How to Respond When Family Blames You for Patient Dying

[CaliRN2019, BSN]

What is the appropriate response when family blames you for the patient dying, even if you did nothing wrong and death insists on taking its course? We have had so many Covid situations lately where patients are DNR/DNI  but are in respiratory distress and family refuses comfort or hospice. Such a slow and awful death. The other day a spouse was fixated on the fact that we had not been feeding her husband ( Sp02 70-88%, lethargic, ALOC) and insisted I take off the non rebreather to give him his PO meds and feed him to "save his life". She continued to scream at me ( over the phone) that I was killing him. It feels so unfair to watch a patient slowly suffer and die without relief due to patients own specific parameters and then get blamed for it. 

[TheMoonisMyLantern, ADN, LPN, RN]

People respond differently to tragedy and when tragedy happens we often have to find reason and assign to blame to someone or something. It can be hard enough to get family at the bedside to be on board with palliative care but when the family can't see the decline, like so many of the families of our Covid patients, it's even harder for them to reconcile. The main thing we can do is continue to educate and assess what the family's concerns are and to help guide them to adjust their expectations of treatment and prognosis. Even still sometimes it's just like talking to a wall. Even though you don't deserve to be blamed, and you know you are not to blame, I would try to be forgiving right now in how they respond.

Also, I would try getting the physician involved when they are out right blaming you for the death so that they can reinforce education to the family. Sometimes families just need someone in a white coat to talk to them.

You are not alone, and you are certainly not to blame for any of this.

[RNperdiem, RN]

Sometimes there is nothing you can do.

People grieve and get irrational. Once Covid case I had was a man who had caught the virus from his wife. He and his wife were once teen sweethearts, and had married later in life after mid-life divorces. During the family conference to withdraw support, I got the sense that the man's children were blaming the new wife for their father's death. 

[LovingLife123]

It’s very difficult for people to understand especially when they can’t visit.  They feel helpless.  Just as helpless as we do.  They are grieving.  And while it’s not appropriate to berate you, sometimes you have to give them a little grace.  They are losing their loved one.

I think throughout this whole pandemic we have become a little numb to death as we see so much of it.  It’s why I’m so adamant about staying home and social distancing.  I don’t want people to have to go through this.

[Wuzzie]

On 1/3/2021 at 12:37 AM, CaliRN2019 said:

She continuED to scream at me ( over the phone) that I was killing him.

I’m sorry but no amount of grief means you have to be subjected to this and no amount of anyone telling you that “it’s just her grief, she doesn’t mean it” is enough. We are human and words like this do damage to our souls. The ramifications of this kind of damage varies from person to person. We have nurses who have become suicidal due to the constant barrage of anger aimed at them for things entirely out of their control; the virus, visiting restrictions, delays in care, etc.  

When a person talks to you like this OP there is nothing you can do to make it better for them. They are beyond reasoning. Trying to explain things only makes it worse. The best you can do is be kind but protect yourself. I work in Oncology. It is not infrequent that we get these kind of calls (worse now because of COVID). When it happens I allow the person a few minutes to rage (but only listen enough to get the gist of their issue not internalize any of the nastiness) If this diffuses the situation great. But if it doesn’t and they keep up I will say something like “I am so sorry for the pain you are going through. You clearly only want the best for your [insert relationship]. I need to ask you to lower your voice/quit screaming/stop using profanity or I will be forced to terminate the call”. If this works that’s good. If it doesn’t then the last step is to say something along the lines “I asked you to lower your voice/quit screaming/stop using profanity. I will notify the physician of your concerns. Goodbye”. And then hang up! Now often they won’t stop talking long enough for you to get this in so you might be forced to talk over them. Never raise your voice to do that. Then document the crap out of what happened and I mean word for word. My last line in my documentation is always “the call was politely terminated”. 

I’m so sorry for everyone involved in your situation OP. The patient, the wife and you. It’s a terrible time for so many people but you do not deserve to be on the receiving end of anyone’s verbal abuse no matter the cause. Protect your heart and keep strong. ?

[Daisy4RN]

Agree with wuzzie. I also worked Oncology and this was pretty much a normal thing for families to behave this way. I worked Onc for 10 years and I can verify that it does in fact affect your soul. I learned not to take it personally and not to take it period. You can be compassionate while simultaneously not accepting blame and letting families know that you accept zero blame. In person, I would just explain the rationale for what ever is happening medically, and if they continue I would ask if they wish to speak to the MD, either way if they continue I would just say something like...it seems you need some time to think about that so I will check back later.. and then just walk out. Same for phone calls. I can only imagine how much harder covid has made everything but please do not let people dump all their blame and burdens on you! You may not always stop the screaming but you can try to stop it but at least let it roll off and don't internalize it. 

[speedynurse, ADN, BSN, RN, EMT-P]

People can truly respond irrationally out of despair and grief. I saw this multiple times in the ER - I will never forget a spouse that blamed everyone for the death of her husband.....she screamed and actually tried to hit a staff member. She blamed me, the doctor, director, tech....anyone she could blame she did. Ironically, prior to his death, she adamantly refused all life saving measures....even very basic measures like a second IV insertion for IV fluids. I think she knew the only one to blame was herself for refusing all care but she instead chose to blame everyone BUT herself. I really always try to look at things from all sides....that’s what the role of a nurse is.....but you also have to set limits with patients and families even if they are grieving. Pure and simple - it’s not safe to give oral meds or food to a patient with low oxygen sats and I would tell her that....kindly. At a certain point though, your patient comes first and not her. I finally learned if I can’t set limits with an irate family member or patient, then leadership needs to be involved. Your priority is your patient. Leaders that don’t have a patient assignment can handle things like that.

[speedynurse, ADN, BSN, RN, EMT-P]

On 1/3/2021 at 9:30 AM, LovingLife123 said:

It’s very difficult for people to understand especially when they can’t visit.  They feel helpless.  Just as helpless as we do.  They are grieving.  And while it’s not appropriate to berate you, sometimes you have to give them a little grace.  They are losing their loved one.

I think throughout this whole pandemic we have become a little numb to death as we see so much of it.  It’s why I’m so adamant about staying home and social distancing.  I don’t want people to have to go through this.

People always deserve a little grace. However it is also OK to draw limits - and a family member can do a lot of damage that can be very traumatic as well. I left the ER for so many reasons.....the constant death and dying but also the abuse and occasional narcissism and manipulation.....I think as nurses we are sometimes expected to make everything perfect and happy and sometimes that really just doesn’t work out that way. I will never forget a patient that kept coding over and over and over in the ER.....finally I went to my other rooms for my other patient care and a patient with a mild mental health issue and their family were downright cruel for the delay in care. I couldn’t say what happened in the other room due to confidentiality other than I had a critical patient.....but it’s like there are some people that truly are irrational and can’t feel for others hurting around them. Even those in much worse situations (actively dying situations).

[Hoosier_RN, MSN]

years ago, in my first job, ER, a  gangbanger (yes, he was well known in the community, I'm being factual) was brought in, DOA with over 20 GSWs. Mom came in screaming that we didn't save her innocent angel, cursed everyone, made threats, slapped the ER doc on duty. She even tried to sue the hospital. It was sad, because mom was a hard worker, who tried to raise her kids with the resources available. Her 3 sons all died in the streets

[Davey Do]

I've posted this before but believe it to be a pertinent truism.

Daniel Gilbert said in his great book Stumbling On Happiness said "People feel better about something when they can have someone to blame for their pain". (possibly paraphrased)

Sometimes we just need to be sacrificial lambs.

But as Daisy and speedynurse pointed out, people also need to have limits set for them. Not only because it's the reality of the situation, but because people also need to feel and believe that someone is in charge.

Working in psych, I many times had to curb a patient's inappropriate behavior. I was not well liked all the time, but feel and believe that I was respected  because I let them know where the buck stopped.

[Corey Narry, MSN, RN, NP]

Agree with these outbursts stemming from anger which is certainly one of the known stages of the grieving process given the circumstances we are in right now.  I think a few things can help...one, you shouldn't be the only one bearing the brunt of family members' frustrations.  Has there been family meetings (by Zoom) with the care team including providers? Are family members allowed to Zoom into patient rooms to see their loved ones? Also, in our case, we allow limited visitation for end of life cases even if the patient has COVID, that does help with closure.

[JKL33]

Hard to say how I feel about this. I agree with parts of what each poster has already written.

For me it probably comes down to the idea that I don't really internalize guilt from situations I couldn't change or comments that are factually incorrect. It's the same reason that a patient could try to insult me in any other way and if there is no truth to what they've said then there's just no truth to it and it isn't too much of a struggle to avoid internalizing it. If I was told that I was killing someone as mentioned in the OP, I would feel the speaker's grief and care about it very much and have empathy while at the same time not feeling guilt.

However, in general the poor treatment that one family member only does on one day because of their acute grief, is not just one minute of poor treatment for a nurse, who will face the brunt of patients' and families' grief or other dissatisfaction repeatedly. There is a cumulative effect. After awhile it doesn't matter who you are or what the justifiable reasons are, people generally don't thrive in having to absorb that over and over and over.

This is one of those aspects of nursing that I can handle with strong admin support. And one that becomes intolerable when a nurse feels that they are not trusted and supported by admin. Because in that latter case, then others' accusations become something that can be a tangible problem on top of any emotional distress they already caused.

Sorry. Random thoughts.