RUDE pt and spouse=everyone fired from care!

DusktilDawn · May 26, 2006

What about a multi-disciplinary meeting that involves the primary physican, PT/OT/ST, unit manager, etc. Setting realistic goals and discussing them with the patient and family. Definately limits on behavior needs to be set (ie: calling the unit clerk a b**** inappropriate). Also document objectively what is going on.

bonesrn · May 26, 2006

Agree with the above poster...need to get unit manager/DON/MDs and SW involved. Sounds like they definetly need someone to talk to..this is a life altering event but it doesn't give them license to be mean and rude to the staff. Keep documenting and try to keep smiling!

gr8greens · May 26, 2006

Sounds like an awful situation...so sorry. We have a patient relations person to intervene in a situation like that. But it certainly appears that the attending and all other heads of depts. involved with pt care should have a pow-wow w/ the SO and pt and their family. we've even taught the family how to do tube-feeds, t/p, feed properly, etc. if staff weren't "quick" enough. Good luck!

meownsmile, BSN, RN · May 26, 2006

I agree, there needs to be a meeting to come to some agreement for patient care that is within reason for all concerned. If that isnt doable then maybe it is time for them to hire a private duty nurse 24/7. Then the responsibility for the care is completely in their hands.

Then again, sometimes people have to have total control of situations because NOTHING else is controlable in their lives. If that means complaining to management and someone actually being fired from employment they will do that too. Ive seen people actually fired because someone "wanted their job" because of a percieved wrong. Unfortunately in this make the customer happy at any and all costs mindset that facilities are getting it will happen more now. Talk about victim of circumstances. My guess is these people couldnt control their own lives before illness, now its just refocused and this is the next battle in their lives for total control.

Tweety, BSN, RN · May 26, 2006

What about a multi-disciplinary meeting that involves the primary physican, PT/OT/ST, unit manager, etc. Setting realistic goals and discussing them with the patient and family. Definately limits on behavior needs to be set (ie: calling the unit clerk a b**** inappropriate). Also document objectively what is going on.

Good idea. Limits need to be set and understoond, reinforced, and supported by management. It sours an entire unit and hurts moral.

During this meeting the option that they find another facility should be discussed.

BittyBabyGrower, MSN, RN · May 26, 2006

Yes, you need a meeting with all involved. Does your facility use a hospice service? Many offer services for chronic ongoing conditions, so maybe something like that would be a good service.

As for "firing" people...that wouldn't fly where I work...you get who you get because sometimes you have no choice. And if they are po'd about the lack of response time, I would state that it takes time to find help as they don't want X amt of people to help. They really have been let to do what they want and you are going to have a hard time reining back control.

Good Luck.

fergus51 · May 26, 2006

SOmeone needs to lay down the law with that family. I have worked in places where "firing" nurses is allowed to happen and it never turns out well. One family in particular had fired numerous nurses. It took another family confronting them to stop it. It's bad for the staff and bad for patient care. If they feel the care is so bad, they can be offered the option of transfering elsewhere. Allowing one patient to create such chaos is stupid IMO.

BTW, I get that sometimes nice people just lose it and need control over something and act out, but some people were just jerks before they came in. Regardless of the reason, it has to stop.

redshiloh · May 26, 2006

We have a similar situation on our rehab unit. This is what we have done with some success. First, I got the nurses to document EVERYTHING in notes and since we have electronic records, identify the doctor as cosigner to make sure they read it. Second, I went to the interdisciplinary team and asked for help and support. Then we had a meeting with the patient (actually it has taken several meetings) and discussed what was expected in rehab and that his behavior was disruptive.

You are rehab, this means that the patient has to DIRECT care that he is unable to do (and politely) and this is what has to be ingrained in the patient.

SO FAR our patient has been better.

Now, the family's behavior sounds like you really need to get the staff to call security when they become disruptive like that.

Your patient 'firing' all the staff is staff splitting.

I feel for you...this has been very hard to deal with. Good luck!

Antikigirl, ASN, RN · May 26, 2006

Man that would SOOOOOO not fly with me at all! I would have had the administration right on this...heck, I don't understand why they aren't standing up already considering so many staff are 'fired'.

Perhaps this family needs to look at hiring a private CNA or nurse to go along with the staff already taking care of him? My facility I use to work for (ALF) had its share of folks like this, and it was basically brought down to the point "you hire a private caregiver for additional assistance beyond what we do, if that doesn't work for you, you will have 30 days to find a place that does." Of course it had to be very bad, and beyond a rational time limit..LOL, ya know facilities...money speaks loudly! But eventually they would realize it was going to be their heads rolling, and patient safety and continuity was at high risk!

Hospice or transitions services (transitions is like Pre-Hospice...not as many features, but very nice!!!) is another excellent option for those that qualify!

The administration needs to be involved, and sign off on a care plan that will be DONE by all concerned...including family! If that isn't possible it is 30 day notice time!

And I agree with documentation of EVERYTHING. I had the caregivers and nurses write everything down that was said or done. We also put in a 1 hour checklist/sign off that had what the pt was doing, what you did, time, and sign. So if you get a load of crud from the patient or spouse, you grab that and say "well at such and such time, so and so came in and did this". Lots of documentation I know, but keeping out of trouble and possibly getting that patient that isn't appropriate at that facility out of that facility by documentation is a serious beni and most of the staff I worked with gladly did it!!!

Psychaprn · May 26, 2006

Man that would SOOOOOO not fly with me at all! I would have had the administration right on this...heck, I don't understand why they aren't standing up already considering so many staff are 'fired'.
Perhaps this family needs to look at hiring a private CNA or nurse to go along with the staff already taking care of him? My facility I use to work for (ALF) had its share of folks like this, and it was basically brought down to the point "you hire a private caregiver for additional assistance beyond what we do, if that doesn't work for you, you will have 30 days to find a place that does." Of course it had to be very bad, and beyond a rational time limit..LOL, ya know facilities...money speaks loudly! But eventually they would realize it was going to be their heads rolling, and patient safety and continuity was at high risk!
Hospice or transitions services (transitions is like Pre-Hospice...not as many features, but very nice!!!) is another excellent option for those that qualify!
The administration needs to be involved, and sign off on a care plan that will be DONE by all concerned...including family! If that isn't possible it is 30 day notice time!
And I agree with documentation of EVERYTHING. I had the caregivers and nurses write everything down that was said or done. We also put in a 1 hour checklist/sign off that had what the pt was doing, what you did, time, and sign. So if you get a load of crud from the patient or spouse, you grab that and say "well at such and such time, so and so came in and did this". Lots of documentation I know, but keeping out of trouble and possibly getting that patient that isn't appropriate at that facility out of that facility by documentation is a serious beni and most of the staff I worked with gladly did it!!![/QUOT
If I understand you and all those people were fired because of 1 family's complaints-I'd RUN, not walk to find another job. You could be next the next time. Your administration must be nuts not to have fixed this problem after the first firing! I've worked at jobs and left because bosses took the "customer"s" words as truth vs. staff's-who needs that kind of work environment!

ZASHAGALKA, RN · May 26, 2006

i know prognosis is poor, but we (pt/ot/st/nursing/cna/housekeeping)have done just about everything we can do to make them happy, just ain't working!! help!!! :lol_hitti we are all going nutz!!

why is the prognosis poor? many gb pts make a full recovery and most have a return to function of at least most of their abilities.

as far as firings: this should simply not be allowed. that is a failure of your management team. manipulative behavior is only allowed when it is tolerated.

if i were the manager and a family member called my staff a name at the station, they'd be escorted off the premises and asked not to return unless/until they leave the attitude and warned that if it happened again, they would be persona non grata for the duration.

and in no case would they be allowed to 'fire' individual staff members. 'firing' staff is tantamount to 'firing' the facility. at that point, they need to find an accepting hospital for transfer.

if that were me, i'd sure work as hard as possible to be on the 'fired' list. if management wants to allow manipulative behavior, i'd rather be on the 'fired' end of that behavior.

~faith,

timothy.