Patient Families

[1fastRN]

Ever feel like our jobs would be 10000x easier if families were not allowed in the ED?

I'm not a complete jerk, I'm very nice to family members, try to accommodate, make them comfortable, keep them in the loop, and always ask the family if there is anything I can do for them on the way out. I'd want a family member there if I was sick and I would definitely want to be there for my family member as well. But sometimes I want to rip my hair out when they don't understand that they're delaying my ability to do my job.

1) They are glued to the bedside. I politely ask them if they can scoot over so I can do my assessment or start my IV. They take a gazillion years to actually stand up, pick up their purse, jacket, and their 10,000 other personal belongings. Then they leave the chair sitting there in my way. Gee thanks. I move said chair out of my way and walk out for two seconds to retreive an item I need (i.e. gloves, patient labels, tubes, something I forgot) and they've parked themselves back in the chair. Oh lawd!

2) The patient is without complaint, but the family is giving me an ear full. Why haven't they gotten a bed assigned? They've been waiting 10 minutes for a transporter to take them to CT scan. They want a private room. My favorite? "My mom is in so much pain, did you even give her the 2nd dose of pain medication?" Um, well judging by the fact she's now asleep....I'd say the pain medication is working and I'm not going to wake her up to find out.

3) They're babying the patient. 20-something young person with abdominal pain. Time to pop an IV in. Patient looks a little hesistant but I ensure them it will be quick! Mom or dad practically just across the stretcher to hold their hand (again, getting in my way) and completely over dramatic. "Oh honey, it's okay, I know how much you hate needles...nurse can't you use a smaller IV than that, like a butterfly?" *rubbing patient* Patient is now MORE anxious. Your son or daughter is my peer and not a child. Yeah, yeah, no one likes needles, I get it. I know what I'm doing so zip your lip and the deed will be done before the anxiety sets in. Cut the cord!

4) They answer questions FOR the patient. Sometimes the patient can't answer, in which case family is very helpful! But please don't talk over your loved one.... I appreciate additional input after the fact, but we're here for the patient so let's get their story first.

5) They don't want to stay any longer. Patient is going to be admitted for observation, all tests so far are negative. Or maybe we're waiting on a repeat troponin prior to discharge. Patient agrees with plan.... meanwhile the family member is furious because they're tired and they don't see the use of additional testing when nothing is wrong so far. Obviously you cared enough to bring them in the first place, so what's the issue?

6) They're hungry or have some other complaint. "I'm diabetic and I didn't eat anything all day, can you bring me a sandwich?" You're an adult. How do you survive on a daily basis? Go to the vending machine or find a nearby food place. I'll even tell you where there are some local spots. The patients come first. "I have a headache, can I have a tylenol?" Sure, if you'd like to register at the front desk!

7) "I have this rash on my foot, can you look at it?" Sure, you can register at the front desk. We'll get that checked out and take care of that headache, too! Maybe we can get you a mealtray as well.

8) It's a family reunion. You don't need the entire extended family and uncle leroy 2x removed at the bedside. Unless it's life or death you're going to have to take turns.

9) You're making suggestive comments or flirting with me. No, just no.

10) They decide to lay in the empty stretcher next door. Ugh, come on. What makes you think this is okay?

Any you'd like to add?

That brings end to my light-hearted post-shift rant :) Hurray, today is my "friday!"

*Disclaimer: Most of these fall to the wayside with very critical patients. I understand and advocate for family to be involved. It puts the patients at ease, gives the healthcare team more information, and just generally adds to the holistic care of the patient. I always try to accommodate when I can... I'll bring coffee if I have the spare time, try to keep family involved in the plan, and give them a business card with my name and contact info if they want to go home for the night and get a status update. Most families are very cool and understanding of whatever I ask them....even if I tell them they have too many visitors and they have to switch off in the waiting room. They're concerned for their loved ones and scared. But at the end of the day my focus is on the patient, so please let me give them the best care I can. I want you involved but not interfering. I promise, they're in good hands!

[Esme12, ASN, BSN, RN]

I am always annoyed at the "butterfly" suggestion. They heard it on TV and there is no longer any such thing (well not exactly) in use today for starting an IV. They like the word "butterfly" because it sounds nice. Grrrrrrrrrrrr

[zmansc, ASN, RN]

I tell em, I have no idea what a butterfly is, I'm just the janitor but they gave me this old rusty needle and told me to go start an IV in rm....

It get's em every time.

[ChristineN, BSN, RN]

I am always annoyed at the "butterfly" suggestion. They heard it on TV and there is no longer any such thing (well not exactly) in use today for starting an IV. They like the word "butterfly" because it sounds nice. Grrrrrrrrrrrr

I just tell them at my facilities we do not use butterflies. That usually shuts them up

[DawnJ]

But butterfly just sounds​ so much gentler

[Ruby Vee, BSN]

My personal favorite is the drama queen/king. "Oh My Gawd It Hurts So MUCH!" (Yeah, I've had paper cuts before and they're painful.)

"My BABY MY BABY MY BAAABBBEEEE!" (Yes ma'm, we get it. This 25 year old with 40 tattoos is your baby. We still have to start an IV.)

I have in-laws who take pride in how big of a fit they can throw for the nurses viewing pleasure, and even compete to see who can throw the biggest fit!

[CodeteamB]

My favorite is the one-uppers.

"Wow, your hysterectomy sounds like a total horror show, and 3 surgeries in one year? Wow, you have suffered so much! I would love to hear more about it when we are done shocking your son's heart"

[1fastRN]

Here's some more I can think of....

The defensive family member: "And how are you related?" I am his WIFE. (Okay.... I was just asking. I never want to assume and I want to make sure it's OK if I discuss the patient's health in front of this person in the room.)

Even better, Do you ever get a "jealous" look from a family member? I swear it's not in my head... but sometimes wives/fiancees/girlfriends give me a dirty looking because I'm taking care of "their man". Relax, I'm a nurse, not a call girl...I didn't go through the stress of nursing school, shell out thousands of dollars, and sacrifice my sleep (and sanity ) to hit on men all day.

The health expert: Three types here;

1) The nurse/doctor/NP/PA- This person is usually cool and we can have an intelligent conversation. I respect them as a professional. I always make sure to take extra good care of this person or their family member and make sure everything is by the book. I'll often print out lab work and whatnot since they're able to decipher it. Professional courtesy is a nice thing and I appreciate it when I'm on the other end.

2) The "other" healthcare worker. They're a medical assistant or NA or work as ancillary staff in a medical setting. These people can also be cool, but they can also be a know-it-all. They'll be very vague about their title, so I don't know what they actually do. But they sit on their medical pedestal and try to get information about their family member that they aren't even educated enough to digest. They can often be rude or snotty and keep referring back to how they work in the healthcare field.

3) The WebMD professional. They've researched their family member's symptoms to the end of earth. I'm happy you're trying to educate yourself, that's wonderful! But let's face it, symptoms are often very vague and can be anything. "I read on the internet that this is a symptom of cancer." "I read that a lot of people have died from this medication." The list goes on and on. I recently had an older patient with dementia who was on a laundry list of medications. They were waiting 5-10 minutes before I was able to come in the room due to an 8 patient assignment. I eye-balled them as I was rounding and my priority at the time was my intubated patient. The daughter came storming up to the nurses' station and started yelling at me, "We've been here a half hour and NO ONE has seen my mother!" (Mind you, they were triaged and hadn't been waiting long at all.) "She might have serotonin syndrome and on the internet it says that this is a medical EMERGENCY!"

The fighting family member: They're making passive aggressive jabs toward the patient. There is tension in the room and you feel like a screaming match is about to take place. It's just all around awkward. I've heard people discussing ex-wives, accusations of affairs, all kind of juicy stuff!

The nosy family member: They're asking about other patients. This usually irks me when their is a code situation. "Did that guy die?" Or they'll be staring at a code in progress. We usually clear all visitors but if it's not busy we'll let them stay if they're far enough away. Recently, a husband of a patient kept walking to the sink and going out of his way to STARE at a man in a cardiac arrest. Sometime's it's unintentional and they're just in shock of what they're seeing. But would you want someone staring at your mom/dad/husband/wife as they're dying or getting a tube shoved down their throat? Have some manners! I shouldn't have to ask you to give some respect to that patient and their family member.

The hawk: They watch every single move you make. Not just in the patient's room. But with all of your other patients. They stare at you while you chart on the computer. Maybe they think I'm on facebook or something. A lot of times I think they're just fascinated by the hustle and bustle of the emergency room. Not always a bad thing! Sometimes they see that you are busy running around with other patients and they are still displeased you aren't in the room enough. A few weeks ago one of my patients was admitted and awaiting a bed assignment for hours. I had gotten her a meal tray and updated them telling them they probably won't get a bed tonight, but I'll try to get them to an area for holds if one opens up. I assured them we would keep them as comfortable as possible during their stay in the ED. Soon after, my other patient decompensated and had to be intubated (along with a central line, multiples IVs, 3 pressors, the works). The daughter of that other patient was STARING at me and looking at me like she wanted to kill me. As I was running to grab another IV pump channel for my sick patient, she had the nerve to start yelling at me about how upset she was that her mother isn't get a bed assignment. She was also demanding a straw at that moment. ARE YOU KIDDING ME!? Hold the intubation! This lady needs a straw, STAT!

I'm sure I could write a book with these!

[Emergent, RN]

I hate it when the visitor wants to give you his/her own complete medical history. I'm forced to feign polite interest, while inwardly rolling my eyes.

I also hate it when every, obviously unemployed, friend or family member has to come to this big event of someone coming to the ER for a very minor thing. They usually all reek of cigarettes, BO, and pot, sit around texting and playing with their phones, drinking their pop, and snacking on chips.

[1fastRN]

I hate it when the visitor wants to give you his/her own complete medical history. I'm forced to feign polite interest, while inwardly rolling my eyes.

I also hate it when every, obviously unemployed, friend or family member has to come to this big event of someone coming to the ER for a very minor thing. They usually all reek of cigarettes, BO, and pot, sit around texting and playing with their phones, drinking their pop, and snacking on chips.

Even better when the patient is NPO and the family comes in with a schmorgasbord of McDonalds. I'm sure I'd love to be smelling food and watch everyone around me eating when I'm not allowed to eat.

[Ruby Vee, BSN]

Even better when the patient is NPO and the family comes in with a schmorgasbord of McDonalds. I'm sure I'd love to be smelling food and watch everyone around me eating when I'm not allowed to eat.

It used to be just common courtesy not to eat in front of someone . . . now not so much. We've actually had to bar visitors from eating or drinking in the rooms.

[Emergent, RN]

Another thing that irks me- pt is uncomfortable, has to get an IV or blood draw, or other uncomfortable procedure. Boyfriend is smiling, very amused by every grimace and moan, totally entertained by SO's distress.