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How to deal with those family members who are "nurses"?

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I've had a bad experience with a pt's family member who I "think" is a nurse. During report, I was told that this pt's daughter, who is the "nurse" and the wife made the day shift pretty miserable and guest relations was called and the day nurse was reported for being "rude".

Well, I work in a MICU, still in orientation, and my preceptor and I decide to be open minded about this family. I work nights and visiting hours are over at 20:30. Well, I get report and I have another pt who is considered "ICU" status, while this pt is considered "tele" status (just waiting for a bed). I'm at the desk looking up my medications and this pt's daughter and wife barged to the desk demanding to know who "my daddy's nurse is" and I need to see her "right now". My preceptor explained that we are just now getting out of report and his nurse is looking up his medications and will be in there shortly. The daughter states "well, he is wet and needs to be changed". I told her I will get there as soon as I can.

Since my other pt was the more critical pt, I went to see her first, grab her vitals and do her assessment. I then go see my other pt, and his daughter "the nurse" had taken out linen, a gown, and pads and placed them on the bed for us to change him. I went to get my preceptor because I didnt want to be alone in the room with them, and we decided I will do my head to toe assessment while we change him. We wash him up, check his bottom for skin break down, and the daugther and wife BOTH is sitting there watching us clean him up and once we turn him back on his back and change his linen, the daughter asked us if he had a bowel movement because she thinks he did! I said, we just checked him, cleaned his bottom and checked for skin breakdown, there was no stool. She says "are you sure because I think he did". I said, "you can check the sheets if you like".

The daughter is dressed in scrubs and as we are trying to bathe him and turn him and assess him, she is looking all in the cabinets, put on gloves and started cleaning the counter with alcohol wipes, took his suctioning canister out and dumped it in the SINK, cleaned it out, and wrote the date on it and placed it back in the holder! She also took his NG gradual and "threw it away" (according to her) because it was "filthy". Not only that, I was doing gastric residual because pt was on tube feeding and I put the pump on hold and pulled out the gastric residual with a large syringe and dumped the residual in a gradual so I can measure it and she tells me I shouldnt do it that way! My preceptor stepped in and told her that I am a new nurse and I am still learning and have been trained to measure gastric residuals that way. She then asks what school I went to, do I have a BSN, etc. I calmly answered her questions, but wanted so bad to tell her if you are a nurse yourself, you will understand you are making a very difficult working environment. I put the residuals back in the NG tube and turn the pump back to feed and she is standing there watching me like a a hawk. She then asks me for a blanket.

I leave the room to get the blanket and in the meantime, my other pt bp is dropping. She also have a 21:00 med due, so I grab the med and head off to her room to give her a bolus of NS, and the daughter sees me with syringes in my hand and STILL asks me for a blanket. I politely told her that my other pt is critical right now and I have to pass meds before she crashes and I'll have to get her a blanket when I'm done. She then "yells" for another nurse to come to the room to give her a blanket. It was way after visiting hours.

This upset me greatly. Something tells me this person was not really a nurse, but probably a tech. And oh, by the way, I caught her giving oral suctioning to the pt. I told my preceptor about it. Any advice on how to handle these types of family members in the future? The ones that are "nurses" or part of the medical profession?

kvsherry

Specializes in ICU.

First off, I would come right out and ask...something to the effect of, "I can't help but notice the scrubs, are you a nurse?" If so, engage her on a professional level. It's obvious that whatever capacity, this person is not ICU. Either way, she is worried about her father and you have to remember that and keep it in mind when she turns into a royal pain. These types of families can be a burden, but with a little politics and salesmanship, you can work them pretty easily and successfully.

As far as asking for blankets when your busy etc...ask someone who's not busy to grab a blanket, I know your still new so asking for 'favors' may seem hard at first, but trust me, it will make your life tons easier. When it comes to priorities, you did great with explaining that you have a sick patient. I often excuse myself in mid sentence or cut someone off because I have to check an alarm or something, most families do understand. Also, regardless of this woman's educational level, limits must be set. Say that you appreciate her trying to help, but you need to measure the residuals etc., and you really can't have her emptying equipment. As far as the suctioning is concerned, unless the patient should not have been suctioned, I've always been happy to let the family do something simple like that. It makes my job easier, and gives them a task to focus on. It puts them at ease and lets them feel useful in an otherwise powerless situation.

Thank you so much for your reply! I didnt want to "rock the boat" by asking her where she worked, what school she went to, etc.

I understand her father was sick, but I wondered why she wasnt just in the "family member" role, considering if she was a nurse herself, she can see both sides of it. I understand all too well what's it's like to see a family member in the ICU, although you've see plenty of pts, it's nothing like seeing your own flesh and blood. So, I certainly understand her frustation.

But I just couldnt understand the "criticizing" of my care, although I'm a new nurse. I tried not to let it get to me, but it did upset me. If she is a nurse, she understands how it feels to be new, at one point in time.

As far as suctioning goes, this pt was getting oral care q 4 hours. I guess I had an issue with her dumping the canister in the sink (we take the entire canister to the dirty utility room and replace it with a new one), then cleaning it out and writing a date on it. She was NOT at her job, she was a family member of a pt, so I think that kinda crossed the line, in my opinion.

sarajasmine

Specializes in ICU, Tele, M/S, Psych, Rehab. Has 22 years experience.

I can TOTALLY relate to you! In most cases, if the family members are actually Nurses-most are not bedside nurses(most are Nurse's aides)...if they are, they would understand the priorities and the critical importance of dealing with urgent matters first!

I have over 27 yrs of Nursing; mainly in Critical care and some Psych delt with all kinds of families. I've had family members take down a diary of everything that was given to their family member, every NS IV flush, current hemodynamic readings, drip rates and PRN meds. They documented how often the patient was turned. Initially, I felt insulted that they were questioning my knowledge, but I began to understand that it was mainly THEIR fear, they felt out of control. I realized this when my Uncle was in ICU, and all of my relatives made sure the staff knew that I was an ICU Nurse! It may have intimidated a few, but some talked to me as a Nurse. All I knew was that I was on the outside, looking in! I felt helpless.

Over the yrs, the constant watching and recording of the details doesn't bother me anymore. I learned through my experience with my Uncle, people want information. I explain everything that I am doing or giving their loved one-they just want to know what's going on and if they are without pain.

It wasn't a personal attack on me...they thought they might be losing their loved one.

The only thing I have a problem with is-if a family member 'says' they are a Nurse and come to find out-they are NOT an LPN/LVN or RN! If they're a CNA, they are NOT a Nurse! I have no issues with CNA's, I was one myself-did private duty, worked in a Nursing hm. But, I never pretended to be a Nurse when I hadn't earned that licence.

It seems the more you explain to patient's families, and ask how can I make 'him or her' more comfortable? A radio, special tv show, a warm fuzzy blanket..? You will end up being the most requested Nurse!

I can TOTALLY relate to you! In most cases, if the family members are actually Nurses-most are not bedside nurses(most are Nurse's aides)...if they are, they would understand the priorities and the critical importance of dealing with urgent matters first!

I have over 27 yrs of Nursing; mainly in Critical care and some Psych delt with all kinds of families. I've had family members take down a diary of everything that was given to their family member, every NS IV flush, current hemodynamic readings, drip rates and PRN meds. They documented how often the patient was turned. Initially, I felt insulted that they were questioning my knowledge, but I began to understand that it was mainly THEIR fear, they felt out of control. I realized this when my Uncle was in ICU, and all of my relatives made sure the staff knew that I was an ICU Nurse! It may have intimidated a few, but some talked to me as a Nurse. All I knew was that I was on the outside, looking in! I felt helpless.

Over the yrs, the constant watching and recording of the details doesn't bother me anymore. I learned through my experience with my Uncle, people want information. I explain everything that I am doing or giving their loved one-they just want to know what's going on and if they are without pain.

It wasn't a personal attack on me...they thought they might be losing their loved one.

The only thing I have a problem with is-if a family member 'says' they are a Nurse and come to find out-they are NOT an LPN/LVN or RN! If they're a CNA, they are NOT a Nurse! I have no issues with CNA's, I was one myself-did private duty, worked in a Nursing hm. But, I never pretended to be a Nurse when I hadn't earned that licence.

It seems the more you explain to patient's families, and ask how can I make 'him or her' more comfortable? A radio, special tv show, a warm fuzzy blanket..? You will end up being the most requested Nurse!

Thanks so much for the advice! I did eventually end up engaging in converstation with the daughter, and she did reveal she worked in a SNF. I didnt ask if she was a nurse or not. I knew she felt out of control, so I tried to make her and her mother as comfortable as possible. I think I lost brownie points when I couldnt get them the blanket they requested due to my other pt being a priority at that time.

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience.

You know, when my mom was in the hospital with cancer I did not want the nurses that were taking care of her to know that I was a nurse because I did not want to make them feel uncomfortable. There were a few of the nurses where she got her outpatient chemo that knew but otherwise no. I had a couple of run in's with the nurses while I was there, not their fault, it was mine. I was under a LOT of stress. Only child, holding down more than a full time job and taking care of my mom full time with no help from anyone. A couple of times I really lost my temper.

I guess the best we can do as nurses is include them in the care. I try to give them small tasks to do if they seem like they want to help and I try to keep them up to date on the treatment plan. I review the progress notes and give them up to date information. I think that the more informed they are, the less anxious they become. That's about all you can do.

You know, when my mom was in the hospital with cancer I did not want the nurses that were taking care of her to know that I was a nurse because I did not want to make them feel uncomfortable. There were a few of the nurses where she got her outpatient chemo that knew but otherwise no. I had a couple of run in's with the nurses while I was there, not their fault, it was mine. I was under a LOT of stress. Only child, holding down more than a full time job and taking care of my mom full time with no help from anyone. A couple of times I really lost my temper.

I guess the best we can do as nurses is include them in the care. I try to give them small tasks to do if they seem like they want to help and I try to keep them up to date on the treatment plan. I review the progress notes and give them up to date information. I think that the more informed they are, the less anxious they become. That's about all you can do.

I'm learning so much in nursing. I have already decided if I ever have to be hospitalized or have a loved one hospitalized, I will NOT be telling anyone I'm a nurse. I had the experience when I was a nursing student when my grandpa was in the ICU, and I went up to the hospital in my scrubs and the nurses wanted to know if I was a nurse, and when I replied a nursing student, I was spoken to in medical terms and things like that. I understood some things, but not everything. I decided from that point foward, I would not reveal I'm a nurse if I'm ever in the hospital and told my family the same. Since I understand the other side as well, I will not try to make the nurses job any harder than it has to be. I will try to help out as much as possible, (like I can change a gown or get my own water or blanket), but I won't overstep boundaries by acting like I'm at work when I'm not.

No, it didn't create a positive environment for you. But, just keep in mind that they are acting out of love for their family member and they do have a weird way of showing it, but that thier motivation is love. Look for things that you can do to relax them, and show them that you are in control and will take good care of their family member.

Some folks show love in different ways. Controlling family members may also be feeling guilty for some reason concerning their past or current relationship with thei hospitalized family member.

Alsway consider the reason behind the behavior of your patients and family members, and it can help you to understand them better and hopefully deal with them better.

Also, when you are the family member, you see things very differently. After my mom had heart surgery, and I was the nurse/family member, I understood where many of the family members were coming from.

mamamerlee, LPN

Specializes in home health, dialysis, others. Has 35 years experience.

We just had a big discussion thread on this same topic. It's really not a matter of the family member's background - it's usually a matter of loss of control. If there are actual visiting hours, you can ask security to enforce them when they get difficult.

I always tell the staff that I am a nurse; my family member has probably already told them. My nursing knowledge has literally saved the lives of two of my family. When my then-fiance' was getting Levaquin and kept getting red all over, I begged them to stop giving it to him. They wouldn't listen, and the next time he got it, his BP dropped - and I turned off the drip and demanded a doctor. They stopped the med.

When my dad was desatting, and SOB, I noticed that he had only 10cc - TENcc's of urine output in 20 hours. I loudly demanded a doc immediately - and a few hrs later he was back on a respirator and the balloon pump.

He hadn't been able to cough up a huge mucus plug, and went into near-total organ failure.

There are other stories I could tell you - too many, unfortunately - and it makes me so sad that I feel I have to be so watchful for my loved ones.

When I was just recently in the ER for my own issues, I overheard a nurse giving blatantly wrong information to a patient in order to get her to agree to a test. I piped up with a question. I saw a nurse recap a needle in the air - no one-handed scoop kind of thing. I should have called for a supe, but I was too tired to intervene.

I hope I have been a better nurse than the examples I have given here. The ER things were in the past 3 months, by the way.

KeechieSan

Specializes in ICU, MICU, SICU. Has 8 years experience.

>

Isn't that a little anal?? I mean, sure its the wrong way to do it.. but come on! Call the supervisior because someone recapped a needle incorrectly? Lol

mamamerlee, LPN

Specializes in home health, dialysis, others. Has 35 years experience.

No, it is NOT anal - - it's against everything we have been taught about infection control. DO NOT RECAP NEEDLES. That's when we get stuck. I come from the days when I saw nurses uncap needles with their teeth, and accidently stick themselves in the lip. Clean needle, maybe, but now they may have injected someting in themselves. So I learned that this is not a good thing.

I come from the days when we rarely wore gloves - but we wear them now to excess.

I repeat WE ARE NOT SUPPOSED TO RECAP DIRTY NEEDLES.

Getting Hepatitis or AIDS or anything else, including the med still in the needle is not the way to go.

I agree that it is a control issue and stress. I have been a family member many times. Nurses have made mistakes and you tend to watch. But the good nurses out weigh the bad.. Just had a family member in the hospital and I can say that they were excellent, such an improvement in that hospital in a year. Only thing, I wish that we could get our own blankets, linen, drinks for the patient without asking a nurse. It would be so much easier. I did make the bed and gave the patient a bath and they would say, are you sure? I like to help them when I can. I NEVER tell them that I am a nurse, they will act different and I don't know everything.

systoly

Specializes in LTC, Memory loss, PDN. Has 23 years experience.

As many others, I've been on both sides. Several family members make it a point to introduce me as "This is systoly, he's a nurse", to which I will say something such as," yes, but I'm here as your brother-in-law". I believe some of us, during times of stress, may succumb to family pressure and expectation to be all knowing, all healing, no matter what our area of expertise.

Having been on both sides of the bed recently.......I am well behaved when I am not the patient and don't tell anybody I'm a nurse but the family always says "This is so and so and he's an ICU RN" I don't intervene with anything unless if something serious is going on. I'm not there to work but I haven't turned the RN off either. I do ask a lot of questions though :)

As a patient...I try to be a good patient but tend to become hell on wheels when it comes to certain things. I was just recently in the hospital and I cleaned my bed with dispatch and sani-wipes before I would get into it. We all know how well those beds are cleaned :yeah:

I was also a nazi about hand washing. I did not allow ANYBODY to touch my PICC unless they had washed their hands with chlorahexadine in front of me.

Just my perspective

Orca, ASN, RN

Specializes in Corrections, psychiatry, rehab, LTC. Has 25 years experience.

I went to visit a cousin in a hospital in Canada several years ago. He had just had surgery, and he was asking me about recovery, medications, etc. I gave him some general information about how things were likely to proceed. His nurse happened into the room during this time. Rather sarcastically she said "You seem to know a lot. I suppose you're a nurse." Without saying a word I pulled out my RN license and showed it to her. She hastily apologized and left the room.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

I engage them in conversation, like "Oh, where do you work?" "Do you like it there?" "How long have you been a nurse?", "How long have you worked at XYZ facility?" etc. Often I find out that the "nurse" is really a CNA, but not always. Sometimes they really are a nurse, or a retired nurse. Sometimes it's the patient who tells me "My daughter is a nurse" because they don't understand the distinction between a CNA and a nurse, and I don't correct them. I just run with it. It's really unimportant, since the patient's safety and well being is the priority, not whether the family member is really a nurse. I let family members help with care, unless it is a safety issue, like trying to give a drink of water to Grandpa who aspirates because he had a stroke. Then I step in and educate, politely and respectfully. The other place I draw the line is with looking at the chart. I had a patient who was getting a procedure done, and I caught the daughter, who identified herself as a nursing student, reading the chart. I took it from her hands and said "I need that, thank you." in a polite tone of voice.

I once had a very complex elderly gentleman whose daughter had "a nursing background" (that's all anyone was able to get her to reveal) and was very demanding, antagonistic, and hostile. We all loved caring for the patient, as he was a very nice man who needed a lot of attention, but we hated having to deal with her. Even if we bent over backwards to please her, to be nice to her, to make her Dad our top priority, she never let up on her attitude. She must have figured she had to be a bulldog to get good care for her Dad, and that she was doing the right thing by him. She fired two hospitalists, demanded access to the medical record without going through the legal process, and many other things that just made dealing with her extremely unpleasant. With someone like that, you just keep doing your best for the patient, and don't take their attitude personally. It's their problem. Remain professional, don't let them get you flustered, and do not give them any ammunition if they decide to go after you.

In my short time in the ED, I have had lots of practice at dealing with demanding/rude family members in general. People get really cranky when there is a long wait, they will stand in the doorway and glare at everyone, they will ask the first person in scrubs that they see for a blanket or some soda, even if that person in scrubs has an armful of medications, tubing, syringes, etc. and is walking very quickly, they gripe about how cold it is, how hard the gurneys are, that their family member hasn't eaten "all day", and everything under the sun. You would think we went to their family member's home and dragged them to the ED just so we could torture them.

How I handle them is to just be polite. If they ask me for something I am able to help them with, I just say "Oh, sure, I'll get that for you now.", or something like that. If I can't help them with it, I just politely tell them "I can't do that right now, but I will be there as soon as I can.", then go about my business. If they want to be upset about it, too bad. I just let it roll off my back, because patient safety trumps everything. As long as I am polite to all patients and family members and place patient safety above all else, then no complaint anyone can ever make because I didn't get Grandma some juice or little Johnny a warm blanket, will ever be valid.

I recently have become the "supportive spouse" of my partner, who has been diagnosed with a chronic illness. At his most recent appointment, I instructed him NOT to tell ANYONE that I am a nurse. When I am with him at appointments, I am wearing my "family member" hat, not my nurse hat. Though the nurse hat is in my back pocket, just in case I need it! ;D

I've had a bad experience with a pt's family member who I "think" is a nurse. During report, I was told that this pt's daughter, who is the "nurse" and the wife made the day shift pretty miserable and guest relations was called and the day nurse was reported for being "rude".

Well, I work in a MICU, still in orientation, and my preceptor and I decide to be open minded about this family. I work nights and visiting hours are over at 20:30. Well, I get report and I have another pt who is considered "ICU" status, while this pt is considered "tele" status (just waiting for a bed). I'm at the desk looking up my medications and this pt's daughter and wife barged to the desk demanding to know who "my daddy's nurse is" and I need to see her "right now". My preceptor explained that we are just now getting out of report and his nurse is looking up his medications and will be in there shortly. The daughter states "well, he is wet and needs to be changed". I told her I will get there as soon as I can.

Since my other pt was the more critical pt, I went to see her first, grab her vitals and do her assessment. I then go see my other pt, and his daughter "the nurse" had taken out linen, a gown, and pads and placed them on the bed for us to change him. I went to get my preceptor because I didnt want to be alone in the room with them, and we decided I will do my head to toe assessment while we change him. We wash him up, check his bottom for skin break down, and the daugther and wife BOTH is sitting there watching us clean him up and once we turn him back on his back and change his linen, the daughter asked us if he had a bowel movement because she thinks he did! I said, we just checked him, cleaned his bottom and checked for skin breakdown, there was no stool. She says "are you sure because I think he did". I said, "you can check the sheets if you like".

The daughter is dressed in scrubs and as we are trying to bathe him and turn him and assess him, she is looking all in the cabinets, put on gloves and started cleaning the counter with alcohol wipes, took his suctioning canister out and dumped it in the SINK, cleaned it out, and wrote the date on it and placed it back in the holder! She also took his NG gradual and "threw it away" (according to her) because it was "filthy". Not only that, I was doing gastric residual because pt was on tube feeding and I put the pump on hold and pulled out the gastric residual with a large syringe and dumped the residual in a gradual so I can measure it and she tells me I shouldnt do it that way! My preceptor stepped in and told her that I am a new nurse and I am still learning and have been trained to measure gastric residuals that way. She then asks what school I went to, do I have a BSN, etc. I calmly answered her questions, but wanted so bad to tell her if you are a nurse yourself, you will understand you are making a very difficult working environment. I put the residuals back in the NG tube and turn the pump back to feed and she is standing there watching me like a a hawk. She then asks me for a blanket.

I leave the room to get the blanket and in the meantime, my other pt bp is dropping. She also have a 21:00 med due, so I grab the med and head off to her room to give her a bolus of NS, and the daughter sees me with syringes in my hand and STILL asks me for a blanket. I politely told her that my other pt is critical right now and I have to pass meds before she crashes and I'll have to get her a blanket when I'm done. She then "yells" for another nurse to come to the room to give her a blanket. It was way after visiting hours.

This upset me greatly. Something tells me this person was not really a nurse, but probably a tech. And oh, by the way, I caught her giving oral suctioning to the pt. I told my preceptor about it. Any advice on how to handle these types of family members in the future? The ones that are "nurses" or part of the medical profession?

Sometimes when dealing with difficult family members I have to remember that if the patient is really sick, then the family may feel a sense of guilt. Often times I have found that when I am dealing with family members who have siblings or children that are nurses they usually do not like to make this known because it may make the nurse that is caring for the patient nervous, especially if it is a new grad. In contrast if you find that you are caring for a patient that has a nurse as a family member and they are vey demanding, this may be a sign of power control. Some people like to have control whether they are nurses are not. Moreover when dealing with family members like this you have to remember that you can be firm in you word without being mean. If you have someone that is very sick always remember that priority comes first and if you have problems expalining things to the family members then let the more experienced nurse talk to them and observe his/her actions.

OldnurseRN

Specializes in ED, Med-Surg, Psych, Oncology, Hospice. Has 30 years experience.

I'm guilty of recapping needles everytime I use a filter needle to draw lido out of a lido amp. I need to put the smaller needle on the syringe for the doctor to inject that lido and I'm NOT going to remove that filter needle without a cap.

As for revealing I'm a nurse to those providing care to my loved ones, if the situation requires it, yes I will. If my mother is the patient no need, lol. She's told everyone, from the admission clerk to the housekeeper already!