Patients that fire everyone/demand everything

Nurses Relations

Published

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.

Specializes in Emergency & Trauma/Adult ICU.

I really think the starting point is the language that you're using. You talk about the family's "rights" ... there is no "right" to pick & choose staff. The health care organization may *choose* to meet requests and that *may* be considered a form of patient-centered care ... but that is a far cry from a right.

And I'm sorry ... hourly diaper changes? That could have been eliminated within the first shift on your unit -- "hourly changes are unnecessary, but you are of course free to change your child's diaper as often as you wish."

Specializes in Critical Care; Cardiac; Professional Development.

I am known to ask "Who will accomplish this task at home?" when unreasonable requests are made.

Getting "fired" from this kind of family doesn't carry the same weight as other types of issues. Everyone knows what these types of families are about.

I appreciate your feedback and I do think that in the beginning the staff should have set limits with this kind of thing. In the case of this patient I just had recently, they have home nurses who apparently do the hourly diaper changes and such. So they expect this to be done by our nurses. The difference of course is the nurse they have only has their child as their only patient.

I think this thread is challenging my own sense of boundaries and I need to set better ones for myself. Even if the patient had already become used to the special care they got from nurses on previous shifts. I guess I am a wimp in a lot of ways and a people pleaser and very caring. That's what makes me a good nurse but I guess I am allowing some patients to take advantage of this quality I have.

I do expect some parents to feed their newborns and change diapers as they would at home if the baby is just there for observation or is well enough recovered and about to go home. I have even woken up parents to do this if they have been ignoring the kid the entire time or texting while the kid is screaming hungry. But I also can see when the parents are exhausted and I will encourage the parents to sleep through the night while I feed/change their baby. Most parents are easy to work with this way and many will even insist on doing most of the cares because they feel most comfortable with that. Some have special requests and I try to honor those.

I think what I am doing is allowing my own personal boundaries to be stepped on because the hospital has allowed its own boundaries to be stepped on and so have previous nurses to this patient, so I an assuming it's the acceptable thing to do. I will have to work on tactfully but firmly setting boundaries to families like this.

I will have to say things like you suggested: "Typically we check diapers every two hours and we turn our patients every two hours. If you want to change the diapers more often than that, feel free to do so." But then they will argue that previous nurses did it hourly so why can't I? I am uncomfortable arguing back because often these parents are master manipulators and I will never win.

They also will often fire doctors the same way. Dr. Y is at bedside trying to explain why a certain med is not needed for the child. "Well Dr. X gave my child that PRN of such-and-such last night. Why can't you do it? I want to talk to Dr. X." And then Dr. Y will not want to step on Dr. X's shoes (because maybe Dr. X is senior to Dr. Y) so they will prescribe a one time dose of the requested med. And now the parent knows they just have to use this line night after night to get what they want.

The situation I got into a couple nights ago was a scheduled med had been ordered on days, but the child's condition was not safe to give that med even when the parent requested it on my shift. I explained to the parent about why I could not give it, and the parent had a fit and demanded to speak to the doctor. Another nurse called the doctor while I stayed with the child, who was actually looking worse and needed an MD at bedside. The parent actually grabbed the phone from the nurse's hand and spoke to the doctor directly about me holding this med. While the same nurse was trying to voice concerns about the patient's condition. In this case the doctor came to bedside to assess the patient's condition and agreed with my assessment and the holding of the med and the patient was transferred to a higher level of care.

So I can be assertive when it's safety-related but it's more difficult for me when the precedent has been set already by previous staff about requests for routine care that are over and above what is reasonable.

Specializes in Critical Care; Cardiac; Professional Development.

That is hard but gets easier with practice. Sounds like you know what you need to do! It bears noting the child gets very little quality rest if diapered hourly.

Specializes in Urology, ENT.

I don't know what to say about the doctors, though I'm inclined to think someone needs to have a serious talk with them, probably both doctors and nurses.

If the family had their own nurses then they can get those same nurses to do round the clock care like the q1h diaper changes.

I work in extended care home health, where firing staff is par for the course with average families as well as high maintenance families. The agency gives in and yet another nurse is without their livelihood while the family members' egos are stroked and the agency alienates another good employee. This is the extreme. On a daily basis the clients run the show, to the point of endangering patient safety or the nurse's willingness to be placed in jeopardy. Eventually the best of nurses will get enough and change fields to get away from morale killing clients and employers.

Specializes in Clinical Research, Outpt Women's Health.

The hospital risk manager needs to step in and do their job. Write up a contract that states what is and isn't possible and then let the staff know these guidelines and back them in implementing them. Where is management? This should be their shining moment - ha ha.

I am uncomfortable arguing back because often these parents are master manipulators and I will never win.

You can win. ;) you just have to become a master manipulator too. which is a good skill to have in your back pocket and whip out when you need it.

a bit of passive-aggression can be a beautifully effective thing. re: q1hr changes, act as if the parents are being so overly demanding because they don't know how to properly care for their little one, the poor things! :p clearly they just need lots and lots of education and training! next time they ask for something stupid, act like you would be just overjoyed to teach them how to do it. "it's wonderful that you're so involved in your child's care. i know you want to learn as much as possible about how to care for him/her because you're such hands-on parents. It must be so frustrating for you to have to rely on the nurses to change him/her every hour! I'll be glad to work with you and show you everything you need to know to be as independent as possible." Then demonstrate and explain how to change the diaper, as if you were explaining it to someone who really wasn't quite sure how to do it. Then have them demonstrate that they're able to do it.

An hour later when they're ringing for their next change, "you're going to try it? great; you've got this! here's a fresh diaper; i'll be right here in case you need any help". Followed by congratulations if/when they do it themselves: "great job! it's so empowering to be able to do these things for yourself and have them done exactly the way you want it, isn't it? Anything else you're having trouble with, just let me know; i'll be glad to teach you!"

you have to be a good actor to be able to pull this off; you have to really act as if you think they want to learn how to do it themselves but just don't have the training. :p but it WORKS.

i work with adults and do the same thing, i.e. someone's on the call bell for the fifth time to have something handed to them that they can easily reach? "oh you must be so frustrated, having to call every time you need something! here, let me show you how to get that for yourself- i know how much you want to be independent." (blah blah blah about supine to sit and/or bed mobility techniques, possibly train them on how to use the reacher that the OT gave them, then have them show me they're able to reach everything on their table- great! now you can do it all for yourself! glad i could help.)

Specializes in Med Surg.

I get "fired" from these patients as soon as possible. Not by arguing with them, but by treating them with respect, fairly and at the same time attending to my other patients.

They can't stand that.

Specializes in Critical Care, Education.

Here's an off-the-wall suggestion. Does your facility have a behavioral health service line? If so, are there any behavioral health nurse specialists that could provide consulting services for the staff re: behavioral modification techniques to use with this 'difficult' family? I have done this with Critical Care 'issues' and it worked out very well. Our 'consulting expert' was also able to help the staff deal with their frustrations.

Just a thought. . .

You can win. ;) you just have to become a master manipulator too. which is a good skill to have in your back pocket and whip out when you need it.

a bit of passive-aggression can be a beautifully effective thing. re: q1hr changes, act as if the parents are being so overly demanding because they don't know how to properly care for their little one, the poor things! :p clearly they just need lots and lots of education and training! next time they ask for something stupid, act like you would be just overjoyed to teach them how to do it. "it's wonderful that you're so involved in your child's care. i know you want to learn as much as possible about how to care for him/her because you're such hands-on parents. It must be so frustrating for you to have to rely on the nurses to change him/her every hour! I'll be glad to work with you and show you everything you need to know to be as independent as possible." Then demonstrate and explain how to change the diaper, as if you were explaining it to someone who really wasn't quite sure how to do it. Then have them demonstrate that they're able to do it.

An hour later when they're ringing for their next change, "you're going to try it? great; you've got this! here's a fresh diaper; i'll be right here in case you need any help". Followed by congratulations if/when they do it themselves: "great job! it's so empowering to be able to do these things for yourself and have them done exactly the way you want it, isn't it? Anything else you're having trouble with, just let me know; i'll be glad to teach you!"

you have to be a good actor to be able to pull this off; you have to really act as if you think they want to learn how to do it themselves but just don't have the training. :p but it WORKS.

i work with adults and do the same thing, i.e. someone's on the call bell for the fifth time to have something handed to them that they can easily reach? "oh you must be so frustrated, having to call every time you need something! here, let me show you how to get that for yourself- i know how much you want to be independent." (blah blah blah about supine to sit and/or bed mobility techniques, possibly train them on how to use the reacher that the OT gave them, then have them show me they're able to reach everything on their table- great! now you can do it all for yourself! glad i could help.)

Awesome! I'm totally doing this next time I have unreasonable patients/families!

Also, OP, have you mentioned to management that caving into this one family's demands is going to get them 20 poor P.G. scores? Weighing one poor survey against 20 or so might light a fire under them.

Specializes in Emergency & Trauma/Adult ICU.
I think this thread is challenging my own sense of boundaries and I need to set better ones for myself. Even if the patient had already become used to the special care they got from nurses on previous shifts. I guess I am a wimp in a lot of ways and a people pleaser and very caring. That's what makes me a good nurse but I guess I am allowing some patients to take advantage of this quality I have.

Consider that being a "wimp" and a "people pleaser" DO NOT make you a good nurse.

These traits all but make it impossible for you to advocate for your patients, or to light a fire to get the wheels of the hospital machinery to get spinning when needed. They also make it very difficult to properly educate patients.

+ Add a Comment