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.

[KatieMI, BSN, MSN, RN]

I'm sorry that you're going through this. As many others have said... LTAC nursing STINKS. It's not necessarily the nurses fault either. The ratios of nurses and techs to patient's are horrible and it is nearly impossible to provide adequate care to all patients. You cannot be in two places at once. That does not excuse the charge nurse from being rude, however. You couldn't pay me enough to work in LTAC or a SNF. If it were my father, and I could not be there 24/7, I would do my best to hire a sitter. Someone who IS comfortable turning him, changing him, feeding him, etc. I work in a med-surg floor and I have had patients come with their own private hired sitters. It's quite nice for most of them! Some of them are nothing but a pair of eyes and company in the room to keep them from getting out of bed. Others are more experienced and will change briefs, bathe the patient, feed them (encourage them to eat as well). It makes a HUGE difference in outcomes for older adults with decreased level of function who cannot do their ADL's by themselves. I've had other families that will do that around the clock for their loved ones at home and in the hospital. In fact... just had a patient with a family like that this week. It was kind of irritating on one hand, because everything was questioned and it took a LOT of time and patience dealing with the family and explaining the plan of care, why we are doing what we're doing and why we can't try X instead. LOTS of messages to the doctor. As frustrating and time consuming as it was, I really REALLY appreciate the fact that they were trying to do the best that they could for their father. Before his hospitalization, someone stayed with him at his home at all times. They took shifts around the clock. They bought a lift to get him up to chair during the day. They patiently cut up his food and fed him. It was a labor of love and was impressive to see. He is a blessed man to have family that cares for him so much. Where there is a will, there is a way. You cannot, unfortunately leave the care of older adults to an LTAC or SNF and expect the best outcomes though. It takes work from the family as well.

I'd seen terrible nursing (as well as medical, respiratory, SLP and all others) everywhere from urgent to large academic centers. As well as excellent and all that comes in between.

The thing is, the requirements of society on healthcare system and the way the system really works have nothing to do with each other. As well as what is taught in nursing school has nothing to do with real nursing in real world.

I wonder in what kind of blissful haven the OP did her clinicals, because we were introduced to the concept of "prioritization" right after saying "hi".

[nursingvisionair]

I agree with roser13.

[Farawyn]

I agree with roser13.

I kind of always do.

[/username, BSN, RN]

Not really, my post is pretty accurate to his current condition. He currently has the cdif and 2 pressure wounds. He had one of the worst strokes the doctor has seen (his words, not mine). We are just trying to take it day by day.

The crazy thing is is that when I walked into his room and saw his feet flat on the bed his heel suspension boots were on the floor! I know I am not perfect and definitely can say I am stressed and emotional but it is hard to not be so frustrated when there are little mistakes like that being made.

You are aware that care happens while you're not there, right? Just because they were not on when you walked in the room doesn't mean they weren't on since the last time you were there... Devices like this need to be removed in order to maintain skin integrity.

[CJMR]

When my father was hospitalized for a few weeks I tried to turn my nurse if, but I couldn't. I'm kind of glad because I saw the situation for what it was. My father was being a noncompliant ass of a patient. Lol! He'd try to sick me on the nurses when I would come in. No way, dad, I'm not falling for that crap. I've seen it a million times. A lot of patients act like angels when family is there then won't participate in care as soon as family leaves. He'd refuse physical therapy, lab draws, dressing changes, and repositioning. He'd try to get up by himself without assistance or his walker and nearly fall. He'd take off his dressings and kick off his moon boots. So I got to do what I do best. I told him as bluntly as possible what damage he was doing lying in bed all day, stuffing his face, watching TV, and not participating in care. Some patients NEED a pushy ***** for a nurse so that's what I gave him!

[nursemike, ASN, RN]

First, I have to admit I've skipped a few pages of replies, so sorry if this is redundant. To the OP, when my Dad was ill, and eventually, dying, I learned how very hard--impossible, actually--to be an objective nurse for someone you love. Be a daughter, first, and use your nursing skills to help with that if you can, but never forget there are very good reasons we don't take our families as assignments. BUT, I've also learned some things about dealing with the families of patients who've felt their loved one wasn't getting the care they need and deserve. You mention you're new, so maybe you haven't dealt with that,. but if you work at the bedside, I'm sorry to say you will, and I'm sorrier still to say there will be times you know the family is right. Right or wrong, you begin with, "I understand your concerns." Any other reply is stupid. I don't care if they are being completely unreasonable. They have to know you are at least trying to see their side. Next, "Here is what I can do about it." Again, if they are being unreasonable, you are not going to be able to give them what they want, but if you explain what you will do and educate them why it's appropriate, it may just help. I tell you absolutely truthfully, I've had families that couldn't be reasoned with, but I've had more than a few who were fuming at the start of a shift hug me at the end of the shift, and that feels good. But you also have to be humble, and honest with yourself, because I think we've all been in the position of not being able to give the care we wish we could. Sometimes it's a real struggle to be marginally adequate. It's hard, at such times, to hear the family advocating for excellence. But you have to, have to, have to hear it, and take it to heart, and you have to be able to say, "I'm sorry. Here's what we are going to do to make this better." And the best you can do may still not be excellent, but maybe it will be good enough until we can get to excellent. Hey, I could be wrong, but I have a strong feeling your post would read a lot differently if the nurse you spoke of had responded more along those lines. Nursing is a human endeavor. Families don't always get that, but if you give them the chance, some of them do.

[LisaFarner]

I do not think her comment is lack of compassion, but we have all had that family member/Nurse that nit picks everything. I can understand the frustration and wanting timely changes when it comes to diaper changes, but pillow props are every 2 hrs and if your fathers foot falls off his pillow than fix it.

[GGirll22]

I understand your frustration but try a different approach so that they can understand your concerns. Keeping you in Prayer.

[citylights89, BSN, RN]

I'm sure your Dad appreciates your efforts. I wish I had as much gusto as you when my Mom was in a facility. I would let them know what needed to be done, but often I felt like I was bothering them. At the end of it, she was my Mom, and he is your Dad. do what is best for him.