please help - difficult family, feeling hopeless

[Wobie]

Hi everyone,

I am a new nurse and got my first job in a homecare setting working with children a few months ago. I haven't minded it so far, but I have a problem with one patient I see and their family. They make me feel incompetent and like I am not good enough to be looking after their child. I try to be empathetic to their situation as I can only imagine how much stress they have caring for a child with special needs 24/7, and I understand their actions only stem from fear. However it has taken a huge toll on me mentally.

I am there for respite care sometimes on days, mostly on nights. however the parents don't trust me to be alone with the child and they stay up with me (even at night) and watch my every move with the patient. This makes me extremely nervous every shift. They talk to me in condescending tones and if anything happens (like the child feels nauseous or wakes up) they say it is my fault in the way I touched the child or in how I fed the child etc. It's gotten to the point where NOTHING i do can please them or is 100% perfect for their child. I have been reallly understanding with them and have done everything the way they want me to, however they still can't seem to trust me to let me do my job.

I see them 2-3 times a week, and I thought by now the relationship would have gotten better as they become more familiar with me, but it has only gotten worse. The way they treat me has shattered my confidence to be a nurse and I constantly feel inadequate. This has caused me to become anxious and to be honest a bit depressed. I spend my days off dreading when I see them next. I spoke to my manager about the situation and she just laughed and told me that is what the family is known for. Since it is a private company, I have been told by coworkers that they will always take the patients side. Sometimes when they speak to me its very much in the "sit down and shut up sense". I have had this problem once before with another family however, after a couple weeks, the relationship improved. It's been months I have worked with this family and nothing has gotten better. I am feeling hopeless. I have started applying elsewhere, but it is difficult as I only have a few months experience and only in the homecare setting. So right now that is not an option. Now i know why this place hired people so easily!

Anyways, I was wondering if people could share similar experiences, words of encouragement or ways to handle the situation.

Thank you so much :)

[caliotter3]

I did not finish your post. Get another case. If the agency does not have another case, wait or go to another agency.

[Davey Do]

Hi Wobie! Welcome to AN.com!

My mantra during times like this is "My happiness does not depend on what others do or say, or what goes on around me. My happiness is a result of being at peace with myself".

Your feelings and reactions to the actions of the family are quite appropriate. However, we need to take responsibility for our feelings. It is us, and not another, who "makes" us feel certain ways. If we think we are incompetent, we're going to be down on ourselves. If we know we are performing competently, we are self-assured.

I have worked home health both as a visiting nurse and as an administrator. Administrators have a tendency to buffer problems with the staff and clients by focusing on those providing the direct care services. The customer is not always right, but they need to be appeased. Working with the direct care staff is the easiest and best way to deal with such situations.

People often express their own basic emotion of fear through irritability, anger, and criticism. We can deal with their fear through giving them power; control.

For example, when a client expresses their unhappiness with criticism, give then the reins. Ask what they would do in a particular situation. This reaction makes them responsible for their actions and allows them to decrease their fear through an expressive process. Validate their thoughts, feelings, and actions: "Oh- I understand you to say..." When their thoughts and feelings are validated, they feel more in control, and subsequently, less fear.

We need to metaphorically dance with clients and not wrestle with them. Allow them to lead. It's how we look playing the game that will achieve the goal of or endeavor: To harmoniously provide quality patient care and satisfy the customer.

The very best to you, Wobie!

[scuba nurse, BSN, MSN, RN]

WOW, your manager is really nice, huh? I can't believe she just laughed at you, that tells me a LOT about the company and her. Clearly she KNOWS this family has had issues with nurses, yet sends you (a newer nurse) to them, when she should be sending a more experienced nurse that can maybe handle the family better. I am sure your nursing care is fine, don't let them get you down. In the mean time, I would be looking for a new company to work at. This company and this boss are not likely to have your back if the family keeps complaining, get out of there. There are a LOT of homecare agencies looking for RN's. Good luck!

[RegularNurse]

Just quit.

Life is too short for this nonsense.

[LessValuableNinja]

DNR yourself. There are other cases.

[nurse2033, MSN, RN]

I have experienced the hyper-controlling family myself, but in the hospital. We had to get administration involved. But you have no such depth of assistance. If my manager laughed at me for a serious concern I had, that would be the end of that relationship. I would immediately look for another job. If you want to persevere, understand that the family's reaction is understandable given the nightmare situation they are in. This is one adaptation people will take. Don't take it personally! You have to create a professional space in which to work, creating some distance from your feelings and ego. Not everyone can do this. You can't control what people do, but you control how you react to it. Google "inspirational quotes"... Good luck.

[bsyrn, ASN, RN]

I totally agree with the others, drop this case and if you can't, go to another agency!

[TheCommuter, BSN, RN]

There are other ways to earn your livelihood that do not involve scorn or blaming from the family. Drop this homecare case like a hotcake.

If your agency does not support you in your decision to extricate yourself from this case, find a new agency.

[luvmyc]

No job should be making you feel like that. Just because you have a sick child doesn't mean you theat the nurse like crap. I never did. Just move on.

[Emergent, RN]

I did a couple of homecare cases years ago. One of them was similar to what you describe. I would never do homecare again, it's too weird to be enmeshed in weird family dynamics. The parents of the pt, especially the mom, were totally controlling. Everyday was a lesson in nursing 101 in the care of her adult son who had suffered a TBI in a car accident. She also shared with me her frustrations with the liberal priest at her church, her obsession with the Fatima apparition in Portugal, her disgust with her lesbian daughter whom the husband had banned from their life, then she'd take a smoke break. Her husband just plain gave me the creeps.

[AliNajaCat]

A bit different scenario, but perhaps some insight (though I agree, hit the road on this one):

I just learned of a case with a very disabled teenager (terrible medical malpractice perinatal, no argument there) whose parents have their own narrative about what the child needs and what the child's capabilities are. They read what they want into the reports; they ignore the inconvenient facts as "just recommendations, just suggestions" and choose to misinterpret both what the experts have been telling them (these are well-educated professional people) and the neuro-related behaviors the child exhibits. When I gently corrected one of their misconceptions, they said, "Oh, that's not what they told us," and looked very uncomfortable.

None of this family's narrative is remotely congruent with any expert recommendations from the many medical and nursing specialties they've consulted and it certainly didn't square with my personal observations. The few opinions they have agreement with are from other "soft" specialists who apparently have not read the neuro and other hard sciences diagnostics. The parents were displeased with my dispassionate neutral recounting of my observations and recommendations, because they didn't fit their internal narrative.

While I agree that parents get to choose their child's care as long as they're not straying into actual abuse/neglect, even if it's not fruitful, I got some good insight into this couple from their legal counsel. She told me that at the end of litigation, parents come to the realization that this is it, this is permanent, this is not going to get any better any more than it has for the last X years of futile "interventions." Then, denial no longer possible, they're looking around for somebody to blame, somebody to lash out at, even if it's completely illogical. They're more to be pitied than censured, in the words of the old song. The stages of grief come into play here, obviously.

So with your patient's family. Don't take it personally; it's not the last time it will happen but if you're sleeping well at night because you know you're doing the right/best thing (even if it takes you a few sleepless nights to realize that), then ... well, that's it. And if your management doesn't recognize this, then they're not smart enough to be managing cases like this and you're better off going to work for somebody else.