Feeling defensive

Well, I don't work in a hospital, I work in a facility for mentally and physically handicapped. Some of what you say I can understand.

However, the attitude of not being able to call the family for "every little thing" just won't fly where I work. We have to call. It's REQUIRED. Even if we find a bruise, a small scrape, a small laceration, that only needs a bandaid. If the family comes in the next day, you would be glad you called.

What if you restrained that person and they then somehow got twisted up in those restraints trying to get out of bed and choked to death in them?

Granted you might have a doctor's order but to me that the family....or ME if it was someone in my family...would not have been called that you were applying restraints is unsconscionable.

At least if you call and tell the family then you have given them the choice to come sit or go ahead and let the restraints be applied.

Restraints, IMHO, do not come in the category of "every little thing".

I'm sorry.

ALL the time! I work agency at a local hospital, and I have to talk to family members all the time about these situations and explain that I may not know all the bells and whistles of this facility, but know where to get the answers!

Many times the "med error" deals just need to be explained. I have many patients that come in and don't take their prescribed home meds and that freaks people out. I explain the the MD has ordered meds on a priority scale...and dependant on the issues..meds that deal with those directly need top priority, and sometimes other meds decrease or increase the potency of the med...so meds are changed for this time for maximum effect in acute situations. And if they have any probelms copy the list of their relatives medications and have it handy to discuss this with their MD when they visit. That usually handles it. I put the power back in their hands, which typically is what they need or want (feeling helpless isn't a good feeling..they need tasks to help and guidance on WHOM to discuss these things with).

As far as restraints or confusion/combativeness...I do call the relatives, and I don't care what time or day! I let them know, remind them that their loved one is ill and in a strange place and that can be very scary for them. I also remind them that although us nurses do our best to provide comfort and decrease fear or too much stimuli, we have to do that for other patients and can't be in a room full time...which many of us would like to be able to do. That helping our loved ones through illness or injury is an all team deal...every one must be involved for the best results! Working with a team works, working against the team does not...and we are all on the same team...helping that loved one overcome this situation to the best possible outcome, and provide comfort and security :). When I put it into the 'team' perspective people tend to understand much better (and again the feeling of helpfulness).

I explain these things in a positive light with having the family feel helpful and part of the team. I don't make excuses, I am straight forward stating facts...but I do make sure I leave a room (or telephone convo) with that person knowing that hospitals are not hotels with 24hour nurse on staff in that room, that it takes everyone (family included!) to make things better (which is not something taught in our culture sadly...when someone here is ill you send them to the hospital, leave them or sit there and complain...that is what we are taught from an early ag, unlike some cultures that stay and tend to their loved ones!).

I think that I provided a bad example. I DO NOT consider restraining someone or medication errors "little things" or "no big deal." I do get in touch with the families and do all that the other posters have described. I don't want what I said to be misinterpreted. What I am trying to say is that our job is really hard, and it is difficult to hear people who have no idea what it is like to work in an environment like that say "well, this is what they should have done..." or "this is what they did wrong..." I think that the majority of us really strive to do the best we can, and it is hard to hear nurses being put down by those who don't understand.

I think that I provided a bad example. I DO NOT consider restraining someone or medication errors "little things" or "no big deal." I do get in touch with the families and do all that the other posters have described. I don't want what I said to be misinterpreted. What I am trying to say is that our job is really hard, and it is difficult to hear people who have no idea what it is like to work in an environment like that say "well, this is what they should have done..." or "this is what they did wrong..." I think that the majority of us really strive to do the best we can, and it is hard to hear nurses being put down by those who don't understand.

Now from this perspective I can understand more of what you are saying.

The public doesn't always understand, and our jobs ARE hard. VERY hard. Mine is, I know.

HOWever, there are things I'd still better do and calling the family is one of them, and on my job, yeah, we call for just about every little thing.

And the family thanks us for it, for taking good care of their loved one, and keeping them informed. You have no idea how much trouble you can avoid by making that call as soon as possible when the person has a change in healthcare events. Call them. It really doesn't take that long, and in alot of cases you've saved your butt.

I can see how you might feel defensive. As nurses, we work very hard to take good care of our patients. It doesn't feel good to hear a load of complaints. It's true that family members sometimes don't have any idea of how hard we work, or the responsibilities that nurses face. Sometimes their ideas of what nurses should do is unrealistic. On the other hand, I have to agree that family should be called before putting on restraints. With confused and combative patients, we are supposed to use the least restrictive measures first...bed alarms,family presence, sitters, etc. If you tried to contact family & exhaust other alternatives, by all means...sometimes you have to use restraints. Sometimes you have emergency situations. But it really is a good idea to call the family.

I had loved ones hospitalized in the past, and I have to say that some of the staff were flat out rude to me as a visitor/family member. I don't think I was demanding at all...just concerned and wanting to know if my loved one was stable/ok. A little compassion and kind words would have meant the world to me. I try to remember that when I see freaked out family members yelling and coming unglued where I work. They are often scared, and frustrated. They need even more TLC, and a few minutes of our time to explain what we are doing for their loved one and why.

I think also it helps to listen to people vent. Your neighbor's bad experience doesn't necessarily reflect on your own nursing care. You could validate his experience by saying,""That must be very frustrating and stressful." He probably feels powerless, and just wanted a sympathetic ear.

That is why I try to be proactive and educate folks about the differences between nurses and docs (gotta love all those things family say and they expect you to rewrite orders or make orders to cater to them)...and education about nurse/patient ratios and the need for patience.

I also find the time to do a little education about using hospitals as PRIMARY care (dependant on circumstance). And try to promote healthy lifestyles, seeing your doctor annually and before symptoms get bad acutely, and keeping the lines of communication open with your PCP! Most families I run into don't take proper care or illicit proper care for their loved ones before probelms start...now they are trying to catch up and they are overwhelmed and complaining at every little thing to regain control! Good time to help guide them before the next acute situation!

BTW I totally understood what you ment by 'every little thing'...I didn't take that litterally. No, restraints aren't 'little' but I understood what you ment. In ALF I had to call family about everything like the previous poster...even for a bandaid! But hospital is a different horse all together, and there isn't time to call for each outburst or behavioral probelm as they occur. I do call on the majority of them though, because typically I need that family member in there to soothe their loved one, and provide a familiar face in a strange land so to speak (also shows the family that we nurses aren't being lazy or are crazy...that these probelms are REALLY occuring and they get to see it first hand!).

Where as when I worked in a developmentally disabled home I didn't call family for the daily and frequent behavioral issues because typically that was baseline. If it was strange or acute..heck yes! But no, that is why people go to developmentally disabled facilities or homes...so that their loved ones are taken care of in facilities/homes that are supose to specalize in caring for these types of issues (yeah...I got one day education provided on how to get hit properly and only defend sensitive parts of my body as they hit me...nice! So I understand that "specialized" persona...yeah right, you learn as you go big time! But that is the selling point and reason people put their loved ones in these facilities...despite the reality of being severely short staffed, abused, overworked, and little or no federal or state assistance to help!).

I think that one reason that my defensive side tends to flare up is because I DO somehow associate what they are saying with my own nursing care. I think this is because I want to give each patient the best possible care all the time, but my practice environment does not always allow me to do that. I am sure most of you know what that feels like - very frustrating!!

Hear ya there! LOL, I say it is akin to living in a large house with a bunch of sick kids...but sadly you can't say "knock it off mommy's busy! Be there in a MINUTE...GRRRR!" LOL!

Like last night..oh brother. I am renewing myself as a med surge nurse...but last night they threw me 5 patients (which is normal...but the others had 3!). I had two that needed blood, two that needed new start tpn and lipids..and sadly...I had NEVER done that before! One patient who was combative and getting oob every few minutes, and the last one a brand new ampute (BTK with a total hip same side), who got 80 of lasix but had her foley removed earlier with no order to put it back in! She was up to the BSC every 15 minutes and it was a 15 minute deal just getting the abductor pillow off, SCUD off other foot, dangled, tranfered, on the BSC...then again in reverse! UHGGGG! SO here I am trying to learn blood and tpn...and being buzzed every 3-5 minutes for something else! I barely saw two of my patients...and they were all alone, scared, and I would have liked to have spent some TLC time with them, heck I would have liked to have time to do a proper head-toe assessment which wound up being a quicky on the fly! My meds were late, pain meds late...uhggggggg CALGON!!!!

I felt horrid inside...I wanted so much to just be able to help them all...but couldn't. I am sure those families are going to say..."well we never really saw that swing nurse yesterday...she just wasn't there...doesn't she care about me/my loved one?". That makes me feel like I failed miserably, but there was no alternative (short staffed only one CNA for 30 beds...EEEEEEKKKKKK!).

I hear ya...but I just kept telling myself...even if I do one thing...that is better than none. Somedays I do more, somedays I have to struggle to do just one...par for the course. I can't be a professional unless I realize my own limitations...and not worry so much about my persecptions on what a family member feels...I do my best..and that is all I can do... I just do a lot of smiling and be poliet, educate or give family tasks to feel helpful (and help me! LOL), and well...somedays that is all I can do!