Patients that fire everyone/demand everything

[anon456, BSN, RN]

I am coming off several shifts with a difficult family of a patient. I work peds so the the family is at bedside 24/7 with the patient. We get people like this every so often and it really saps the energy and morale of the best of the nurses on the floor. This family has demanded every special service the hospital offers and then some, including additional staff at bedside at all times. They complain about everything. They question everything. They want everything just so.

This particular patient is complex and has a lot of nursing and care needs. They would have been a time consuming patient to begin with. But then the parents demand that the needs have to be performed just right. I'm not talking about doing things safely, I'm talking about doing things exactly as they want us to do them because they like to control everything. Examples: lining up the diaper tabs just so, changing the diapers every hour on the dot, positioning the patient to the left on the even hours and the right on the odd hours of the clock. There are signs all over the room in small writing that dictate the types of things the family wants done for the child. And no one has time to read them because the parent is talking our head off the whole time.

They have fired many of the nurses and aides on the floor, as well as the special services people the hospital is paying to stay at bedside 24/7 to assist with this family's needs. They tell a nurse who is the room how terrible another nurse is-- not realizing that we all talk about it outside the room to each other. They do the same thing with the doctors, and the doctors also will talk about it outside the room.

The family demands certain things from the medical team. They demand that we call the doctors to bedside frequently throughout the shift to the point where one night the doctor parked themselves near the room in case they were called again. This doctor was in charge of many patients and would have to leave and see them, too, and then the parent would be very upset and take it out on the nurses.

I had to refuse to give certain medications sooner than scheduled, and also refused to give some PRNs based on the patient condition-- giving them would have caused harm at that time due to the patient's condition.

I literally spent hours in that room. Even though the other patients I was given were easier on purpose-- and I did the required assessments and all that on them, one of them commented on this high needs family and said that since they came to the unit, they "never saw their nurse anymore." They also commented that they felt sorry for the nurses who had to take that family as the parent was a "piece of work." We are a teaching unit and it takes time to talk to the families and teach them care when they are close to discharge.

This high needs family is obviously sapping the life out of the staff, the hospital, and even affecting the other patients on the unit. In the age of satisfaction surveys and customer service, where do we draw the line? When can the higher-ups say enough is enough about patients like this?

Also since our hospital has specialty areas, there is nowhere else to go if the family wanted to move to a different hospital. And one family we had a couple years ago who tried-- the hospital sent them right back to us because they were so complicated.

[loriangel14, RN]

So why is being allowed to happen? Where I work this would have been nipped in the bud immediately.Having the doctors attend the bedside constantly wouldn't happen, neither would "firing" staff.

[anon456, BSN, RN]

So why is being allowed to happen? Where I work this would have been nipped in the bud immediately.Having the doctors attend the bedside constantly wouldn't happen, neither would "firing" staff.

I don't know why it happens. I guess because the management gives in a little bit, and then a little bit more, and the next thing we know the family is running the entire unit. What they probably don't realize is that while they are pulling out all the stops to please one family, the other families on the unit are going to fill out bad satisfaction surveys because their nurse was having all their time taken up by the demanding family.

Isn't it the patient's right to not have a certain nurse if they are not comfortable with them? What would management say if the patient demanded a different nurse? Usually this family waits until the end of the shift and then says, "I don't want Nurse M taking care of us again." (And usually that nurse will be doing the happy dance in the office!)

We cannot ignore call lights. We cannot ignore a family's direct request to page the doctor. It's a safety issue. We have to provide a companion if the patient is at risk of pulling out lines. If the patient has disabilities then we have to cover for their special services according to ADA. I would give one example of how far this was stretched but it would give away too many details about the patient.

As far as the other stuff-- like Q1H diaper changes (did not have any diarrhea or another reason to change diapers this often), things being just so, I will sometimes tell them I'm not making any promises on that but I will try. I usually like to make each patient feel like they are my only patient, but in this case I will allude to the fact that "everyone needs their bedtime meds now so I will come back when I'm done with that." Sometimes works, sometimes does not.

[Altra, BSN, RN]

I would have a bunch of advice for you, but ...

1. patterns have already been established

2. I don't know what kind of support your management will provide

For starters, I wouldn't use apologetic language - just state facts calmly and unemotionally. "I have to take care of my other patients. I will be back." Period.

I can't believe your MDs are putting up with this.

[loriangel14, RN]

There should be nothing wrong with letting the family know you have other patients to care for. Expecting the doctors to come to the bedside on their every whim would not fly where I work.Neither would "firing" a nurse. The doctors would come when they felt their was a need, not every time the family wanted them to come. There is a bad precedent set by this.

[LadyFree28, BSN, LPN, RN]

I would have a bunch of advice for you but ... 1. patterns have already been established 2. I don't know what kind of support your management will provide For starters, I wouldn't use apologetic language - just state facts calmly and unemotionally. "I have to take care of my other patients. I will be back." Period. I can't believe your MDs are putting up with this.[/quote']

THIS.

I think moving forward there should be protocols to set limits to families that have such behaviors; even if it means going to court to prevent them from interfering with care...time to put a foot down; psych consults, whatever it takes where they do not interfere with care of OTHER patients.

[anon456, BSN, RN]

I agree with making a policy for families like this. When I get families like this I feel like an abused waiter.

Thank goodness 90% of the families are a pleasure to work with and I love my job. It's just that we seem to have one of these high needs families on the unit at any given time.

[anon456, BSN, RN]

So what can I as a lowly floor nurse do? I will take the advice to make them aware that I have other patients, but I doubt they will care. If I get fired it is because the family has voiced a complaint about me and that looks bad to management. I am sure I would not get let go over it-- the floor managers are sympathetic to what the nurse is going through. They often will even take time to talk to the family and make sure they are listened to so they can then get it out of their system and leave the nurses alone.

So if the parent told you a certain way they wants things done for the patient and it's ridiculous and you don't have time for it (and it's not a safety issue) what would you say and how would you say it?

[anon456, BSN, RN]

I do remember one case where court did get involved and the child was placed into protective custody until the health issue had resolved. But this was extreme. This same parent was accusing staff of being unsafe and threatening to sue, to the point where we had to have a staff member at bedside to serve as witness that the nurses were not doing anything unsafe to the child. It was ridiculous. But the child needed complex medical intervention and we could not turn them away.

I just assumed this was typical of most hospitals to have this kind of situation. Not the extreme case mentioned above but having high needs families with rights to fire nurses, etc. Maybe it's not normal and this is a hospital management problem? And they are trying to avoid being sued or something because these same families would be the type to sue over anything they perceive to be unfair. They probably would not win but they would try.

[rumwynnieRN]

Oh lord, I would be happy to be fired from that family. It's too bad management won't or can't have a discussion with them about their behavior, and my god, what doctor hangs out on the unit for patients (okay they might actually do that other facilities, I just haven't seen it)? Why aren't they doing the q1h diaper changes themselves? If they're that involved in their child's care they should be doing some of this crap themselves.

[chopwood carrywater]

To quote another nurse I know " The 'h' is for hospital, not Hilton."

[anotherone, BSN, RN]

Depends on how my other pts are but for q1 hr demands that are not needed and I am busy , I have and will say something lile "many of my patients need things at 6:00, I can't be in 6 rooms at once." or will tell them why the request isn't needed. people like this are

a blessing to be fired from. Some of our drs have no issues "telling them off" wheras almost all the nurses, myself included, mostly give in