Parents and Firing Nurses

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Hello,

Just wondering how your units handle these difficult situations, where a parent ( for whatever reason) tells the manager they do not want this nurse taking care of their baby anymore AKA firing a nurse!:argue: Does your unit follow through and not allow the nurse to care for the child or do they use another strategy.

Specializes in NICU.

We encourage parents to ask nurses if they will be their baby's primary nurse (entirely up to the nurse whether she accepts or not). Some parents choose to "fire" nurses and usually they are allowed; no guarantees, however. The funny thing is the reasons they give; they are usually quite unimportant. The major things seem to escape notice.

Some parents end up with several names--and like others have mentioned, if there were an official list, the rest of the nurses would be clamoring to get on it. They are usually the parents writing everything down and going over the notes with an eagle eye (that's another topic altogether :rolleyes:).

They are usually pretty good about not assigning nurses to babies they have asked not to have, too.

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This is my first post and I have really enjoyed reading the conversations!! I only wish I found this forum sooner!!

I have been in NICU for 6 yrs, can't say I have ever been fired from a baby.

As for parents "firing" staff, I have found many are looking to have some kind of control in a situation that is mostly out of control (this NICU thing didn't fit into my birthing plan). We have had parents call the unit and ask which staff members are coming in for the next shift and they "pick" from the group. Some staff will do anything to make the parents happy and it gets very frustrating!:banghead:

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Specializes in NICU.
This is my first post and I have really enjoyed reading the conversations!! I only wish I found this forum sooner!!

I have been in NICU for 6 yrs, can't say I have ever been fired from a baby.

As for parents "firing" staff, I have found many are looking to have some kind of control in a situation that is mostly out of control (this NICU thing didn't fit into my birthing plan). We have had parents call the unit and ask which staff members are coming in for the next shift and they "pick" from the group. Some staff will do anything to make the parents happy and it gets very frustrating!:banghead:

Heh, at least they don't let our parents choose from a list, LOL. Under special conditions (say a terminal baby and a nurse who has taken the family under her wing, so to speak) a charge nurse will switch nurses, but both nurses have to approve first :).

And welcome :D.

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I have been fired once, and I was ok with it, I didn't like the mom any more than she liked me. We have had a few lists from parents.

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I am generally one of those people that get along with everyone and usually build a good rapport with families, but even the nice, easygoing nurses sometimes clash with the families. I had a family that despised me and I wasn't too fond of them either. The mom had issues. Major passive-aggressive type behaivors. I refused to take care of that baby. I have never refused a patient in my 10 years of nursing.

Another situation that comes to mind when parents want to "fire" their baby's nurse is when you happen to have their baby who has been doing very well then they decide to crump on your shift. The parent's tend to think somehow you are at fault even though you are not.

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Specializes in Neonatal ICU (Cardiothoracic).

....or you've just busted your hump all night trying to fix a baby that went bad on your shift, only to have him start to improve on day shift after you've left. Makes you look like a crappy nurse, and only further inflates that day-shift diva nurse's ego. (come on, we all know ONE day shift diva :>P)

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Specializes in Nursing Professional Development.

My hospital has "fired" the nurse (though we have never used that term for it) in order to protect the nurse from the family. We wouldn't want the family to blame that nurse for anything and everything that might go wrong. The nurses appreciate that protection. Most of them hate caring for a baby knowing that the parents don't trust them and are just waiting for something to go wrong so that they can file a lawsuit or whatever.

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Specializes in Level III NICU.
....or you've just busted your hump all night trying to fix a baby that went bad on your shift, only to have him start to improve on day shift after you've left. Makes you look like a crappy nurse, and only further inflates that day-shift diva nurse's ego. (come on, we all know ONE day shift diva :>P)

Yeah, there is nothing worse than giving report that the baby had a horrible night and then coming back and hearing, "I don't know what you were talking about, he was so good for me today!"

I'm a day-shift nurse now. Hope I'm not a diva! Not yet, anyway. :)

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"Another situation that comes to mind when parents want to "fire" their baby's nurse is when you happen to have their baby who has been doing very well then they decide to crump on your shift. The parent's tend to think somehow you are at fault even though you are not."

I hear ya. I had that exact situation happen to me not too long ago. I "fired" myself from caring for that child. I could hear the mother in the background whenever I talked to her on the phone writing down every word I said. I had to spell my name several times for her. Her child ended up needing substantially more oxygen support at the end of my shift. The next shift I worked, as I was walking in, I heard her say to the nurse about to give me report, "Oh, that's the nurse who had her last nite." And you know she's blaming the fact that her baby needs more support on you. Sheesh! I felt sorry for the infant, as she is a sweet child who is (unfortunately) developing into a chronic lung kid; but, I didn't want to put myself in that position. My license is too important to me.

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Our unit uses primary nursing for all of the potentially chronic kids that come in. We also have "conflict lists" that either the parents can put staff on or we can put ourselves on. At anytime we can refuse an assignment, and be ressigned to someone else. The neuro and GI kids tend to be "cycled" after awhile, this happens when the infant is extremely irritable and it would be unfair to have the same nurse dealing with it for three nights.

Most of the time we have the same assignment all three shifts but I have also worked 4 in a row and had a different assignment every night.

Yeah and let me tell you how great it feels to have a kid scream 12 hours staright (even with Morphine and Versed) and then have day shift tell you "I never had to give him/her anything, they were a perfect angel' I want to say "Yeah cause he was up all night screaming for me"!

Liz

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Specializes in NICU, PICU, PCVICU and peds oncology.

In the world of big kids, this problem crops up with disturbing frequency too. It's usually the families of kids who were born under a bad sign, the ones who, through no fault of the hospital staff, end up with every possible complication, and even some that no one has ever seen before. Last year we had such a child, who was on his third VERY long stay with us. (It lasted 199 days and ended just the way you think it did.) Some of the complications this child developed had us all scratching our heads in puzzlement. Dislocated hips? Huh? Clotted portacath? How? Interstitial tunneled central line? Wha? This family had already decided before the child was even admitted which nurses were never to darken their door. For the most part we were the nurses who refused to buy into their determination to direct his care. (I'm sorry but putting him in a wheelchair at 5 pm to take him, his ventilator, his inotropes, 15 of his favorite toys and his open abdomen out for a walk in the park isn't something we'll be doing today.) Over time and as his needs shifted from hypercritical to more chronic but still complex, the assignment more and more often was given to the more junior staff. Well the parents had a fit about that! They wanted only the most senior nurses... even if that meant me. Nobody wanted that assignment and our management had meeting after meeting with the parents to try and come to a compromise, but it never happened. Instead they kow-towed to these people and let them run roughshod over the nurses every day. The day his mother (an RN, of course) pulled out his GT when we were turning him because she hadn't seen that it was between her hips and the bed and then blamed me for it was the last time I ever entered the room. I felt so bad for that poor little boy, but not bad enough to be willing to spend 12 hours with his parents.

This was the only time I've ever been on the stay-away list. I'm usually one of the ones the parents want with their child. But you know, I'm alright with that. I've worked with another family who had just as many reasons for being extra-vigilant and selective, but they were and remain very easy to get along with. They were able to voice their concerns in such a way as to identify the issue and find a resolution without making anyone defensive or feel like a scapegoat. They worked WITH us and the difference is staggering.

We now have a clinical nurse specialist whose responsibilities include ensuring that long-stay patients receive consistent family-centered (but not directed) care and that any conflicts are dealt with immediately so that we don't create any more monsters. She hasn't been in the job long, but I think with the right support from management and administration, she'll do a great job.

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Specializes in NICU.
...consistent family-centered (but not directed) care...

Wow. Now THIS is the difference I think many of our managers don't get. The reason I have come to utterly loathe the phrase "family-centered care". The reason I semi-secretly wish we could go back to the days of locked units and visiting hours. Well, not really, but I nearly mowed down an unsupervised three year old playing on the FLOOR while taking an empty isolette to Soiled Utility the other day, and the FOUR other unsupervised children in the hall looked at me like I had horns.

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