Hostile families

djh123 · May 16, 2016

I have had a very recent and very similar experience. The best thing you can do with 'hostile' families is to be professional, be polite, tell them when 'their person' last got a pain med, when they can have another, and perhaps explain why you think the current pain med(s) are enough, or if you and they both don't think they're strong enough for the situation, talk to the dr.

Maevish, ASN, RN · May 16, 2016

My last two shifts I have had issues with very hostel family members who felt that my hospital and me were not doing enough to prevent a patients pain. I had medicated both of these patients and update the MD when the pain medication was not effective. I understand that these families have their heart in the right place and are doing what they can to advocate for their family member, but how is trying to intimidate a nurse the way to get things done? I did notify the supervisor about the situation. Is there a good way to handle this or is it one of those things that comes with the job?

People are irritated, in general, about something or another if you're seeing them. Bottom line. Either they don't feel good or they're in visiting someone they love who doesn't feel good. People are also woefully ignorant about how nursing care and a hospital work. They think it's like a freaking restaurant where you can "speak to the manager" and have all your problems sorted:lol2:

You basically just have to get used to it :cheeky: They either will understand when you explain ("no, I can't give Mr Smith that 4 mg of Dilaudid because his blood pressure is 60/35 etc etc") or continue to get upset at you.

Worst case scenario, they get "the manager" and you get moved from your patient assignment. Sometimes that's the best thing. It's only happened to me a few times over the years, but it was better for everybody involved.

xo

nutella, MSN, RN · May 16, 2016

The dose of morphine was on the very conservative side and did not provide much pain relief for pancreatitis, which is known to be very painful. When you gave dilaudid you noticed that it was more helpful plus the toradol helped some I guess. At that time it is not good to cont with morphine if dilaudid was more effective and better to change the discuss changing the order to dilaudid.

If pain is acute and severe It is best to check after 15 minutes to see if pain is relieved and not wait too long.

I do not know how your hospital works in terms of PCA but that might be an option as well (without basal rate, just bolus).

Here.I.Stand, BSN, RN · May 16, 2016

It sounds like they had legitimate concerns, and I think you handled it well overall. My Monday-morning quarterback advice might be to be more direct with the MD that the current plan of calling for individual one-time orders is not working -- you're chasing your tail with the pain control, and he (the MD) is having to wake up for multiple calls. Maybe suggest a PCA? Pancreatitis hurts like the devil.

As for the son being convinced the hospital was short staffed b/c there was no MD on the floor, I'm guessing that's due to some misconception. Maybe he's seen too many episodes of Gray's Anatomy where the MD does everything for the pt and the RN stands like a puppy waiting for instructions... in that case I'd simply tell them that in inpatient medicine, overnight we utilize an on-call MD and you are doing what you can to get ahold of him/her. Even in the ICU, our residents on call sleep in the call room unless there is an emergency, admission, or they otherwise want to do their own assessment after speaking to the RN. They are not physically present 24/7.

I'm very free with the patient advocate's phone number for complaints that have nothing to do with me and everything to do with beyond-RN-control complaints -- family irate that there is no MD on the floor, MD didn't address their concerns, TV's too small, food not good, etc. They get paid to address complaints. We are there to nurse.

DeeAngel · May 16, 2016

Hostels provide budget-oriented, sociable accommodation where guests can rent a bed, usually a bunk bed, in a dormitory and share a bathroom.

If you mean hostile families, that means something entirely different.

KatieMI, BSN, MSN, RN · May 16, 2016

Here. I. Stand,

Lay people have a good number of amazing misconceptions about how hospitals and medical system in general works. If you ask most of them, you will find out that:

- docs have a cozy cubicle somewhere very closely where he can watch tv or have some fun with cute nurse, but is ready to run and see ma'baby at any given moment.

- labs are ready at the moment blood hits the vial, and they are read by phlebotomists

- nurses know about ma'pain pill, green pill, and small pink one. They know the names because they read labels. They know nuthin' else about ma'pills.

- diet comes from kitchen guys

- orders to walk come from PT/OT

- nurses do not know labs and tests

- they took my BP and such because doctor wants it

- something done only one time doesn't hurt (3 lbs of fried pickles w/fries, eaten at once with GFR below 20.... well, it did hurt).

- everything can be treated

- everybody can be returned to the level he/she was before if they just try hard enough

- there is no way to figure out what patient can see, hear or understand if he cannot speak

- there is a good drug for everything, doctors just do not want to give it because they will not be payed if everybody gets healthy

Most of the people who either 1) work in healthcare WITH some education, or 2) have family members working in healthcare, or 3) had prolonged stays, do not share at leadt some of these. For the rest, I made my own 10 min "you're in hospital now 101"spiel to be given when they are ready (i.e. settled down, more or less pain free and family is here). It brings episodes like the OP described to minimum if applied early and repeated regularly.

KC,RN · May 16, 2016

I know I spelled that wrong. As I said in the other posts I typed that quickly in the middle of the night without check. Thanks for correcting me. I will double check next time.

KC,RN · May 16, 2016

Thank you everyone. Some really good advice here that I will use in my bag of tricks to prevent this from happening again. It's tough as a nurse when you understand that someone is in real pain and there are so many channels that you have to go through to fix it. As for the patient she was very reasonable after the pain was brought to a comfortable level. I don't think the family had any intention of causing problems for me, but like was stated earlier had a misconception of how hospital work.

Editorial Team / Admin · May 16, 2016

I changed the title for you, KC,RN

LadyFree28, BSN, LPN, RN · May 16, 2016

Here. I. Stand,
Lay people have a good number of amazing misconceptions about how hospitals and medical system in general works. If you ask most of them, you will find out that:
- docs have a cozy cubicle somewhere very closely where he can watch tv or have some fun with cute nurse, but is ready to run and see ma'baby at any given moment.
- labs are ready at the moment blood hits the vial, and they are read by phlebotomists
- nurses know about ma'pain pill, green pill, and small pink one. They know the names because they read labels. They know nuthin' else about ma'pills.
- diet comes from kitchen guys
- orders to walk come from PT/OT
- nurses do not know labs and tests
- they took my BP and such because doctor wants it
- something done only one time doesn't hurt (3 lbs of fried pickles w/fries, eaten at once with GFR below 20.... well, it did hurt).
- everything can be treated
- everybody can be returned to the level he/she was before if they just try hard enough
- there is no way to figure out what patient can see, hear or understand if he cannot speak
- there is a good drug for everything, doctors just do not want to give it because they will not be payed if everybody gets healthy
Most of the people who either 1) work in healthcare WITH some education, or 2) have family members working in healthcare, or 3) had prolonged stays, do not share at leadt some of these. For the rest, I made my own 10 min "you're in hospital now 101"spiel to be given when they are ready (i.e. settled down, more or less pain free and family is here). It brings episodes like the OP described to minimum if applied early and repeated regularly.

:yes:

I too have a "PediED 101" spiel or "This is how it works" spiel when speaking to families, especially when they come in and the child or pt has had something chronic enough when they expect to see a specialist in the ED immediately-it just doesn't work that way... :no:

Keeping an informative communication stance works so well as well; the feedback and I see the respect for what we do increases when I see families that have NO IDEA what we do or have some bias (whether it be for personal reasons or cultural reasons); I like enlightening people, when it happens.

Kooky Korky, BSN, RN · May 16, 2016

The families might seem hostile, but from my recent personal experience as the family member of my loved one who was an inpatient, I'm not so sure 'Hostile' is the right word. Frustrated, aggravated, tired, so tired of all the stuff we had to go through, terrified, but not hostile - at least for me. I can't speak for everyone.

My LO has been on opiates for several years for chronic pain. When he went in for a totally unrelated illness recently, they judged him to be zonked. Blood gases confirmed a way high CO2 and he was very hard to wake. He was not able to give history because he was so out of it. I see him like this almost every day, I know it's not good, but it is not unusual for him. The staff, however, were legitimately alarmed. What did they do? Stopped his scheduled opiates that he's been on for years and gave him only enough to control his pain from the current illness.

I understood, but asked what they would be doing to prevent withdrawal. No real answer except "We'll watch him". That would be great if he had a personal nurse who would actually have seen him when he started, a few hours later, to thrash about with involuntary "restless leg" movements and lots of other "just can't get comfortable" thrashing. If his nurse had heard him hallucinating and seen him sweating and heard the teeth chattering as he portrayed Frank Sinatra in "The Man With the Golden Arm" I think it was (showing withdrawal from heroin), he might have realized my LO was in opiate withdrawal.

His nurse feared zonking him with his usual dose of opiates and feared giving IV push morphine, so got an order for, not quick onset morphine, but MS Contin. It was an hour and a half between asking for pain med and the time I called the Manager. I saw our assigned nurse busy with other patients, so called Manager, not to c/o but to let Mgr. know nurse was swamped and my LO needed help right away. I hope no trouble comes for the staff RN.

I just could not endure my LO thrashing and hallucinating any more. I was not hostile, I just couldn't take it any more. And LO's nurse was not goofing off, he was busy with other patients, legitimately busy. Didn't make it any easier. IT took 2 more hours for the MS Contin to begin to give any real relief.

As a nurse, I know how the hospital works - I know the doc has to be paged, there's time between page and response, it takes time to get the med once it's ordered, especially if it isn't floor stock and has to come from Pharmacy, there are other patients.

Somehow knowing doesn't help take away the pain I endured watching my LO suffer. Obama and other VIP's would not have to endure waiting, however minimally, why should my LO? Of course, wounded enlisted men, in the ocean after planes and ships were destroyed, were not supposed to be rescued before even non-wounded officers. RHIP. Doesn't make it right or easy to endure.

So imagine how it is for those who only see you doing "nothing" and do not understand the way things work.

Just do your best, do some educating, then try to forget about it.

KC,RN · May 16, 2016

I changed the title for you, KC,RN

Thank you!!![emoji8]