too busy. I really don't know how to be firm but still polite. Then yesterday another wife pushed the call button, this time to say that her husband was told he would walk at 1pm and it was 2pm. I went into the room and the patient was sleeping. Obviously she had pushed the call button. I explained to her that the doctor said he could walk anytime after 1pm, it didn't necessarily have to be AT 1. And she says "well since you're in here now, can't you just do it?" I told her that I would check back in an hour to see if the patient was awake, and if he was then he could walk then. And she responded "Well just wake him up! I think he should walk." Anyway, I have more examples just like these. What are your thoughts about family and how do you deal with their demands? Thanks-

[NurseNora, BSN, RN]

I once had a new dad come out of the bathroom wearing nothing but one of our skimpy towels hand me his dirty clothes and tell me to get them cleaned. I handed them back and told him to have his family members (who were present on and off all day long) to do that as I could not do that.

For the chairs, I would have asked the family to help me move them. I'm old and have a bad back. You're young, but as a nurse, you could easily have a bad back. If nothing else, it would get the job done more quickly and perhaps make the visitors feel a little more comfortable moving things around to suit themselves. You can also use the time to discuss things they can't do: move furniture so you can't get to the person in the bed quickly, move things so they don't reach the O2 outlet, that kind of thing.

Women in labor are very often hot so I frequently have to get warm blankets for the family because I'll set the room temperature for her comfort rather than the family's. Our visitors are allowed to use the pantry, so I'd take her there and show her were things are so that she could make her own. Mention how busy you are and that you want her to be able to do it for herself as you may be tied up with another patient when she wants another one and she would have to wait too long.

The wife wanting her husband to walk at a certain time because she was told that he could do so at a certain time is not so strange. She may well have heard (no matter what was actually said) that he should walk at that time. Take the time to explain to her that at this stage of his recovery/disease process/rehabilitation/ whatever sleep is more important than walking at a certain time. Perhaps he will be too weak or dizzy or drugged to be steady enough on his feet and the sleep will allow the medication to wear off, or for him to regain the strength to walk safely. Put it in terms of patient saftey rather than your convenience and your explanation will go over better. Don't try to convince her she heard wrong. Show her by your explanation that you have her husband's best interests in mind and are taking lots of things in consideration when making your decision to let him sleep rather than waking him to walk. Because that is what you're doing. I assume if the order had been for him to walk at a certain time rather than that he could walk at that time, you would have done so. As part of your nursing process, you are assesing and making judgements as to what needs to be done and when. You may be doing it automatically and not thinking about it on the top of your mind, but you are using the nursing process in your decision. Share that thought in a very simple and basic way and you'll get the wife on your side. Or perhaps she has a specific reason for her desire for him to walk now. Maybe she only has a babysitter until a certain time and she wants to be there when he gets up the first time , or wants him up and walking around so he can be discharged so she can get home before the babysitter leaves.

It's not as complicated as I made it sound. Just let them know where you're coming from and try to find out what they really want with their request. You can usually work something out that is good for both of you.

[Virgo_RN, BSN, RN]

In my opinion, the vast majority of patients and their family members have no earthly idea what a nurse does or how many responsibilities the nurse juggles at any given time. I think it's primarily because they don't see most of what the nurse is doing. The only time they see the nurse is when the nurse is in their room, and they have no concept what else is going on outside the room.

Some key behaviors that you can use to help you with this are delegation and communication.

I know that when you're short an aide, they're pretty busy and you hate to ask them to do more than they already are, but it's not unreasonable to say something along the lines of "I need you to cover my lights because I'm really tied up with XYZ." Where I work, answering lights is actually the aides' job, but nurses will answer lights if they're right there, not tied up with something, or the aide is busy. Asking the aide to cover lights for a period of time will cut out a lot of interruptions of your work for things that the aide is perfectly capable of helping the patient/family with.

Communication with the patient and family can make a huge difference in the kinds of things they interrupt your work flow for, and the time they choose to do it. Before I leave the room, I make sure the patient is all set with water, warm blankets, etc., and I tell the family members where the family room and cafeteria are so they can help themselves. I tell them that either I or the aide will be checking in on them regularly, and if there is anything that cannot wait until one of us does so, to use the call button. People still use the call button for the most minor of requests, and they still sometimes come out into the hall and track down the nurse for small things, but to a significantly lesser extent.

[ktwlpn, LPN]

o my -I haven't worked in med surg for about 10 yrs.I'm afraid that now I would not be able to keep my mouth from getting me into trouble. I remember how insanely busy we were and the thought of re-arranging chairs,running for warm blankets and drinks for family members just sends chills down my spine. Are they *******' crazy? I used to offer juice and fresh water every afternoon and would include visitors. I think I agree with another poster who suggested you explain to the family why you shouldn't move the chairs but I would not have been able to think of that on the fly.In LTC I'll grab extra chairs for visitors because we never have any in the rooms and if we have an end of life resident I'll call the kitchen for a coffee or cold drinks tray.If a family member has spent the night I'll often call for a breakfast tray (I just claim I dropped one) But I am working in a well staffed facility and I have time for that-but if I am in the middle of a med pass that stuff waits (unless a resident is actively dying and they and the family need support) I don't know how you med surger's stand it....The older I get the more likely I am to blurt out something I'm thinking and it might not be appropriate...

[CoffeeRTC, BSN, RN]

You need to be firm. It takes time to master this, but once you do...things will be better.

The chair moving.....I would include them in moving them.

The tea/ request....gee....the cafeteria is on xyz floor...they really only stock the pantry with enough for the patients...I can try to look for a blanket for you, but again..only enough for the patients.

I tend to be more passive than agressive and will alway encourage the family to help out.