How to be a family member or patient

[CoffeeRTC, BSN, RN]

Ugh...it is our turn now.

I know people say "it is all the same no matter where you go" but I have to disagree. It really isn't. Yes, the hustle and bustle is there, the basic care of the residents etc. But there is a huge difference.

I've walked the walk..CNA, staff nurse on all shifts, unit and shift supervisor,RNAC, ADON and temp DON (got out of that asap). I've had experience in large and small facilities. I know how horrible it can be to be that nurse that is swamped and literally spinning around to decide which way to go. I've cried in the bathroom too BUT...............

I would never tell a patient....I don't have time to medicate you all the time.

Would never bark, what do want. Let someone sit on a bed pan for 1/2 hr + more than one time, would never neglect call bells consistantly, would never let my self be observed going out side ever 2 hrs to smoke (I don't smoke) would never let a patient go with unrelieved pain for shifts at a time and refuse to call the doctor. The list can do on and on. I'm appalled and at a loss.

Yes, we'd love to take this person home, but right now he needs the care and coverage of the nurses. I'd love to transfer him to my facility but it is too far away from his primary care giver and the rest of the family and yes, it is about the money.

No, I'm not there all the times to directly observe all of the above, I do trust the person observing all of the above. Family is more than willing to help out staff but what happens when we are not there? Before we mentioned that he is never turned and repositioned. they never did it. (bed sore that is not hard to miss) lack of incontinence care was also a biggy. I dunno.. just reading this persons H and P would give you a pretty clear picture of what is going on and what his needs would be.

So...how do you all deal? I know we are labeled "one of those families" ....especially his sister (she is a recently retired LPN). I have tried to be reasonable and let her know to not "sweat the small stuff" but it adds up with all of the other big stuff going on.

If I was at work and the roles where reversed:

I would have started off on the right foot at admission. Introductions and general orientation to the facility. I let families know that we are different from hospitals. Staffing patterns etc. Who does what?

I would let them know what is going on and what to be expected. Even if we don't know. ex. Family calls a nurse into the room due to difficulty breathing and notable edema. Me..I would actually do an assessment and let them know what could be happening and that I'm going to call the MD. and what interventions are in place and what we can do in the mean time. Then...call the MD and update the family. Seems like a no brainer?

Update the family on changes.

Let them know...we are working on xyz and might not have and answer for a while.

As a supervisor: I would approach the family and find out what is going on. Listen to them. Validation and provide a plan. Get to the bottom of things. Often times it is just a simple solution.

To the rest of the staff: If you have a pt that requires frequent medications...make sure the meds are appropriate. Could this person need a longer acting med? Also, if you know they are on the bell...anticipate. Follow up on care. Plan for it.

I know this is all rambling, but tell me how you've dealt when you were in a similar situation.

[JBMmom, MSN, NP]

It sounds like the things that you observed are indicative of overall substandard care. However, I think our facility does a great job in most ways and all of the above have probably happened at one point or another to many residents. If/when I have to deal with a similar situation, I'll be "that" family member too, but if that's what it takes to get the care needed, I'll do it. However, I've already warned my husband that we're building an apartment over the garage because I won't have my parents living in a facility- even the one I work at where I really hold the staff in pretty high regard. The reality of being dependent on anyone for care 24/7 is very sad. I wish I had some words of advice, I sent my sympathy for the fact that you're in a tough situation right now and hope that things improve.

[bluegeegoo2, LPN]

I have not personally had a loved one in a facility for any length of time, so have no advice there. However, I had a family member who was upset with the medication situation of his spouse in my facility. (She had psych issues with behaviors, and had been medicated into oblivion.) His issue was that she was sedated to the point of being asleep well more than she was awake. He asked me what I would do if I were him, as he was seriously considering moving her to another facility because he felt no one was listening. (We tried to induce changes for him at floor level, but nothing happened.) My answer was this:

Call for a meeting with the MD, DON, Social Worker, Unit Manager and administrator. Have your complaints/needs clearly outlined with examples of past issues and ask them what their solution is to the problems listed. Let them know in no uncertain terms that you expect resolution of the issues and intend to hold them accountable. No need to be nasty, just state your observations. After the meeting, watch. See if the issues are being resolved and that some effort is being made to improve the quality of care. If after a period of time things are improving, great! If not, then I would move her to another facility. In this case, his meeting was successful and her meds were adjusted to where her behaviors were still fairly well controlled (occasional outbursts, but re-directable) and he gets to enjoy a conscious wife again.

In my experience, going way up the ladder will end in one of two ways: Improvement in care will occur and you will know that the issues were mostly at floor level, or that no change will occur and that the issues are systemic of the facility. If your case happens to be in the latter category, then another facility may be your only option.