"Dear Nurses: Please Forgive Me" : A Response

[RNdynamic]

This thread is not directed at any person in particular; it assumes the subject of the OP is a fictitious character. This is the response to the thread linked below, from a couple years ago which some of you may remember. It written from the opposite perspective -- the perspective of the innocent caregiver being abused by the example below.

https://allnurses.com/general-nursing-discussion/dear-nurses-please-789883.html

Dear adult child of dying patient,

You are not forgiven.

You say you know he's dying. You say you get it. You acknowledge that in spite of his inability to overcome his illness, and after all the attention and treatments he was given by his dutiful caregivers, he significantly exceeded all expectations you had of his remaining lifespan by three years. For reasons you don't know or fully understand, you have elected to be socially abusive and all but criminally assault the people trying to help him live. You have chosen to impact the lives of complete strangers in very hurtful, damaging ways.

You say you see the changes in his activity level and respiratory pattern, and you say you know exactly what those changes mean. You reinforce, over and over again, that you see it, and you know, and in in spite of you admitting that fact, over and over and over again, you continue to be rude, abusive, and cruel toward nurses, who to you are strangers struggling with their own lives, their own careers, their own families, their own finances, and perhaps their own dying parents. How dare you ask for forgiveness. You have no idea how much hurt you have caused.

You say your dysfunctional ways (your words) need to be understood; that you prefer to glare instead of cry, prefer to be a control freak instead of being helpless. What understanding do you think you deserve? Why should you be catered to? You have selfishly managed to make your father's dying process all about you, your needs, and your own inner turmoil and seething. You are extremely self-absorbed, and people like you are toxic. You have demanded that resources designed to make your father either healthier or more comfortable be diverted to placating your sick thinking. Interesting that you mention that you are guilt and fear laden. Could that be you don't love him and never have? You go on to mention that you were once laden with sociopathic tendencies. It shows.

It shows.

Forgive you please, your many sins? Get out of nursing. Get out of healthcare. Get out of this world.

(thoughts?)

[Esme12, ASN, BSN, RN]

Lets be clear...I have had outrageous families. I have had families that made me want to scream!!! I have had to kindly set limitations. But I ALWAYS.....I ALWAYS try to see it from their point of view. See what the problem really was and try to help them find that place of acceptance. I would never tell them if they were a nurse get out of nursing get out of life....unconscionable.

[Esme12, ASN, BSN, RN]

I agree with the OP in this thread. I also agree with Esme that we need to show compassion for family members and not be condescending.

I would never say a dying patient didn't belong in ICU to the family, that's inappropriate. I would never say, "Well, he is 80 years old;" I say, "I am sorry this is happening." Yes, there are nurses who have no tact, just like there are people in other professions who have no tact.

However, I am not one of those people with no tact, and even if I was, I still wouldn't deserve to be treated like a punching bag. I got a 80s-ish year old man up to my ICU recently. I admitted him, and was trying to do admission charting while the family members kept trying to look over my shoulder and snoop in everything I was doing. I suggested to them as nicely as I could manage while my skin was crawling and my brain was shrieking at me to get the heck out of the room - "You don't have to stand; you're welcome to sit down if you like." I am not claustrophobic usually, but in that moment I was.

I got pulled aside the next day by my manager; the family had complained about me.

Apparently, I was "throwing my weight around" and "trying to control them." I "forced them to sit" and "talked down to them like they were children." For the record, they had asked if someone needed to stay and I wanted to yell, "NO!!!!" with all of the volume I had because of how uncomfortable they were making me with their hovering and being right up in my personal space, but instead I told them we had a policy that one person was indeed allowed to spend the night, and that I would be happy to get sheets, blankets, and pillows for whichever family member wanted to stay. I am a person who needs my personal space. I don't even let my best friends stand so close to me that I can feel their breath on the back of my neck, but that's exactly what these perfect strangers were doing to me. They were also standing so that they were between me and the door. I literally felt trapped and like I had no escape route, and I still managed to be pleasant to them.

These families need to take responsibility for their own attitudes. I am still irate that I got complained about when I was nothing but polite, and offered a gentle suggestion to the family members that they sit down instead of telling them to back the **** off because they were giving me the creeps, which is what I wanted to say. Next time, I think I may just refuse to let family back into the room before I get my admission stuff done. I have been greatly soured by these nasty pieces of work. I understand that they were losing their father, and it was awful, but... when the family makes me dread going into the room, when my flight or fight response is telling me to never go back into the room again because I feel threatened, this is a problem, and the person who suffers the most is going to be the patient. These nightmare families need a reality check that their attitude is possibly going to cause their loved one harm. No nurse intends to neglect a patient, but if I know I'm going to get harassed when I walk in a room, the temptation to not walk in at all is really strong. Don't get me wrong, I'll still do my job - but I will do it in as few steps as possible and make sure I cluster my interventions as much as I possibly can so I can spend the bare minimum amount of time in the room. If these people really care about their loved ones, maybe they should learn not to threaten the people who can save their loved one's life.

I am obviously still bitter. This was the first complaint I've ever received, and I didn't even deserve it. I have never wished so bad that I had really told someone exactly what I thought about their behavior. If I was going to get pulled aside by my manager anyway, I wish I could have educated the family a bit on exactly how being hovered over made me feel. My coworkers might have benefitted from the family being made aware they were exhibiting threatening behavior. I'm quite sure that the family has no idea of how their actions are being perceived, and I'm sure they still are engaging in threatening behavior with everyone else. At least I have the benefit of not being allowed to care for this patient anymore. My coworkers are not so lucky.

I have had these families that are real pieces of work...trust me. I KNOW all about them..been there done that. But you still need to handle them with kindness. I get it but that post from the OP touched a nerve.

Forgive you please, your many sins? Get out of nursing. Get out of healthcare. Get out of this world.

[RNdynamic]

I think to take something personal that was shared from the heart of a nurse who's father was dying is not appropriate.

The idea of this thread is a sort of hypothetical reply from a fictitious staff nurse to the "worst nightmare" depiction of the generic hell-raising family member causing immense grief to innocent employees and asking to be excused for highly irrational and hurtful behavior. You're yelling at me, when I'm utilizing a narrative voice of a nurse that doesn't actually exist. In literature, the "opposing response" is an intellectual reimagining of a situation, heard from the other side.

It is not meant at any nurse in particular. It is an intellectual reply to an author who published what we are calling an article on this website, utilizing a similar theme. It is not meant to be taken personally, certainly no more than the original article is supposed to be.

[Susie2310]

I think to take something personal that was shared from the heart of a nurse who's father was dying is not appropriate.

I have to tell you that when my 80 year old father was ill and deteriorating quickly... if I heard ONE MORE TIME "Well... after all he is 80 years old..." EXCUSE ME??

YOU want to make this fat old nurse fly into your face and give you instructions and directions straight to Hell...then so be it.

You know what? Before my father became ill with pyleo he was an active 80 year old man. Sharp as a tack! In FULL control of his faculties. He was a member of MENSA and a far better person than anyone else I know. Yes he had rheumatic heart disease, HTN, renal insufficiency, had a valve replaced, and an AICD. But that by NO MEANS diminished his value to his family. He had just flown back to Chicago from visiting my house in New England. He still walked every day and drove to the store. He LOVED HIS FAMILY above all else!

In the hospital , a hospital I used to work at, he was treated as if he was already dead. Yes he went into renal failure...probably due to the fact when I arrived from the airport my father was unconscious from hypoglycemia, slumped over his bedside tray with his ted hose and footies on the bedside table covered in dry skin flakes next to his lunch tray..... my mother was crying because no one would come..as I questioned the CNA she stated she knew he was dozing when she brought the tray...OK sonorous respiration's is dozing! I WAS OUTRAGED!!!!

I mean why be concerned...he is after all 80 years old.

After surgery for his 3rd VAS cath because of incompetency of the staff...one "clotted" one "leaked" could that be from the scissors you were using? To betadine still on his skin with old OR patches 3 days later. To the dialysis tech who at my fathers bedside happily chatted how she wouldn't wish dialysis on her worst enemy. But that is OK he is, after all 80 years old.

As his condition deteriorated my sister and I (ALL RN'S) decided that we would try dialysis....see of we could pull this out. The next day he was his old self! The calm before the storm? Probably.

ON the third day he was due dialysis agai even though his "numbers were "OK" but his LOC had slipped once again. As I watched the dialysis tech...yes tech...touque his vas cath and fracture the hub...after I told her not to and asked her to get help...after I called the staff to help stop her..she fractured the VAS cath.

But it's ok he is 80 years old.

It was decided that because it was Saturday, his numbers were good and he "was 80 years old" it could wait till Monday. I told the MD that I had known for years that I would hold him responsible is anything happened...I had a bad feeling...I mean he had always listened to my bad feelings before..but after all my Dad is 80.

My dad coded that night and we removed from him life support the next day...he wasn't there anymore. I mean that's ok he was after all 80 years old.

I loved my dad like no one else. Who your parents are the luck of the draw and I happened to get a good ones. Oh... he had his flaws but above all else he LOVED his family. To infer that because someone is a pain in the nurses behind that they maybe didn't really love them and are guilt ridden makes me really angry.

I am extremely patient and a peacekeeper. I will go to great lengths to avoid conflict....but...If I am a pain in your behind you need to pay attention.

Don't get me started when my BIL died from bone cancer and the conversation a nurse had with my RN sister about her dying husband in HORRIBLE pain and paralyzed by the tumors in his spine.... how they had to be careful of addiction...and a DNR coughing up clots the size of liver didn't belong in ICU...do NOT START ME!!

That thread was about someones father dying. How can any nurse wiht an ounce of compassion in their pinky ignore the the poiginant story of how one nurse felt as her father lie dying and trying to give a families perspective and that they are just not ready to let go.

There are those who meed to leave those profession but it is not the writer of that post.

To infer that someone should leave being a nurse outrages me even more. To say get out of this world is outta line.

I seldom get angry and I am angry. I miss my DAD EVERY SINGLE DAY! He was my friend. My cheerleader. My mentor. My DAD.

I quoted all of Esme's post intentionally because I feel equally angry. Reading the OP's post I felt nothing but disgust towards the OP. The OP is the person who should get out of nursing in my opinion. Who is the "innocent caregiver who is being abused?" The nurse's dearly loved family member is dying. The nurse's account of her experience with her family member did not equate to abusing a staff member.

To the male OP: It is really a shame that people like you go into nursing. I will do my best to protect my older relatives from nurses such as yourself.

[RNdynamic]

I quoted all of Esme's post intentionally because I feel equally angry. Reading the OP's post I felt nothing but disgust towards the OP. The OP is the person who should get out of nursing in my opinion. Who is the "innocent caregiver who is being abused?" The nurse's dearly loved family member is dying. The nurse's account of her experience with her family member did not equate to abusing a staff member.

To the male OP: It is really a shame that people like you go into nursing. I will do my best to protect my older relatives from nurses such as yourself.

Please re-read the post I just made.

[Ruas61, BSN, RN]

Please re-read the post I just made.

Reread the last line of your initial post.

Get out of this world.

Really, you just wrote yourself as you see them.

[jadelpn, LPN, EMT-B]

It is difficult to watch someone fade away. People deal with it in all sorts of crazy and not so crazy ways.

By using the terms "abusing the nurses" it is the NURSE that is making this a personal thing, and about them. Sometimes you have to use resources, get others involved, step away from any triggers that make this about anything other than the patient. It sometimes takes redirection.

And what I find the most eye opening part of this is a "get out of this world". That is taking it WAY too far.

Sometimes we have to take the family at face value. If they are in a place that is not helpful to the patient, then you need to put your "family centered care" hat on and get them some support. Sometimes, a nurse gets pretty burnt pretty quick on taking care of people at the end of their lives. Then it is up to the nurse to seek support and counseling for themselves.

I find the passage in general very passive aggressive. The OP states that they are upset over a family member's dysfunction, but at the same time feeling as if they are being treated poorly. And while all of this riga-ma-role is happening, what is the patient doing?

The focus needs to be on a peaceful, as pain free as possible death for the patient. We can not pretend to know what the family decision maker and the patient chose to happen when the time came for decisions. Or why the patient would chose who they did to make plans and decisions. The hardest part is taking all this at face value and not internalize what has very little to do with the nurse.

[Carpediem1012, BSN, RN]

This time, I would like to offer hugs to you Esme. I hope in the same situation, I would act as you did. You were acting out of best interest for a loved one. No one should judge that. In fact, I'm sure you were probably bang on.

[RNdynamic]

As a nurse you need to understand how the family is feeling. Frightened, alone. confused. As a medical professional and a family you are burdened to make the right decisions. Whatever that may be. I am not one to be a pain in the behind but I WILL advocate for my family...no matter what. If you find that offensive...then so be it.

Nurses are people too. They are subject to being frightened and confused by crazed adult children as well. Nurses, as human beings are vulnerable, can be driven to substance abuse, suicide, and other pitfalls of life. They have a right and responsibility to advocate for themselves. And the article to which this thread replies too, depicts, in my carefully considered opinion, a crazed person who freely admits to having sociopathic tendencies and will (quote) raise holy hell with dietary staff (read: other human beings, and complete strangers who have done nothing wrong) to get red colored jell O because they can't control anything. That is the individual to which the narrative voice of this thread is directed at.

If you wouldn't behave in these ways to perfect strangers on the street, why would you behave this way toward anyone else?

[dudette10, MSN, RN]

Without addressing that this was a response to a real situation (although I'm not sure if the OP is aware of it)....

I recently had a patient with a distraught, overbearing family in denial of the pt's very poor prognosis. The pt was still alert and oriented, though extremely fatigued. The wife was constantly messing with the patient's pillow and bed sheets, the adult son would yell at his mom in frustration that she wouldn't "leave him alone," the adult daughter had a constant flow of tears at the bedside, and even the teenage grandchildren were getting in my face about why I wasn't making the patient eat.

Through all this, the patient would weakly wave his hand for his wife to leave him alone, for his son to shut up, for his daughter to stop crying, for his grand kids to stop berating me. I recognized he was TIRED, and all these grief-stricken family members were causing him more harm than good. They just weren't leaving him be, and they were making him angry.

I finally had to make up a reason to get the family to leave the bedside, and I asked the patient, "Do you need some rest? Do you want them out of the room for a couple of hours?" He said yes. I did manage to get them to go home, using the "You can't take care of him if you're exhausted" line. He fell asleep within minutes of their leaving!

All this is to say that family "advocating" for the patient is sometimes taken to an extreme, and the patient ends up suffering.

[RNdynamic]

Reread the last line of your initial post.

Get out of this world.

Really, you just wrote yourself as you see them.

Try to see the fictitious letter of my OP as a reply from a staff nurse whose emotions are equally amped up as a result of abuse, if it helps you to cope. You're really missing the point of the thread. The voice of the reply I wrote belongs to a fictional nurse who just read the letter (addressed to no one real) that I linked in my OP. It is me emulating the voice of a nurse reading what the originator of that article wrote.

I repeat: this is a work of creative writing.

[wooh, BSN, RN]

Don't write an "article" if you're afraid of a response. That goes for both OP and the article that OP responded to.

Why is it ok for one article writer to express their feelings but not another?