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.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Thecommuter thanks so much for your post. It definitely gives me insight on the other side of things. This is exactly why I posted this. This is difficult but I also have said many times how difficult it is for the nurses and have thanked and thanked again the nurses for being so great. I appreciate your insight!
Really, it does not matter how many times you've thanked the nurses -- one episode like the one you described in your original post will completely erase the impression of niceness that your copious thank you may have left. On the other hand, your thanks may have left the impression that you were being condescending. You really do not seem to understand workflow or communication skills. Please take some of the excellent advice you have been given here and apply it when Dad is next moved. It may, unfortunately, be too late to salvage your relationship with the nursing staff at this facility.
Sometimes its best not to know so much when a loved one gets ill. When my dad was in the hospital, I was the same way. He had severe CAD but did not want bypass surgery. He ended up with a piece of plaque lodged in a spinal artery and paralysis from the wast done. My family followed him from hospital to hospital before he was discharged. I questioned nurses , asked doctors about bloodwork, took his chart from the cart and read it, and thought most his nurses seemed never to be around much. I asked for help pulling him up in bed, etc.
Looking back on it now, I think I would have hated me as a family member, and probably those nurses were avoiding me. Be patient, ask for help, and consider their work load, ask questions, but keep in mind, if you tell them thank you for caring for your father, they will remember that and be sure to check in frequently with your dad when you are not there.. Try to work with them. If you see something wrong tell them about it in a cordial way and they probably will rectify the problem. Take a step back and look at the whole picture. This is a stressful time. Good Luck
There are many different levels of frustration you are and will continue to go through. As a family went through this recently with a family member, It got to the point that it was all consuming and effected relationships within the family, It will turn family members agaist each other.
You need to try to figure out how you will survive this experience and be able to continue your nursing Job, personal coping skills, growth as a person and a professional. As you continue your transition from student into working nurse your personal experience will have a negative effect on your transition and personal expectations, it can't cause you to fail your professional transition.
As you will learn to see when dealing with patients and family members, it turns into it is all about the family not patient care.
There are no easy answers to the issues you are going through let alone what your father is going through.
You need to find a healthy way to cope or an unhealthy one will find you
You do realize that is serious breach of patient confidentiality right? You do not just grab your Dad's chart from the cart and read it; if you wanted to read the chart, you go to the charge nurse and/or manager and make the request so that you can read the chart using the correct channels. I really hope you don't do this whenever your loved ones are in the hospital--not only that is a breach of patient confidentiality (and since you are posting on a nurse forum, I'm going to assume you are a nurse so you should actually know better), but it will be used against you if you do have a complaint...especially if it's a complaint you got from reading the chart.
To the OP: I'm sorry this happened to your Dad. Reality is, the staff to patient ratio at the facility that your Dad is at is probably higher than it should be. Staff is spread thin. So certain things might get pushed to the side as a result of it.
Do not manage the staff--bring the issue up with the manager and maybe formulate a care plan with the staff for your Dad's care. Do not manage the staff!! I had a family who literally wrote the times we came in and what we did and how long we stayed in the room at each instance. They had a copy of the patient's medications and knew when each was due. If we were late with turning and giving meds and we weren't in the room within a minute of the call bell going off...boy, they sure let us know (never
mind the fact that the turning was late because I was trying to alert the doctor of abnormal labs or cleaning up poop in another patients room). Let's just say we transferred that patient to another unit asap.
That could be your Dad if you don't stop managing the staff.
I'd talk to the managers about the charge nurse but cut out all the subjective observation.
It is difficult to balance the knowledge with just being a family member. When a family member is there we work to take care of him. I have many times jumped in to help with his care because I know there isn't enough staff to move him on their own or they have more important things to do. I also have had many conversations with my dad about his minor complaints and explain that his level of acuity is no where in comparison to others that may be on the floor.
With that being said I do not think it is wrong of me to worry about how he is being treated when I am not there. I don't think it is wrong to request that while he is in the facilities care that the staff do everything they can to make sure he is progressing.
If he has pressure wounds on his feet this does not allow him to work fully with physical therapy to maximize his stay and get the best results he can. If he has cdif it isolates him to his room and makes him unable to leave bed because he has so many BMs that he also can not participate in physical therapy. Both pressure wounds and cdif as most nurses understand are due to not being turned and most of the time poor hand hygiene from room to room. Yes I understand I haven't been in the field long enough to know the struggle but I do know the cause of the complications he has had since the stroke.
I know this is a business and I have learned in the time since his stroke that insurance SUCKS which results in no funding for hospitals which equals not enough staff which ultimately means the patient suffers. I totally get it, doesn't mean I have to be happy about it.
I appreciate the positive feedback even if it was hard to hear. I will take it with me during this journey with my dad and into my career!
Wow. This is a great example of how we as nurses eat our young. Many of these comments are bordering on rude. Could we coach her in how to approach this instead of attacking her?
Wow. This is a great example of how we as nurses eat our young. Many of these comments are bordering on rude. Could we coach her in how to approach this instead of attacking her?
OP, I'm very sorry your father is going through all of this. I've read through pg 3 and appreciate your openness to all of the feedback.
I wanted to share that I worked in an LTACH for 18 months, and SNF subacute rehab for about 3 yrs. I've never worked LTC as an RN, but saw the RNs/LPNs busting their butts in LTC while working there as a CNA.
There were times, especially in the LTACH, that I would be reduced to tears -- because I KNEW I was providing subpar nursing care. There were literally days where I would take one 15 minute break for my entire 7a-7p shift, AND stay over 1-1.5 hours to do ALL of my charting (except the MAR, of course I documented meds in real time.) Four vented pts, sometimes 1-2 hour dressing changes, sometimes an admit directly from a high-level ICU...
It added insult to injury when a family member would come in with guns blazing to complain that the pt's meds weren't given on time (not outside of the window -- 4:00 meds not given AT 4:00.) Or in the case of floating the heels, maybe I did float the heels...but an hour later, the pillows had settled under the weight of the pt's legs and now the heels were on the mattress again. But guess what, I might not even get in there for another hour or two because I have meds that truly are overdue, I have to be physically present to get that vented pt up into the chair, and my 4-ulcer wound vac is alarming low suction and I have to troubleshoot or change the whooooooole dang dressing. Most of us would have the tendency to get defensive in those situations.
I'm not saying it's ok to not turn pts. Is he being left in one position all day, or is the RN/CNA simply late over the 2 hr mark? If it's the latter, you need to cut them some slack. It's a fact of biology and physics that staff cannot divide themselves in half and stay perfectly on schedule. Greenish/yellowish exudate could simply mean that the wound has some slough that does need to be cleaned...but when prioritizing may well be near the bottom when you consider everything else the RN needs to do.
Has your dad been seen by a WOCN for management of those ulcers/prevention of new ulcers? The suggestion for a low air loss mattress is an excellent one. Mepilex dressings come in sacral and heel shape; those are what we use for existing ulcers and for prevention. (All of our ICU pts automatically get one on the coccyx, or if the pt is in a Rotoprone bed we'll cut them up and put them where the pads and safety belts press. PUs are veeeery difficult to avoid while in the Rotoprone.)
You'll all have an easier time if you or whoever is at the bedside put the call light on and say "Can we reposition Dad when you're able? I'd really appreciate it!" than "Dad has been in that position for 3 hours!! That can NOT happen, and I am going to report you for this." Both convey that Dad's due for a turn, but the former makes you an ally on your Dad's care team. The latter is adversarial and helps nobody.
Hugs, and prayers for your dad's continued recovery!
Both pressure wounds and cdif as most nurses understand are due to not being turned
C.diff is due to not being turned? That is really something new in medicine.
It is ok to be worried and concerned, and it is even ok to feel not satisfied with care. It is NOT ok to react and act as you do while supposedly being an adult, mature person ready to step into very same shoes very soon.
You can complain personally to CNO and CEO all you like, but everything you will get is abundance of sorries because it is these guys who put facility to hiring freeze in order to save money. You need to contact your State Rep and your State nursing organization to address the issue of safe staffing.
We also know that insurance sucks more often than it is not. If you so desperately unhappy with the care your father receives in six different places, you are more than welcome to call the said insurance and inquire if they will partially cover private care at home, or find and hire private care aide instead of nit-picking staff. You are also welcome to visit and research any facility you are offered for your father in the future. There is a book named "Thirty six hours' day", which has everything you need to know about the process and how to do it right.
As it was mentioned here many times already, your concerns, while rightful, were most probably expressed the way which alienated every single staff member you encountered. This can seriously hurt your dad's chances because many staff members are not typically inclined to walk extra mile for micromanaging families. That includes case managers, who are responsible for finding placement for your father and can easily spread information to insurance people. So, please listen to what you are told here, because I doubt you will get this sort of knowledge anywhere else.
If I were you, I would find the charge nurse you ordered to leave the room as if she was a misbehaving third grader, and apologize long and hard.
I have to admit I'm appalled at some of the comments on this thread. Cheers to those who have provided genuinely constructive feedback and advice about the topic at hand - how to separate being a nurse and a family member. But there's a heck of a lot of blaming OP, labeling OP a person who is "micro-managing" her father's care, and outright defending a manager who was rude and aggressive with a concerned family member. My advice to anyone in this situation who is concerned about how to separate being a nurse and a family member - don't. Seeing this kind of crappy care and bad attitude when my mother was terminal is what drove me into this field to begin with. I wanted to know how to best care for my loved ones should the need arise, and becoming a nurse is one excellent way to do just that in addition to helping others along the way. For everyone who is so concerned about creating hostility/ fear on the unit should they learn about your status as a nurse: that's a sign of a poorly run unit. A great unit would use that information to their advantage by including the family, esp. that family member, in the patient's plan of care. I won't say that this particular unit was adequately staffed or that individuals being at the nurses station is or isn't a sign of anything - we all know how much work needs to get done at the nurses station. But this manager's reaction and communication were outright unprofessional and I would be embarrassed to work on a unit like this (unless I was dedicating myself to changing the workplace culture from within). Anyone who is making excuses for the attitude and crappy care is doing just that - making excuses. We need to make certain demands of our hospitals as family members and consumers in order to initiate the changes that could result in better staffing and safer pt/nurse ratios. I applaud OP for standing up for her father's care. Keep going up the chain if you have to, OP.
Wow. This is a great example of how we as nurses eat our young. Many of these comments are bordering on rude. Could we coach her in how to approach this instead of attacking her?
NETY would happen when the OP will be given three patients (and families) nobody else is willing to deal with any more out of her assignment of, say, 7 on med/surg floor (everybody else being given 5) and then written up three times per one shift for not propping the said legs on pillow right in time, for propping them but not marking the box in EMR, and for asking a CNA to help her to prop the said legs of a patient who weights five times as much as herself while the said CNA was minding her own business on Facebook. And all that will happen with her being old, ripe 2 weeks off orientation. And after that she will be asked to stay over and do double, but without overtime pay, as she is not off her probationary period.
That's how it would look like in acute. For LTC, multiply assignment by 4 and paperwork by 10, and add write-up for not timing and dating applesauce.
Ruby Vee, BSN
17 Articles; 14,051 Posts
Really, it does not matter how many times you've thanked the nurses -- one episode like the one you described in your original post will completely erase the impression of niceness that your copious thank you may have left. On the other hand, your thanks may have left the impression that you were being condescending. You really do not seem to understand workflow or communication skills. Please take some of the excellent advice you have been given here and apply it when Dad is next moved. It may, unfortunately, be too late to salvage your relationship with the nursing staff at this facility.