Separate being Family vs Nurse

[Mommy_RN1211]

Hi all, I am a new RN and am curious about some experienced RN's perspective on this topic. My dad recently had a very debilitating stroke. We have been to 6 facilities in 5 months and I have seen the good, the bad, and the ugly of nursing staff.

Often I find myself having to remind the nurses to float his feet for pressure wounds and turn him every 2 hours. He has been left in soiled diapers for longer then is acceptable among other communication issues.

I draw a line this past weekend when I went and asked to speak to the charge nurse just to get more info since his assigned nurse was an agency nurse and didn't know much about his history or long term care plan. She acted so unprofessionally. If you have a moment to read our dialogue it is below. (It is typed because I intend on sending a complaint to the company.) If you want to skip that part I totally understand.

[[[Nurse entered his room and immediately had an attitude which was demonstrated in her tone of voice and dismissive body language. She stated You asked to see me, what can I do for you?” and I responded by stating my observations of the treatment of the heal. I stated that there were 3 nurses sitting at the nurses station (one of which had their phone out) and she immediately interrupted me by saying I don't have 3 nurses so that's not true.” I responded by saying Well I saw 3 people at the desk none of which offered to assist with my concerns.” She interrupted me by stating What is your point, get to your point.” I stated My point is I came in and his heal was flat on the bed with a soiled bandage and I want to make sure it is off the bed as prescribed. There is available staff that are capable to attend to this task.” She interrupted me by stating I know you're a Registered Nurse so you think you know but I know how to run my floor and we are doing everything we can to assist him.” I asked to then speak to her manager who was currently unavailable. I asked her to please stick to the concern which was the wound as it had a green drainage that could indicate infection. She stated If the patient had an infection he would have a fever.” I responded by saying A fever is not the only systemic change a patient will have with an infection.” She interrupted me and stated I am not going to play this game with you. What else do you need?” I was completely floored at this point and requested she leave the room and please remind her staff to keep his extremities elevated.]]]

None the less, how do you balance being a nurse and having knowledge on how things should be handled versus being a concerned family member and letting things slide because you know how the system works? I am so disappointed in how some nurses have acted and feel sometimes (with any job) when you have been doing it for so long you really probably shouldn't do it anymore if you lost your passion.

Frustrated daughter/RN.

[Mommy_RN1211]

Katiemi thanks for the insight. I actually asked the nurse to leave the room because for the first time I actually had a license to think about and didnt want to lose my cool. I am totally aware of keeping my cool but also not compromising my dad's care because I am worried about getting a job. Moving forward I will not ever tell anyone I am a nurse in any of these facilities because it is clearly only putting a target on me and that results in negative care for my dad.

I agree we need a book! It should be required text to read! Lol

[kalycat, BSN, RN]

OP, I am sorry to tell you that, but if you just wanna to survive in this rough world, you got to learn how to separate emotions and facts, as well as facts from books and facts from life, and do so quickly.

There are 1001 thing which "may" signify infection. Approximately 1002 of them can also signify 1000 other things, discharge (any color, from any wound) is among them. So, if you want to get what you want, stop teaching people how to do their job, especially in the form of citing textbooks. Also, stop counting those who are so shamefully sitting at the station and apparently do nothing to adddress your "concerns", rightful or not (going a bit ahead, you probably will spend insane number of hours sitting there waiting for a doc to call back, for a lab calling stats, for Micromedex search, for searching the condition/drug on smartphone because hospital computer system does not allow Google or just way too slow, and the like activities), and stop seeking problems where there are probably none (I am talking about "attitude", for in the name of the God I cannot get what it is about).

I work in LTACH and know patients like your dad and their families rather well. You went through A LOT, we know it, nobody says it is not so. But all that doesn't change baseline of being polite, not attacking people for not moving their bodies precisely to your liking and finding who is actually responsible for the task before asking about it.

P.S. please also know that the nursing is, in fact, a very small world. Being a new one and behaving like you did may seriously compromice your future job search in the locality if you irritate someone in seniority enough to mark your last name. For the very same reason, it is highly recommended to speak about your nursing status as little as possible.

P.P.S. this is why we need a book named "A Total Idiot's Guide To Being A Hospital Patient" ASAP, and it must be written by floor warriors.

Katie, I can't love this enough. I use my phone for the exact reasons you mentioned - I can access Micromedex or Medscape in two seconds on my phone and 3-5 minutes on a portable computer (boat anchor) provided by the hospital. It is what it is. My hospital even knows this and considers it acceptable use.

And that book needs to happen. Now. :)

[nutella, MSN, RN]

Hi OP - I am sorry you are having a rough ride and I am sorry your Dad had a stroke and is going through all of this.

It can be very hard to be the "daughter" and not "the nurse" . Of course as a daughter you feel different about "urgency" and you want the best possible care for your dad. That is normal - when a family member is sick, especially a close one, we get tense, worried, emotional, and such. While it is useful that you have some nursing knowledge you and your dad would probably served better if you could compartmentalize a bit here. Your job right now is to be "the daughter" and not "the nurse". Your worries and stress over his problems are understandable but expressing some of it in the form of anger, provocation or even hostility will only make things worse because the staff will respond to that in a less compassionate way, which will in turn drive your anxiety and worries higher leading to even more emotions. In addition, they may start to avoid going into his room because they do not want to deal with your behavior.

If you have reason for concerns or need the staff to change your dad or reposition him, press the call light and let them know in an acceptable way, do not get argumentative.

There are proper ways to complain if care is not acceptable and you should voice your concerns to the manager or supervisor, you can also talk to an ombudsman (if there is one), of course there is always CMS to complain as well.

If he is not on an low airloss mattress you can see if he can have one though it is getting harder to get an order for that. If he has multiple pressure ulcers and problems with moist skin you can ask if it is possible to get one to prevent further skin deterioration.

I hope that things improve for you and him!

[margin261]

OP- as I just very recently went through multiple hospitalizations with my father, I wanted to say how very sorry I am that you're going through this.

It's very difficult to be a nurse AND a daughter. Some of the advice I want to give you has been covered, but I think it's important.

I know you want the very best care for your Dad- so does every other family member that has a loved one in the facility but unfortunately, care that is 100%perfect isn't possible. You have to 'pick your battles'. Obviously if you see something egregious, speak up- but otherwise, observe for a bit.

Whatever you can do for him, do it. You'll learn which nurses/CNAs are 'better' at their jobs- they will be your best allies.

I never tell anyone I'm an RN- sometimes they figure it out by my questions or my willingness to help with my Dad's care. By that time, I know who isn't going to react negatively/defensively to it.

You didn't say in what type of facility you currently work, just that you're a new nurse. But if someone accused you of having all the time in the world just because you happen to be sitting down- I bet you'd be offended? I would. I've worked in all kinds of places- hospitals, clinics, NH- and at all of them, sitting equals craploads of charting, phonecalls, or getting info for med pass, etc.

All I'm saying is don't alienate the people you're depending on to take care of your Father.

Good luck to you & your Dad, I hope his recovery is quick.

[hppygr8ful, ASN, RN, EMT-I]

To answer a few points:

1. I currently work full time and cannot be there all of the time. So when I say his feet are not propped up I assumed nurses would understand that of course I prop them up and am always willing to change his diaper. I cannot do these things if I am not there. When I see his feet flat on the bed I can fix it THEN but cannot correct it if I am not there. That is my concern and why I chose to speak with the charge nurse to make sure in my absence those concerns are addressed.

I always help with his care when I am there! If I can do it I will never ask a nurse to. The key word is when I am there. If I am not there I have to rely on the staff to do it.

2. I just took my boards so definitely am a new RN which I disclosed in my post but I don't think that is a bad thing. Keeps me fresh on what should be done versus what short cuts are taken sometimes.

3. We have been to 6 different facilities for insurance reasons. He recently had the stroke so we have been in and out of hospitals, LTAC, rehab, short stay in a SNF where he got 3 pressure ulcers in 2 weeks, etc. So definitely not because of care (other then the SNF) just have to move because of insurance.

4. Being on phones is a risky behavior because it is all about perception. In my eyes regardless of what profession if you are on your phone you have time to be doing anything else. All I ask is simply peak your head in the door and make sure his feet are propped.

Although I did expect some negative feedback I am curious to know how some nurse's can become so numb to situations. I am brand new and still have a soft heart so to speak and I hope to never lose it. Through this experience I have really encountered some nurse's who I question why they are nurses but I guess that is with every profession.

Thank you everyone for your posts. Opinions are always appreciated.

OP - first of all Hugs to you and I hope your dad is getting better care. I am going through the same issues with my mom except that in my case I don't actually like my mom. She was a horribly person and abusive to boot - still I wouldn't want her mistreated in any way because that's just the person I am.

I am also a Charge nurse in a long term care facility with up to 30 patients to care for at any given time. Yes it is my job to make sure your dad gets proper care which includes floating his heels and turning and repositioning him. Most of this I am forced to delegate to my fabulous team (I really mean that) of LVNs and CNAs. They really are some of the best in the business. Still the law says that the facility needs only to provide staff adequate to meet the needs of the patients and guess who decides that? The management of the facility. In California a patient in LTC is required to receive something like 1.6 hours of care from an RN per 24 hours ( A very weird complicated system that I am still trying to figure out) The facility where I work is beautiful and the staff work really hard but there was a lot of communication breakdown dissatisfaction from patients families. When a CNA has 18 patients on their run they can only take care of 1 person at a time. I don't know what your initial attitude was but I can say that if you gave an accurate description of the charge Nurse's attitude you are right to be angry. My initial response to your concerns would have been to float his heels immediately and also turn and reposition him myself. If you had concerns about his care I would get you with the case manager for a care conference. Bottom line is no one will care bout your dad like you do but that is not an excuse for inadequate care. IMHO 3 pressure ulcers in 2 weeks is very poor care. Still I don't know how much you know about pressure ulcers but they are a B*&^ch to heal and take forever. Stage 3 and stage 4 often have a lot of drainage which is actually a good sign and at least were I work under the direction of a really good wound care surgeon dressings get changed every three days unless they are on the sacrum or coccyx and become soiled with feces or urine.

You may want to soften your approach a bit and just be a daughter instead of a nurse when visiting. You can never really turn it off (I know) but most of us really do know what we are doing. I actually use my phone a lot while at work to look up stuff and to call physicians - who trust me to call them directly with emergent concern's (Saves time over paging). Try not to get into power struggles with nursing staff but's it's ok to let people know when something doesn't seem right to you.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

Oh and I just want to add that my mother with vascular dementia just loves to tell her nurses what a Big Wig her Daughter the nurse is and how they are all going to get fired when she ( I) finds out what going on around here! Then she starts calling airlines and arranging her vacation plans to Hawaii (Is that nice house the president spent Christmas at available?)

Hppy

[evolvingrn, BSN, RN]

Hang in there. It's important to have realistic expectations with the resources available . You may not have a clear picture of those realities due to where you are on your nursing journey. I keep it a secret when dealing with my son and medical professionals..... Because I know that family who are a

Nurses have a bad rep....and there is a stigma.

As for your concern with the heels.....Try a little note at the end of the bed saying " elevate my feet please" still obnoxious but a more effective method than complaining to the charge. Best wishes!

[Mommy_RN1211]

Wow, overall I am overwhelmed by the awesome feedback. Thank you everyone who responded. I am never above humbling myself and taking constructive criticism!

I have read all of these posts and the diversity of responses is great. Really given me a different perspective. Thank you everyone! I appreciate it!

[Karou]

I am sorry about your dads health, OP. I know it can be incredibly difficult being both a daughter and a nurse.

As a floor nurse, I think we can sometimes expect extra from patients family members who are also in health care. I have heard many times, "well why can't she do it, she's a nurse too!" or, "she should understand, she is a nurse also". We don't expect non medical family members to be extra understanding of issues like short staffing/acuity, ect... There is this assumption that since you are a nurse also, they you should KNOW, you should be able to DO more. That's a difficult thing to ask someone who is also a child/sibling/parent to the patient.

Like any other person, we want our loved one to receive the best care. We need to be able to trust the providers taking care of our family members, not only when we are there, but also when we are not.

I am not saying anyone should expect perfection, but it's perfectly normal to expect adequate care for your loved one, and to advocate for them.

OP was upset this instance over heel elevation, but also mentioned her father has developed multiple pressure ulcers and acquired c-diff. That would make almost any family member mistrustful and extra aggressive about their loved ones care.

[Ruby Vee, BSN]

To answer a few points:

1. I currently work full time and cannot be there all of the time. So when I say his feet are not propped up I assumed nurses would understand that of course I prop them up and am always willing to change his diaper. I cannot do these things if I am not there. When I see his feet flat on the bed I can fix it THEN but cannot correct it if I am not there. That is my concern and why I chose to speak with the charge nurse to make sure in my absence those concerns are addressed.

I always help with his care when I am there! If I can do it I will never ask a nurse to. The key word is when I am there. If I am not there I have to rely on the staff to do it.

2. I just took my boards so definitely am a new RN which I disclosed in my post but I don't think that is a bad thing. Keeps me fresh on what should be done versus what short cuts are taken sometimes.

3. We have been to 6 different facilities for insurance reasons. He recently had the stroke so we have been in and out of hospitals, LTAC, rehab, short stay in a SNF where he got 3 pressure ulcers in 2 weeks, etc. So definitely not because of care (other then the SNF) just have to move because of insurance.

4. Being on phones is a risky behavior because it is all about perception. In my eyes regardless of what profession if you are on your phone you have time to be doing anything else. All I ask is simply peak your head in the door and make sure his feet are propped.

Although I did expect some negative feedback I am curious to know how some nurse's can become so numb to situations. I am brand new and still have a soft heart so to speak and I hope to never lose it. Through this experience I have really encountered some nurse's who I question why they are nurses but I guess that is with every profession.

Thank you everyone for your posts. Opinions are always appreciated.

I am glad you always appreciate opinions. Since you are a new nurse you don't have much experience as a nurse, and you do not seem to be familiar with workflow in the facility your father is in, or in how to speak with other professionals. You seem more than a little nit-picky. No one could ever possibly measure up to your standards of perfection. Your father's care will not benefit from your continued efforts to manage the staff or direct his care; instead it will suffer because no one wants to deal with the "know-it-all, nit-picky family member." You're not doing Dad any favors here. Back off. Start looking for the things the staff is doing RIGHT and praise that.

[Libby1987]

I went through something similar with my dad before we lost him, not being upset with the staff but with trying to make sure his needs were met.

I'm going to be the dissenter here and come out and say it, you and your family need to step it up. We live in a world where custodial care falls short of patients' needs due to the economics of it. I'm not even sure you can totally fault the SNF, the reality is, there isn't great reimbursement in the rehab/SNF level and while they could tweak their staffing, it's not going to happen nor would it be enough to meet your dad's 24 hr dependent care.

It doesn't matter that you all have full time jobs, your dad can't get the care you want him to have without supplementing it yourselves.

You, or anyone else, can be righteous about it, but do you want to hold onto being right, or make sure dad's needs are met?

I'm in home health and have been spoiled over the years you could say by witnessing family and friends doing what has to be done. There are some real heroes out there that make no excuses and take amazing care of their loved ones despite having a whole lot of other responsibilities and limited energy.

Right now you've got the rehab staff doing the heavy lifting while you all are at least getting some sleep. Unless there are funds for private pay or LTC insurance for assisted living, once you bring him home you will find out just how often he's going to need to be repositioned and other things throughout his 24 hr day. Instead of complaining about the limits of the nursing staff, prepare yourselves to take over.

And if there is resource money, hire a pvt caregiver to tend to him at rehab.

That all said, best wishes for your dad and family, these things are difficult and overwhelming.

ETA I'd purchase my dad some heel suspension boots.

[Ruby Vee, BSN]

Wait...are you the charge nurse in question?

Even if she did prop his feet back up or change the dirty dressing herself, it is her right, and maybe her duty if her father is incapable, to advocate on his behalf for proper care.

OP, if you feel so strongly about it, I'd keep going up the ladder until you find someone who takes your concerns seriously.

I would guess that you haven't worked bedside in quite some time. If the OP continues to attempt to direct and micro-manage her father's care like this, she may be looking for a seventh facility because this one will invite him to leave. No one likes to care for a patient with a family like that. The absolute best thing you can do for your family member is NOT be that family.