Learning to set boundaries

Batman25 · Dec 14, 2009

You shouldn't be dealing with a family like this 3 shifts in a row. They need to be divvied out amongst all the nurses so none of you get so exhausted. We split up the difficult patients/families on my unit and it really does help. Make your CN aware.

Politely but firnly let them know you need to care for other patients as well. If they need something ask if they need anything else because you will be with another patient for a few. Enforce visiting hours if you can as well to give yourself a break.

PostOpPrincess, BSN, RN · Dec 14, 2009

You shouldn't be dealing with a family like this 3 shifts in a row. They need to be divvied out amongst all the nurses so none of you get so exhausted. We split up the difficult patients/families on my unit and it really does help. Make your CN aware.
Politely but firnly let them know you need to care for other patients as well. If they need something ask if they need anything else because you will be with another patient for a few. Enforce visiting hours if you can as well to give yourself a break.

These types of families do not care about the other patient.

I just tell them I will come in once an hour. If they need anything they can tell me then, if they need me come and get me. I'll decide at that point if it is important. If it isn't, I'll tell them I will do it on the next round. If they complain, I just say I will get it on the next round. If they want to talk to the UM, I get the UM--her direct number or I get it to them on the next round. I don't explain, I don't add any other words, I don't tell them the other patient needs me. They won't care. I just keep repeating, "I'll be there on the next round (of course only if patient is stable..)

J

proudnurseRN · Dec 15, 2009

We have a term for those patients- "one dayers" No one gets a one-dayer twice in a row, unless for whatever reason the nurse wants them back.

Lacie, BSN, RN · Dec 15, 2009

These types of families do not care about the other patient.
I just tell them I will come in once an hour. If they need anything they can tell me then, if they need me come and get me. I'll decide at that point if it is important. If it isn't, I'll tell them I will do it on the next round. If they complain, I just say I will get it on the next round. If they want to talk to the UM, I get the UM--her direct number or I get it to them on the next round. I don't explain, I don't add any other words, I don't tell them the other patient needs me. They won't care. I just keep repeating, "I'll be there on the next round (of course only if patient is stable..)
J

Good advice and I do same with most my patients. Give them a time frame "I'll be back at such and such time, unless there is emergency or I'm tied up with another patient who also needs me". Usually works but also yes your CN needs to help rotate this patient around with other nurses. You being the new one on the block, you may find these kind of pts "shifted" to you!! See it happen alot. Speak up for yourself on this one.

cookienay · Dec 15, 2009

Two words: visiting hours.

squirtle · Dec 15, 2009

If they need anything they can tell me then, if they need me come and get me. I'll decide at that point if it is important.

This can be trouble... My biggest pet peeve with family members is when they come searching for me instead of using the call bell. Do NOT let me turn around and see you walking up behind me in another pt's room. I feel that is entirely inappropriate.

I know this isn't the point you were trying to make, but just had to throw my vent out there :)

I am in ICU and when I have a 1:1 pt then I typically give some little talk at the beginning of the shift about what my plans and agenda are. I have learned that you have to lay out the boundaries from the beginning and follow them or you end up frustrated by the end of the shift (or by mid morning!).

Ruby Vee, BSN · Dec 15, 2009

sounds like the op is in an icu, and needs to keep the patient in sight at all times. the problem is that with the family making all of these request, she has to keep running out of the room to satisfy the requests. and because she has to keep the patient in sight, it's not as if she can hide from the family.

my advice is to strictly enforce visiting hours -- if you're lucky enough to have any to enforce. if not, insist on the family stepping out at regular intervals to "let the patient rest." explain that when they're there, he can't rest properly because he feels the need to entertain them. (even if that isn't strictly true.) explain that he gets his best rest when they're out of the room.

if you can't get rid of the family, you're going to have to set limits with them. explain to them that they need to group their requests. if that doesn't work, just say no. no, you can't leave because you have charting to do, must watch him closely or whatever. another thing i've tried is insisting that the family leave the room every time they think of some patient care thing they want done. "i just turned him ten minutes ago. i'll turn him again as soon as you step out of the room if you think he needs to be turned again." "i'd be happy to change that dressing again. why don't you go get a cup of coffee while i do it."

if all else fails, get your management team involved in limit setting. some managers are better at it than others, and i'm crossing my fingers that you have a good one!

TemperStripe · Dec 20, 2009

Thanks for the tips, everyone. I'm going to work on my boundary-setting skills. We do have some wonderful patients and families...I don't want to let this one experience get in the way too much, but I've definitely learned a few things from it.

Virgo_RN, BSN, RN · Dec 21, 2009

These types of families do not care about the other patient.

This. Don't offer explanations. Explaining why you cannot do this or that is like trying to reason with a two year old, or worse yet, an 8 year old who will argue back and try to subvert your logic.

If the requests are for the family members, just tell them how they can help themselves, like where the cafeteria is, or if it's closed, where the nearest vending machines are.

If the requests are for something the family thinks the patient needs, do as JoAnn suggests and tell them you'll do it/get it on your next round.

Every time you respond in this manner, look the person making the request directly in the eye, and use a firm, matter of fact tone, as if you do not expect any arguing. You are not negotiating here. You are the nurse, you are in charge.