Hmm...that's nice

**LibraSunCNM, BSN, MSN, CNM** · Mar 28, 2017

Are you really saying that a reasonably behaved family member who is authorized to receive protected health information standing next to the nurse discussing their family member's care while looking at a relevant screen with the nurse i.e. lab values, is behaving inappropriately and violating personal space/crossing boundaries? If so, I don't think it's the family member who has the problem with boundaries.

Do you really think looking over a nurse's shoulder at the computer, where there very well may be other patients' information on the screen, breathing down their neck and invading their personal space is "reasonable behavior?" I sure don't.

NurseBeans, BSN, RN, EMT-B · Mar 28, 2017

Personally I never out myself, but my husband, who I can only guess is super proud of me, outs me to anyone and everyone, every chance he gets. It's really embarrassing.

When a parent (I'm a school nurse) mentions that they are a nurse, I do the same as OP. "Oh, how nice", and know that when I speak to them about their child, I can use medical and nursey terms. It is what it is.

NurseSpeedy, ADN, LPN, RN · Mar 28, 2017

The patients who mention to me that a family member/friend who is visiting is a nurse don't really bother me. A lot of times they seem to appear awkward that that patient brought it up.

Now, the paid CAREGIVER (not even certified in anything) who comes in blasting the hospital and staff about stuff that is unrealistic and also misinterpreted by this person annoys the living crap out of me. I had one go bananas when when I brought in a Tylenol for an elderly patient complaining of a headache after a negative workup for frequent falls at home. She bursts out "Why the hell would you give her Tylenol when her kidneys are failing!!!"...

Me, "Um, her liver is fine. She can have the Tylenol for a headache. Now, her kidneys are doing pretty well for being almost 100 also". I bring up the lab report on the computer at this point because she's calling the POA. She points out the creatine kinase which was drawn in the ER (negative workup for cardiac or neuro involvement) and screams "Even I know that's not good for her kidneys!"....God save me from the village idiot.

This same caretaker is screaming to the POA that she hasn't recieved her meds (It's 7 am. She came up a couple hours ago. The primary doc will be in....and med pass wouldn't even be late until 10am!!!!) and states that we ignored the patients call bell all night. This was after I spoke to the patient with dementia and asked "which button have you been pressing"...points to the TV button. I pointed out the correct button and stated, "I'm sorry, but this is your call light. That one controls your tv. I will see to it that we check in with you frequently to make sure you are okay".

Another was the family that called several times a day for 45 minutes conversations concerning a UTI in another elderly patient with pre-existind dementia. After a couple day I get the granddaughter out of state nurse practitioner asking why we are lot doing invasive tests and psych evals since she's acting so different and tired. UTIs kick elderly butt. Give her a few days. The brain scan was negative. The UA was grossly positive. Come to find out her specialty was PEDs clinic and not geriatrics. We discussed the different presentations of UTIs with this population.

Please excuse iPhone auto correct errors.

audreysmagic, RN · Mar 28, 2017

Was it tempting to remind her that pretending to be a nurse is illegal?

Oh, you have no idea HOW tempting...

la_chica_suerte85, BSN, RN · Mar 28, 2017

It seems like the ones that are actually RNs or LVNs seem to be the most reasonable and know not to say something that might make staff nervous. They seem to like to have the "colleague-to-colleage" type of conversations. It's the CNAs, the housekeepers, the dietary aides, other auxiliary staff, nursing students, nursing student wannabes and family members of all of the above that do not understand that saying something like that to someone comes off as if they are trying to be threatening or get better care for their family members that seem to be the worst offenders. It's those who don't know what it's like to have the spotlight on them and to have to be on guard for their license that really don't get how unproductive that attitude can be.

Ruby Vee, BSN · Mar 28, 2017

What are your feelings when a patient or family member pulls the 'nurse card' (current or former nurse) on you when you or a team member is delivering care? I typically found family members the worse, but as long as it didn't interfere with my duties I would achknowledge the fact but pretty much ignored them and just smiled a lot.

I had a patient the other day whose fiance was a nurse. It turns out that she graduated from nursing school in the 90s, couldn't pass the licensing exam and has been working as a bartender since. Of course she had no idea what was going on with the patient, and she wouldn't listen to the providers or the nursing staff because she was convinced she already knew everything. I'm not impressed.

Ruby Vee, BSN · Mar 28, 2017

As the RN who has had this happen, my standard response was "This (meaning PICU) is such a specialized environment that I would never expect you to know the ins-and-outs of this specialty. I would be lost in your specialty as well- so I will just assume you are NOT a professional and give you the same teaching and info I give all my families" I always felt as though this 'allowed' them to ask 'stupid questions' and put them more at ease.
Caveat: some people are just jerks and want to show off, too!

I agree -- I've taken care of many the patient whose family members WERE actually nurses. (Some of them were even related to my colleagues.) I always tell them the same thing -- this is a specialized environment (CTSICU) and I don't expect you to know any more about it that I know about (ortho/peds/neuro/insert their specialty), but I appreciate being able to use the vocabulary with you. It's really nice not to have to explain what an antibiotic is and why it won't work for your viral infection!

Ruby Vee, BSN · Mar 28, 2017

I despise the "my daughter (or son) will be here later, she's a nurse and she the mean one" conversation. I'm thinking "SO!" But I just smile and say "oh really? in what area does she work?"
I have had family member nurses attempt to intimidate me and stand right next to me at the in-room computer looking over my shoulder asking questions. I despise that, too.
I wouldn't offer up the nurse card unless I saw them doing something wrong or that could be harmful. I would tactfully offer a suggestion or maybe ask questions about what they are doing and maybe explain that at my facility, we do this or that. I wouldn't want to make them feel bad or try to undermine them.

I've had family members looking over my shoulder at the computer screen as well. I tell them that if they're nurses, they must be familiar with HIPAA and to go sit down in the lovely chairs we've provided for them on the other side of the room. If they really are nurses, they'll back off then. If they're not, I've pointedly signed out of the computer and tell the patient I'll be back to enter their vitals in a few minutes "after you've had a chance to visit for a bit."

Ruby Vee, BSN · Mar 28, 2017

I also love it when the 'doctor' in the family is a chiropractor or optometrist ... gimme a break.

I've had folks walk in, announce that they're "the doctor" and start asking for HIPAA protected information. When that happens, I ask "What specialty." Usually, they'll back down then and tell me "Oh, I'm his best friend, and I'm a nephrologist". What really bugs me is when they pull the "I'm the doctor" card, get offended when I don't open the chart so they can look and then I find out that they're a pHd in archeology, English literature or astrophysiology.

Ruby Vee, BSN · Mar 28, 2017

Are you sure they are really intending to intimidate you? Have you considered that they may simply be doing their best to learn about their family member's care? I have stood next to my relative's nurse and looked at the computer screen for my relative's EHR with him/her, and both of us had a conversation about aspects of my family member's care. I was my family member's authorized representative and POA. It is quite likely they were in a similar position, wanting to learn more about the care their family member was receiving. Why not try to be helpful towards them instead of despising them? Also, keep in mind that they may be lawfully entitled to ask questions about the patient's care and to receive proper answers.

Family members who are nurses, doctors or POAs are not authorized to stand in the patient's room and look over the nurse's shoulder at the computer. Yes, they are entitled to look at the patient's chart -- if they're POA or the patient wishes them to -- but most hospitals have a procedure for allowing chart access. It involves signed paperwork and an appointment for a visit to the Medical Records department so that a physician can be present to look over the chart with them. If they merely want to learn more about the care their family member is receiving, I am happy to go over that with them (without them looking over my shoulder at the computer) or to contact the physician to discuss the care with them. Looking over the shoulder is not allowed. Furthermore, it is rude and offputting. I'm really hoping you weren't one of those family members because that will negatively impact your relationship with your family member's caregivers for the foreseeable future.

Ruby Vee, BSN · Mar 28, 2017

Are you really saying that a reasonably behaved family member who is authorized to receive protected health information standing next to the nurse discussing their family member's care while looking at a relevant screen with the nurse i.e. lab values, is behaving inappropriately and violating personal space/crossing boundaries? If so, I don't think it's the family member who has the problem with boundaries.

Possibly it's you who has the problem with boundaries. A reasonably behaved family member who is authorized to receive protected health information can get that by chatting face to face with the nurse, rather than looking over the shoulder. Looking over the shoulder is inappropriate, violating personal space, violating boundaries and usually violating hospital policy as well.

smf0903 · Mar 28, 2017

Family members who are nurses, doctors or POAs are not authorized to stand in the patient's room and look over the nurse's shoulder at the computer. Yes, they are entitled to look at the patient's chart -- if they're POA or the patient wishes them to -- but most hospitals have a procedure for allowing chart access. It involves signed paperwork and an appointment for a visit to the Medical Records department so that a physician can be present to look over the chart with them. If they merely want to learn more about the care their family member is receiving, I am happy to go over that with them (without them looking over my shoulder at the computer) or to contact the physician to discuss the care with them. Looking over the shoulder is not allowed. Furthermore, it is rude and offputting. I'm really hoping you weren't one of those family members because that will negatively impact your relationship with your family member's caregivers for the foreseeable future.

^^^Exactly! I can't even open my OWN chart for heaven's sake. Everyone has to go through Med Records to look at/obtain their chart.

Nurses, doctors, etc should already know that.