Charging with a patient family member

Nurses Relations

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  1. Should they be charging?

    • 49
      Yes, they can charge.
    • 18
      No, they shouldn't be charging.

67 members have participated

Specializes in Critical Care.

Just curious on peoples' views of this scenario:

A charge nurse has a close family member admitted to their floor where they regularly function as charge.

Should that charge nurse have his/her duty as charge suspended while their family member is a patient on that floor? Or, is this acceptable?

Specializes in Stepdown, PCCN.

Why should a nurse not be charge just because a family member is on the floor? I don't understand the problem.

Specializes in Med/Surg, Ortho, ASC.
Just curious on peoples' views of this scenario:

A charge nurse has a close family member admitted to their floor where they regularly function as charge.

Should that charge nurse have his/her duty as charge suspended while their family member is a patient on that floor? Or, is this acceptable?

Whyever would the charge nurse have his/her duty suspended? Are you alleging nepotism? Incompetence?

Specializes in LTC and Pediatrics.

Around here with our small towns and our smaller hospitals, it happens a lot. A nurse can be charge nurse, but not necessarily that patient's nurse.

Specializes in Pediatrics.

Your post title made me *giggle*. What exactly are you and the family charging? The exit...the new snack machine...the cafeteria before all the coffee is gone? :p

Specializes in critical care.

I think the issue the OP is having is the HIPAA violation if the patient does not want the charge nurse to know their medical history/POC. That's a good question, OP. I think I'd have the manager of the floor, or another unrelated party, ask the patient if the charge nurse has permission to review the patient's chart and participate in the POC, as this is part of the charge nurse's responsibilities.

If the answer is no, well... That would be complicated. Maybe assess if that floor is the only appropriate floor for that patient or pull the charge nurse to another floor.

Specializes in Critical Care.

Thanks, but that's not really the angle I'm trying to portray actually.

The problem I see is that the charge needs to be objective on patient care. What if their family member codes? Are they going to be objective as the leader of that code (as well as be able to delegate needs for the entire floor) while their family member is dying? Besides an emergency scenario occurring, there is indeed the issue of nepotism.

For all of those who don't see a problem, do you also not see a problem with the charge nurse as the primary nurse for their own family member? Charge nurses have to be just as objective and are just as able to influence care of patients in their unit.

And yes, I understand that this scenario does take place in small towns where there isn't another charge nurse to take over while a family member is on the floor. This isn't a question of whether it exists, but whether it is best practice.

Specializes in Stepdown, PCCN.

I guess the charge nurses at my facility don't function in the way you are thinking.

Our charge nurses essentially assign admits, offer help and delegate when appropriate, they don't have an assignment so are available for collaboration they aren't really "active" in planning or carrying out care. I have taken care of immediate family members of coworkers, charge nurses, managers, administration, and others. I have also taken care of friends and former friends I did ask them if they would like to switch nurses. I am a professional as are my colleagues it is just part of your job to potentially care for someone you know, but I wouldn't collaborate too much with a nurse about their family's care. I think of privacy issues.

No, I don't think a nurse should take care of a family member because if something happens there would be too much guilt and second guessing. Just like surgeons don't operate on their own family.

If my patient codes, I run it until the code team shows up and others do the same, unless they are uncomfortable with it, in which case someone else will do it. And we have had nurses leave abruptly when family died who were admitted to other units, I left when my SIL was brought in to ICU, severe GIB, she later died. We just suck it up as a floor and get the work done.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Just curious on peoples' views of this scenario:

A charge nurse has a close family member admitted to their floor where they regularly function as charge.

Should that charge nurse have his/her duty as charge suspended while their family member is a patient on that floor? Or, is this acceptable?

Are you just looking to bring a problem to that particular charge nurse?

I don't see a problem with it. It happens a lot in small towns. The only difficulty would be if the patient didn't want the charge nurse to see their medical record, but in that case I would think they should have gone to the other hospital or the one in the next county. Charge nurse was there first.

Twice, I've had to code close relatives of the nursing supervisor (years ago, the supervisor's brother was a chronic leukemia patient and another supervisor at a different hospital had a husband with heart failure) and once my manager's father. I also took care of a colleague's wife.

As long as there was no issue between the charge and the patient (ex the patient requests the person who is normally charge not be involved in their care/see their EMR), I see no problem. I've taken care of family members of coworkers. I've been requested to be assigned to those situations. I've taken care of family members of other employees.

When I worked the floor/stepdown, we didn't have a "set" lead in codes or other emergencies. Generally the person who relayed the story to the responding code team was either the primary nurse or whoever found the patient. Usually people found roles to do - someone recorded, drawing up medications, others took turns with compressions, but if there was some issue one of us told the hesitant coworkers what to do. Not always was it the charge nurse and on a couple of occasions the charge did not participate in our codes - s/he was busy covering other patients. S/he checked on us, saw we had several of us, and checked back to make sure we had adequate staff but this is not usually an issue once the code team arrives. Of course at this hospital you ended up with the house sup, an ICU nurse, an ED or intensivist attending, someone from anesthesia (resident, CRNA, attending) and a pharmacist - so there was a LOT of help, other facilities don't have this, and when there's multiple codes simultaneously the help becomes a little more spread out.

Small town America is pretty small - in some places people are related to half the county some way (cousins' cousin's cousin, etc). I think the final judgement needs to be whether the patient is comfortable and whether the staff member feels they can be objective. If Aunt Lucy raised you and is more mother than Aunt, maybe being in charge when Aunt Lucy is admitted for a seziure where a brain tumor is found on the head CT - that might be a little much for you to handle objectively. It may not. Providing direct patient care? No, not okay.

Specializes in Pedi.
I think the issue the OP is having is the HIPAA violation if the patient does not want the charge nurse to know their medical history/POC. That's a good question, OP. I think I'd have the manager of the floor, or another unrelated party, ask the patient if the charge nurse has permission to review the patient's chart and participate in the POC, as this is part of the charge nurse's responsibilities.

If the answer is no, well... That would be complicated. Maybe assess if that floor is the only appropriate floor for that patient or pull the charge nurse to another floor.

It wouldn't be a HIPAA violation because the charge nurse, in her role as charge nurse, needs to know what's going on with all patients on the floor. The patient could have chosen to go to another hospital.

Specializes in critical care.
It wouldn't be a HIPAA violation because the charge nurse, in her role as charge nurse, needs to know what's going on with all patients on the floor. The patient could have chosen to go to another hospital.

It is a violation if the patient says CN cannot be in their chart or privy to their medical info. In a more populated area with choices in what hospital you go to, just choosing another hospital might be possible. But those people who have a lot of road between hospitals don't have that choice.

I'd play it safe. I wouldn't access the chart until the family member gave permission. Medical history is an extremely private thing, in my eyes.

When I was still in school, my OB clinical instructor (let's call her Fran) told a story. She said her friend (Esmerelda) came in to give birth. Fran jumped at the chance to become Esmerelda's nurse. Esmerelda consented, eagerly. Fran had to do an admission history on Esmerelda, and Esmerelda was absolutely horrified when she realized that she had to tell her BFF that she not only had herpes, but she also had 2 abortions when she was younger.

Not everyone wants to be an open book. Some people prefer family not know some things. Some nurses prefer to not know some things about their family members.

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