How to Respond When Family Blames You for Patient Dying

[CaliRN2019]

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. 

[JBMmom, MSN, NP]

42 minutes ago, JKL33 said:

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.

So well put, JKL33. I was thinking along the same lines. At the end of each shift I try to take a minute and go over with good/bad/could have done better aspects of the night. And truly, if I leave knowing that I have been the best nurse I could for the previous 8-12 hours, I can filter out the outside messages that might conflict.

I listened to a fellow nurse on the phone recently, when a family member called for a patient update but wasn't on the contact list. This nurse apologized profusely for at least 10-15 minutes as if he, and we at the hospital, were doing something wrong by following our HIPAA policies and not giving out information to an unidentified family member. This just fueled the caller's anger and perpetuated a long and unproductive conversation. I will sometimes apologize with phrases like "I'm very sorry that you feel the care that has been provided doesn't appear to be in the best interest of your loved one, but I can assure you we are following the best practices to meet his or her needs", I can put it back on the caller that it's their feeling about care that is upsetting and not the actual care. 

That being said, COVID is bring out the worst because of the isolation of patients and family. No matter how hard we try to update over phone calls, facetime or zoom, accurately portraying the progression of this disease, sometimes leading to death, can be so hard. Families can't really rationalize how sick loved ones are, and many are dealing the the guilt of having passed the virus along to the infected patient. Survivors guilt will abound for years and many families. I'm sorry the OP has had some difficult conversations, just know that as long as you didn't your best, the words might be hard to hear, but they're not an accurate reflection of the care you provided. 

[LibraNurse27, BSN, RN]

Wow! I have honestly never experienced this. It sounds absolutely horrible. I hope you can know that you did everything right and not let these accusations cause you to feel guilt. It sounds so difficult to add that layer on top of the distress and sadness we already feel after losing a patient. Maybe because many of my patients die from complications related to substance abuse, I often deal with family angry at the patient for "causing their own death." I understand they may have been put through a lot by these family members but sometimes I don't know how to respond or console them in these situations. Wondering if anyone else has experienced this, and pts who have alienated everyone in their lives and die alone =(

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

49 minutes ago, LibraNurse27 said:

Wow! I have honestly never experienced this. It sounds absolutely horrible. I hope you can know that you did everything right and not let these accusations cause you to feel guilt. It sounds so difficult to add that layer on top of the distress and sadness we already feel after losing a patient. Maybe because many of my patients die from complications related to substance abuse, I often deal with family angry at the patient for "causing their own death." I understand they may have been put through a lot by these family members but sometimes I don't know how to respond or console them in these situations. Wondering if anyone else has experienced this, and pts who have alienated everyone in their lives and die alone =(

And that does happen - there is a very small minority of people in the world that are truly narcissistic and manipulative. I try to see their side because they must have awfully unhappy lives to be that miserable and make everyone around them miserable....but at the same time, those are the ones that have to have limits set. It seems just easier to try to be polite and nice to get through life. 

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

On 1/4/2021 at 2:01 PM, JBMmom said:

So well put, JKL33. I was thinking along the same lines. At the end of each shift I try to take a minute and go over with good/bad/could have done better aspects of the night. And truly, if I leave knowing that I have been the best nurse I could for the previous 8-12 hours, I can filter out the outside messages that might conflict.

I listened to a fellow nurse on the phone recently, when a family member called for a patient update but wasn't on the contact list. This nurse apologized profusely for at least 10-15 minutes as if he, and we at the hospital, were doing something wrong by following our HIPAA policies and not giving out information to an unidentified family member. This just fueled the caller's anger and perpetuated a long and unproductive conversation. I will sometimes apologize with phrases like "I'm very sorry that you feel the care that has been provided doesn't appear to be in the best interest of your loved one, but I can assure you we are following the best practices to meet his or her needs", I can put it back on the caller that it's their feeling about care that is upsetting and not the actual care. 

That being said, COVID is bring out the worst because of the isolation of patients and family. No matter how hard we try to update over phone calls, facetime or zoom, accurately portraying the progression of this disease, sometimes leading to death, can be so hard. Families can't really rationalize how sick loved ones are, and many are dealing the the guilt of having passed the virus along to the infected patient. Survivors guilt will abound for years and many families. I'm sorry the OP has had some difficult conversations, just know that as long as you didn't your best, the words might be hard to hear, but they're not an accurate reflection of the care you provided. 

You bring up some really good points and people really do say things they don’t even mean when they are grieving or hurting for themselves or family members. As an example, I for one don’t feel that it’s fair for patients to be isolated with a no visitor or one visitor policy. It’s isolating and frightening for patients and family. I know I have tried to go the extra length since covid times to try to keep family in the loop when I am able to.

At the same time - nurses are human beings too with emotions and feelings. There is a difference between being empathetic and listening and being walked all over to where you carry a family member’s or patient’s comments home with you......

[LovingLife123]

9 hours ago, speedynurse said:

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).

I stated it’s not appropriate to berate a nurse.  But, I do try to put myself in their shoes.  We are expecting families to understand what is happening from home.  From home.  They can’t see their dying loved ones.  They can’t see what is happening.  It’s so incredibly difficult for the layperson to understand that we just can’t fix it.  So yes, when I get screamed at on the phone, I give them a little grace and understanding.

Before covid, I’ve had to call security on families who have physically attacked me in their “grief”.  I don’t find it at all acceptable. Right now, people feel out of control and helpless.  It’s terrible.  I’ve been the family member of a critically ill patient in covid.  It’s freaking sucks.  I couldn’t even go in the ER.  I knew what was happening, I knew what treatment was needed.  I never felt so helpless in my life.  And I’m a medical professional.  The lay person?  It’s has to be horrific.

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

4 minutes ago, LovingLife123 said:

I stated it’s not appropriate to berate a nurse.  But, I do try to put myself in their shoes.  We are expecting families to understand what is happening from home.  From home.  They can’t see their dying loved ones.  They can’t see what is happening.  It’s so incredibly difficult for the layperson to understand that we just can’t fix it.  So yes, when I get screamed at on the phone, I give them a little grace and understanding.

Before covid, I’ve had to call security on families who have physically attacked me in their “grief”.  I don’t find it at all acceptable. Right now, people feel out of control and helpless.  It’s terrible.  I’ve been the family member of a critically ill patient in covid.  It’s freaking sucks.  I couldn’t even go in the ER.  I knew what was happening, I knew what treatment was needed.  I never felt so helpless in my life.  And I’m a medical professional.  The lay person?  It’s has to be horrific.

I get where you are coming from. I was a patient many times as a child all the way from birth on up so I understand both sides. But I also understand the ER and what it’s like for nobody in administration to back their nurses in terrible situations. I do recommend every nurse spending at least a week in the ER to see what I am talking about.

We have had nurses assaulted, thrown against walls, punched, kicked, and had weapons pulled on.....THAT is the ER and that is NOT OK. Screaming conversations turning into something a lot more. No, not acceptable. Ever.

That’s more than a little grace. That’s assault and battery. 

[SmilingBluEyes]

It's normal for people to act out inappropriately when a loved one dies, at times (especially if it is unexpected). I would not take this personally. I think you were a convenient target to express their pain/distress/anguish.  That does not make it right,  but it does happen.

If you can go home and go to sleep with a clear conscience, knowing you did your best, you need to remind yourself of that fact and let this go.

I am sorry this has happened to you.

[Kooky Korky, BSN, RN]

It's nice that you all try to console and forgive.  Yeah, that's a good thing to do but who has time for that? 

We need to stop feeling guilty, stop apologizing when someone is dumping us.  If we do a good job and we know we did, we should not allow callers or those at the bedside put us down and take up space in our heads.

I am much too busy to spend more than a couple of minutes being a whipping boy.

[beachynurse, ASN, BSN]

I totally understand how you feel. When my Uncle dies of gastric cancer, my Aunt did not deal with it well. She blamed everyone but the cancer that ate him up. The MD's misdiagnosed him, the nurses didn't take proper care of him. She would repeat the story over and over every time I saw her. They had access to some of the best cancer treatment in the world at Sloan Kettering, and she refused Hospice when they really needed it.  I tried to explain to her that he wasn't misdiagnosed, and he has the very best of care, but up until her own death she refused to believe anything but the worst, which was completely untrue. I felt bad for the staff in the hospital because the closer to the end he got, the nastier she got. Me and my cousins tried really hard to smooth things over, but there's only so much apologizing that can be done with her behavior. I know for a fact they were happy when my Uncle passed so they didn't have to deal with my Aunt. I didn't blame them, not one bit.

[Hoosier_RN, MSN]

4 hours ago, beachynurse said:

I totally understand how you feel. When my Uncle dies of gastric cancer, my Aunt did not deal with it well. She blamed everyone but the cancer that ate him up. The MD's misdiagnosed him, the nurses didn't take proper care of him. She would repeat the story over and over every time I saw her. They had access to some of the best cancer treatment in the world at Sloan Kettering, and she refused Hospice when they really needed it.  I tried to explain to her that he wasn't misdiagnosed, and he has the very best of care, but up until her own death she refused to believe anything but the worst, which was completely untrue. I felt bad for the staff in the hospital because the closer to the end he got, the nastier she got. Me and my cousins tried really hard to smooth things over, but there's only so much apologizing that can be done with her behavior. I know for a fact they were happy when my Uncle passed so they didn't have to deal with my Aunt. I didn't blame them, not one bit.

It's sad when it ends like that. When there's denial, comfort (hospice) is delayed. The patient suffers even more. Sadly, staff is sometimes relieved when bad behavior by a family member makes care the patient a living hell

[JadedCPN, BSN, RN]

Sometimes you just have to accept that you know in your heart you did your best; people and families react very strongly when dealing with death. However no matter the situation it is NOT okay to allow someone to verbally assault you. 

[ClaraRedheart, BSN, RN]

I'm so sorry you are dealing with that! It sounds truly horrible! I'm on a unit that was the last resort for covid patients. They're going in regular rooms and there are patients in the hallways because there is no where else to put them. I had one on bipap (settings said 60L? but I'm new to bipap being used like that, so  not sure) that had to transfer to the ICU, and had an immunocompromised cancer patient in the hallway. I hated that. Anyways, new covid nurse here. I'm also a news junkie, I read it for fun, and my favorite part is the comments. They usually don't bother me, but on a local article about covid, I found a few comments blaming the hospitals for the patients death. I even had a conversation with a family friend that basically said the same thing... The hospital killed her friend. It really upset me. She's usually such a sweet person, when I had surgery a few  years ago, she brought food after. Just the venom and disdain that she seemed to hold for nurses/doctors shocked me.  I had a thought that just kind of clicked after a day of being angry and bitter: Usually, a family member is in the hospital to see if their loved one goes into respiratory distress, turns blue, and requires more oxygen/bipap/ventilator. They're not there because we don't allow them . It's really hard to even find time to call them because our workload has increased exponentially. All they know is that mom walked into the hospital and is now on a ventilator? It does seem suspicious unless you've seen how  quickly a covid patient can crash first hand. Try to give them grace. I like what Wuzzie said about setting limits. I love that experienced oncology nurses that have dealt with this for forever can give us some perspective and help on dealing too ❤️            

By the way, thanks for starting the conversation. I really needed to read the responses!