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

[shoegalRN, RN]

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]

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.

[shoegalRN, RN]

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]

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!

[shoegalRN, RN]

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]

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.

[shoegalRN, RN]

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.

[Penguin67]

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]

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]

>

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]

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.

[retiredlady]

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.