Difficult family (Long)

Specialties MICU

Published

Hello,

This is my first post here and I suppose I just need to vent/hear some words of wisdom and encouragement :)

I have been a MICU nurse for about 7 years now. I have never worked anywhere else. Due to our large cancer population in my MICU, end-of-life care is something my co-workers and I are quite used to.

Quite often, we encounter families who are not ready to let go, even long after modern medicine and technology become futile. Getting these families to accept the death of their loved ones can be quite trying on us, as we agonize over the suffering of our patients. We do, however, treat these circumstances with extreme patience and respect.

Less often, we encounter families who take out their frustrations on the nursing and medical team. These are people who, quite frankly, can be mean and hateful. I am currently dealing with one of these situations. It is the worst for me yet and I have found myself perseverating on it throughout the entire duration of my weekend off!

I initially could stand the dirty looks, the eye-rolling, the heavy sighs. I grew more unsettled under the weight of the passive-aggressive comments. *For example: It is the evening. Family is visiting. Patient is barely interactive except for an occasional silent scream. Family member states as they pat patient's forehead, "I know, I know. THEY are just putting you through so much.* Yesterday, however, was the icing on the cake.

We have a 2-3 person visiting policy in my ICU. Mostly because I am scared of these people, I said nothing as 5 visitors hovered around the bedside all evening. Four of them sitting in chairs pushed up against the wall. Our patient rooms are SMALL. It was very hard for me to squeeze around the bed to provide care. I was asked to bring another chair into the room. I said no. I explained there was not enough room. I admit, I was rushed, I was scared of them, I was annoyed. I may not have smiled when I said this. Suffice it to say this did not go over well.

Family member #1: "Well, you could be nice about it. You don't have to be so snooty."

Me: Trying to not make this personal, trying to pretend I didn't hear the name-calling, I attempt to again explain why I can't bring in another chair. This may or may not have been the right approach. Hindsight is 20/20, but now I wish I just apologized and left. So, here I go, "It has been hard for me to walk around the bed..." Not sure how much I got out.

Family member #1: Just stop.

Family member #2: Shhh. Just shhh.

Family member #3: Heavy sigh.

Me: OMG. Cut off mid-sentence. Basically told to shut up. Have NEVER felt so demeaned, disrespected, and disregarded in my entire career.

I admit that when I told this family that I could not bring in another chair, I may have been rushed and short. However, I will back this up by saying that overall I have been trying really hard to suck up to them because of how much they scare me. This is definitely not a case of me being witch-nurse (and I know we all know those kind of people). Regardless of how I said this one comment, the name-calling and complete dismissal of me was completely inappropriate and I can't seem to shake it.

Thank you to anyone who has listened.

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Specializes in MICU, SICU, CICU.

I am sorry that this happened to you. This is not your fault. They should not be allowed to take their anger out on you, call you names, make you uncomfortable and obstruct nursing care. I would document that the family refused to allow you access to the patient and refused nursing care.

Assuming that there are no drips or vent, I would get end of life and transfer orders from the MD and tell bed control the family needs a large private room due to end of life care and large numbers of visitors. Saying the family wants, the family needs, seems to move mountains these days.

I would emphasize that the new room will be much bigger, quieter and more restful. Carry out your duties in the most professional manner. It would be the fastest transfer in history.

It is awful to encounter this kind of undeserved hostility. It speaks volumes about them not you.

Grieving or not, some people are just unexplainable.

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Thank you so much for taking the time to respond. It really does mean a lot to hear someone say "it's not your fault"!

Unfortunately, we are talking full life support (vent, 3 pressors, CRRT) despite the team's suggestion to transition to comfort. This is why it was so important for me to get around the room safely. If this had been a CMO situation I would not have hesitated to accommodate the family's wishes for more chairs, as the entire focus would have shifted towards comfort and time spent together.

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Specializes in Med-Surg Nursing.

Oh so this person is still a full code and there were 5 people in the room? Oh heck no!! I'd limit it to 3 and if you have to, if you have a charge nurse, let THEM speak to the family or better yet, the on-duty nursing supervisor. I've had to do that before. You cannot take care of their loved one if theres a gaggle of people around the bed.

You didn't do anything wrong. This family is frustrated that their family member is likely to soon die and they're taking it out on you.

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Yes, full code! You are right that these people need limit setting, but my inner coward got the best of me and I initially did not want to make waves by asking some of them to leave. Since they have been getting away with it, I didn't want to be the bad guy and have them target me for it. Also, I really do feel bad for their terrible situation and want them to spend time together as a family. Despite all this, my one attempt to set a limit landed me on their ****-list any ways. Thanks again for the encouragement.

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Specializes in Hospice.

I'm not getting why they frightened you - was it the snark they indulged in at your expense?

A snarky family crowding around a full-code person trying to die ... that is a nasty situation! It comes up more often than you might think in hospice, so I've been there and done that - more than once.

I would say to ignore the poop-list piece, but patient satisfaction surveys make that a dangerous tactic.

It won't be easy, but as long as you have to deal with them you need to continue setting limits. Get support from where-ever you can: co-workers, charge nurse, docs. That can be hard, too, as this is the kind of situation that can blow up in your face. Everyone not involved directly is probably going out of his/her way to stay out of it.

Maybe it would help to talk to someone on the ethics committee?

Is there any reason to believe that you've been thrown under the bus by the ptb?

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They scare me because of their hostile history since the patient arrived. Being mean, passive aggressive, making false accusations, "firing" nurses from the room, etc. Also, they just gave me a bad feeling from day one. I am not one to usually shy away from difficult situations. In all the difficult people I have worked with, I honestly have never encountered people so inherently mean. The last reason they scare me is because I am not someone who easily holds back how they are feeling, and I am scared that something I say will cause them to blow up at me.

This is DEFINITELY a patient who will be brought up during our ethics rounds, no question. That also may provide a good outlet for debriefing for any of the other staff who have been affected.

As far as my approach going forward, I am going to ask that I not be put in the room again. I have mixed feelings about this. I believe in continuity of care and want to continue to care for this person. However, I feel so personally affected by the way I have been treated. It has been spilling into my personal life and my time off. I think it might be best for all involved if I just bow out.

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Specializes in Hospice.

But if you bow out, who advocates for the person trying to die?

To this old faht who never worked ICU, it sounds like your patient will code pretty much any minute. You may not have a lot of time to putz around with ethics rounds and administrative requests.

So what are you going to do when the patient codes?

You need the dnr stat.

Most of your co-workers have probably been through this - do they have any advice to offer?

ETA: I forgot to ask whether anyone has threatened physical violence?

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You ask some good questions!

If I choose not to take care of this patient, he will be in the hands of my amazing coworkers. Is it fair for me to turf it off to them? Maybe not.

I believe they are working on the DNR more this weekend.

This all happened just as I was leaving work Friday night, so I haven't really had the chance to talk to my coworkers about it, but I do work with some great people. I have been letting it really get to me while I have been off this weekend.

Never felt physically threatened. Purely psychologically.

I'm already feeling much better now being able to really talk about it. These people are crazy!

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Specializes in MICU, SICU, CICU.

This is what we call a twelve hour patient. Everyone has to take their turn.

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Specializes in Hospice.

Then just breathe ...

Get all the help you can and do your best, whatever you decide to do.

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Specializes in Hospice.
This is what we call a twelve hour patient. Everyone has to take their turn.

^^^This :yes: ^^^

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