So... how do you deflect family members when you're busy?

[nenabee]

Hello all. I've been a nurse for almost 4 years now, and during that time I worked night shift... but for family reasons I had to switch to days. So now here I am, a few weeks into my new shift... of course it's an adjustment. Yes, I can deal with patients constantly going off the floor to tests, doctors coming in and writing and changing orders, patients being awake and asking tons of questions, patients who are 100% feeds, get patients OOB to chair for meals, etc.

What i can't stand are the FAMILY MEMBERS!!!! Yes, some of them understand you are busy but for the most part they walk up to you at any time and expect instant answers. Pestering me about nonurgent things delays me from patients who, I don't know, NEED MEDICATING/NEED ASSESSING/NEED TO BE TRANSFERRED TO THE ICU/etc.. I tell them that I am busy taking care of other patients but they don't care! So i just spend the whole day dealing with people who are unhappy that I didn't get grandma's diet changed in time for lunch, although I was off the floor transferring a critical patient. (This family SAW what I was doing, I TOLD them where I was going, and still I get complaints!!)

Is it okay to actually say "I need some space?" Or is that too overdramatic? Because that's how I feel!!! I am always respectful (even if they are not), I try to sympathize by saying things like "I know it's a waiting game, I'm frustrated too, but right now all we can do is wait for x to come see you." If anyone has any other lines that I can use it would be appreciated.

I should not take these things so personally.... I know all I can do is my best and if grandma has to wait 10 more minutes to be discharged because I'm dealing with a guy that needs to go to dialysis ASAP, so be it. But it's frustrating when you get no gratitude or understanding.

[Katie5]

Pick the most offensive and vocal of the family members as you go to person(when possible).He/She would curtail the others...most times.

Kind of like picking a bully/class clown to keep the class in check.

[tokmom, BSN, RN]

I had a family member walk into another patient's room WHILE WE WERE CODING HIM, to demand a glass of water for his mother in the room next door.

Families do not understand our job, nor will they try when their loved one is your patient. All that matters to them is the care that is (or isn't) being given.

Wow... I hope she realized how stupid and rude that was.

[steelydanfan]

Haven't read through all pages of replies yet. But this is always a big issue.

At first greeting with patients in the morning, I always try to speak of the general POC, any pending concerns with it, what my plan is for adressing these issues within my 12 hours, (what docs I'm going to call, what labs may or may not be an appropriate request, what pain management needs to be reassessed, etc). Then I make sure that the patient tells me their concerns...even if it is only that they hate milk and will vomit if they see it on their tray today...and I let them see me write my little list on my paper. I make sure I tell the patient what I am going to do to adress those things. It usually doesn't take more than 5 minutes in the med-surg world. Every time I do a walking round I update the patient on what is happening.

Now, when the family comes in...I definitely make sure we set up ONE representative and explain it well and logically about how information can be corrupted the more we repeat it. Then there's always the HIPPA crutch. I provide paper and pencil for the family member if necessary for them to list specific questions. Unless there is something acute with another patient, needed right now, I will at least tell the member the above. Then if I am truly busy RIGHT NOW, I will tell them please wait for within the hour I would be happy to speak with them about the POC and what their loved one AND I have planned for their care. I will even provide numbers of docs IF the doc has been negligently unresponsive to the family member (and staff) and their questions re: things which are illegal for me to adress until the physician adresses them first. This usually quells the family member until we can speak. Now, of course, there are the patients who can not be discoursed with because they are not in shape to do so.....so when the family member speaks to me, I briefly outline what exactly I am working on for the patient within my 12 hours....then the schpeel about one representative....and only if I am truly busy RIGHT NOW...do I put them off until later. This always seems to instill a lot of trust and helps the family see I am on the ball for their loved one. If all else fails....have the charge nurse , CNL, or manager (worst case) connect with the family asap. That's just how I do it. Despite all it's hassles, I love bedside nursing.

Ah, God love ya angel. There is NOT one nurse I know of that could POSSIBLY do all those interventions in the time frame allowed in a 12 hour shift, with 5 or more cranky, entiltled and learning disabled families clamoring for attention. SOMEBODY is going to be ...Po'd at the Doctor or us, calling Management to complain {oh, I'm shakin' in my boots at THAT one)!;, threatening us all with extinction or just telling us that they want loved one to be transferred to MT. Olympus Med center pronto! (GOOD luck with that one).

We do the BEST we can, with what we have. That is ALL we can do. What we can do it often NOT the best, and often times what the family WANTS is detrimental to the pt.

It's a big, constantly changing and gray area. NONE of us are experts, ALL of us are learning.

[Seawitch]

I like your answer, but we were never allowed to say we were "short on the floor" . Our boss said it made the facility look bad.

LOL Our facility is always the place the news goes to when they do their yearly "ED is overcrowded" articles. So short of purposefully killing someone or being absolutely rude, there isn't alot I can do to make our facility look bad. It does generally have a good reputation though (believe it or not! lol).

Things I would like to say (and may have done once or twice to completely abusive, out of control, over the top relatives): Can't you read the paper? Don't you watch the news? You couldn't have gone to see your GP NEXT YEAR for that x1 episode of explosive diarrhoea you had 3 hours ago? (because if you visit him next year with the issue you came in with tonight, you'll still be alive, because it's not an emergency!!) LOL.

[morte, LPN, LVN]

I like your answer, but we were never allowed to say we were "short on the floor" . Our boss said it made the facility look bad.

I don't think she/he meant they were really "short staffed", but that d/t the code there were less persons "on the floor" right now.

[svet456]

Lowering the nurse/patient ratio would help.. So, don't blame yourself for not having enough time to attend all of your patients needs, look at entire picture of American health system failure.. Acuity and complecity of care are raising, but the meanings to provide the care are the same... You can stretch yourself only as far as you can, if you want to to end up with nervous breakdown in a few years....

[Poi Dog]

What has worked for me is showing the family member empathy and following through on my promise. If I cannot do it or am running late, I let them know. I have found that the family members (at least at my facility) are distrustful of the staff and that leads them to become vocal and demanding. I get that they are upset because their expectations of care have not been met, which leads to the squeaky wheel gets the attention mentality. I get it.

I let them know that I hear what they are saying and will do my best to accomodate them. When I gain their trust and confidence, my job is easier. Yeah, they may come in and specifically ask for me and that is fine. I admit I get an ego boost. So when a coworker comes in whining about so-and-so's family, I tell them that they are not like that to me. People just want to be assured that they are heard and taken seriously. Sounds simple but not always easy especially when they are acting like a banshee. The best part is when a family member apologizes for acting the fool, I smile and say no worries.

When the family member comes in the next time, I will pop in the room, say hello and let them know that if they need anything to tell me. If I am busy, I let them know and then write down a reminder to get whatever is needed. The mundane things like a cup of water with 3 ice cubes matter to them. I guess they feel that if we cannot take care of the "small" stuff how the heck are we taking care of the "pressing" issues. *shrugs*

My years of working at a call center for a mega wireless company comes in handy when dealing with irate people. I can usually calm them down. I am no saint and I have entertained the idea of whacking them with a slipper as if they are a flying roach but all they can see is the look of concern on my face.

Just my $.02 on what works for me...

[caregiver1977]

It is kind of hard to remember that nurses have other priorities, no matter how high those priorities are when you are in desperate need of the bedpan. No matter how reassuring the staff is about an accident, it can be VERY embarrassing.

I would be also embarrassed to harrass hospital staff because a family member needs water or ice. I would be happy to do it myself. I think some, not all, of these rude and interrupting family members need to be threatened with being put out of the hospital all together. People are trying to get well, for goodness sakes!

I have seen times that family has been a plus at a hospital because they kept the patient entertained and comfortable so the patient doesn't lay on the call button about everything.

When I was in the hospital getting induced because of pre enclampsia, one of the nurses wanted to put my husband out because we were laughing and talking. I told the nurse that I could either laugh and talk with him or worry and cry and push the call button for things he could do. She left the issue alone.

[BluegrassRN]

I will often be blunt with a family member ("I'm sure you understand that my priority right now is assessing my four very ill pts and making sure everyone is stable. When I've done that, you can be sure I will get your mother her ice cubes."). I make an effort to later approach that family member and have a friendly conversation, and I really try to take the time to answer all their questions. When you brush someone off or call someone out, they naturally feel diminished and defensive. If you are able to later take the time to interact with them professionally and courteously, that feeling typically goes away.

I, too, usually pick the loudest, most in-your-face family member to go toe to toe with. First of all, they make the most noise. Secondly, I don't want them to think they can get what they want by intimidating the staff. Thirdly, they usually turn out to be the best advocate for the patient and the staff, if you can get them on your side. Their loud mouth and aggressive attitude can serve a very positive purpose, educating their fellow family members, spreading information about the plan of care, and also if these people go to administration to complain about something (as they often seem entitled to do, every dang visit), it's nice if they complain about something that I, too, complain about...I like it when family backs me up! Their natural, aggressive tendency needs to be channelled and guided, and I try to provide that. Finally, I'm frankly a bit loud and aggressive, so maybe I naturally go to these people as kindred spirits!