Some family members just CANNOT be educated!

amylou97 · Jan 1, 2009

I currently work in LTC unit attatched to a hospital so we are fortunate that the doctors come weekly but, I have worked in free standing facility in past. One thing that we had done is have a careplan meeting with the md involved and explained the patients condition and what is needing done to care for resident. I also tried to notify them of any new changes. After a while it seemed that the families would start to understand and know what we needed to do and questioned less. It is hard to keep families happy these days and without accusing or questioing staff of procedures etc. due to all the information out there. There are just some families that can't be pleased also no matter what.

CathyLew · Jan 1, 2009

well, it seems the families that do the most complaining are those that are probably carrying the most guilt. The doting family that can be there all the time to harrass staff, but can't take their family member home and care for them themselfs.

families seem to be one of the worst obsticales at times.

jnrsmommy · Jan 2, 2009

I understand that they can be frustrating, and time-consuming, but please, remember to document all interactions involving teaching and any time you see them trying to lower the bed, loosen the bolster, etc. I know that will take up time for you too, but there are some families you need to be careful of and protect not only your resident, but your license.

achot chavi · Jan 2, 2009

I think every profession suffers this, We all have families like this. I once had one who insisted on giving food PO despite our explanation that he is post CVA and lost swallowing abilities . Half of what they gave him ended up in his lungs and he was treated too many times for Aspiration before they got an appointment to do a barium swallow where they saw black on white what they were doing to him. Their apologizing didn't make me feel any better.

Another family kept giving their mom a hot water bottle with boiling hot water and caused so many burns till we had to get a lawyer involved. Their intentions were good they just wanted to alleviate her back pain.

DOCUMENT, Document and inform the DON, SW, MD, CEO- call in the marines in you have to.

BTW it has nothing to do with guilt and everything to do with lack of education. They think they know better than us

kermitlady · Jan 2, 2009

Yes, all the proper "authorities" have been notified and everything is documented.

I was on this resident's unit again today. The CNA's probably thought I'd lost it because I was SO happy to see her wearing slacks and a nice shirt when I went in to give meds!

CapeCodMermaid, RN · Jan 3, 2009

How about a family meeting with everyone from the team there. Lay it all out on the table so everyone hears everything at the same time. This is the type of family who would be the first to sue you if anything went wrong...even though they might have caused the problem. Document everything said and done...and, perhaps to be proactive, call you local ombudsman and let him/her know about the issues with this family. This way if anything comes up, you'll be one step ahead of the curve.

FrustratedLPN · Jan 4, 2009

Only ONE of the many many reasons after 18 plus years as an LPN, I currently no longer work!! Having been on the "other side" as a "family member" when my Grandmother was in a LTC facility, I feel I have seen and understand from both sides of this issue.

Does anyone ever think of the time factor involved in dealing with the same family members day in and day out? One nurse for 30 plus residents, our responsibility is patient first.... BUT administration demands that family members be kept happy no matter the time, cost, or demands involved. I have reported problems to administration, unit managers, and finally the State. Who came out the winner? Not the patient, not the families, certainly not me BUT the facility, yes... the facility. When the chips fall (and eventually they will) administration will NOT be there to support YOU. Administration will be there for the FAMILY MEMBERS, begging them NOT to move their loved one out of the facility. Time and again at several LTC facilities including those within the large "chain" of LTC facilities, I have witnessed the same attitude from management. Often times the best most educated, most caring and hardest working nurses will be terminated for various reasons, while the lazy, uncaring and unfeeling nurse will remain in their positions. Why? Because administration does not want to know the problems or the solutions. If they know there is a problem, they are obligated to acknowledge and "fix" the problem. Better for them they never know. Either way, management can't be held accountable for anything.

No matter what administration may tell you i.e. "we want this to be the best facility around, we want you to bring us suggestions on improvement, it's always patient first". Blah, Blah, Blah. It is not patient first for administration, the name of the game is BUDGET. You'll see this particularly toward the end of the year when "savings" is all that is preached when you ask for supplies or staff. Face it, most LTC facilities are for profit, which means... at the end of the year, each department manager that manages to come in under budget receives a hefty Christmas Bonus usually in the thousands of dollars. Of course the Administrator shares in the wealth and good times along with the managers.

Charge Nurses are necessary, but forget being actually "in charge" of anything. You won't find a unit manager's name or initals on the restorative nursing sheets. (In order to qualifty for restorative, the exercise has to be done 5 out of 7 days for at least 10-15 minutes). Now we all know CNA's barely have the time to do their required 2 hour rounds, let alone stretching muscles, walking residents. These same CNAs are feeding, changing, showering, dressing, etc. Many the shift has gone by without anyone getting a lunch break.

The DON certainly isn't going to sign off on work she/he knows is not being done. Emails from the Corporate office showing what documentation is necessary to keep the patient "skilled" for a bit longer (therefore bringing in more fees to the facility). The MDS coordinator also making rounds to the floors asking that certain phrases be used in nursing notes and documentation, so the patient can be kept skilled... "do they become combative?" And yes, the one thing I am certain of is that my documentation skills are top notch. Having come from a legal background to nursing certainly helped in that aspect.

As far as family meetings, care plan meetings.. reality will prove they do little if any good. I have heard managers talking with possible new admit families, telling them of the varied "choices" residents have for meals, how their loved ones will have quick and attentive staff members within minutes of putting on a call light. When are the family members going to be informed that there are two CNAs assigned to 30 plus patients? That they will be giving showers, tending to ALL these people (usually total care)? Should there be a fall or incident, this will also take time from staff. Let admissions tell the families just how often the physician is actually in the facility, AND is it the Doctor or his P.A.?

I could continue, but I'm sure by now you're quite tired of reading the long list of complaints. I would love to just once before I completely retire, find an ADMINISTRATOR or DON that has the gumption to do the right thing, do what they profess to do, and care like they profess to care. After almost 20 years of looking, I haven't found that.

SuesquatchRN, BSN, RN · Jan 4, 2009

The prblem is that it costs a lot of money to take care of these folks and the Medicare reimbursement rates don't cover it. My facility has a not-for-profit attached and it absolutely bleeds money.

FrustratedLPN · Jan 4, 2009

And the general public wants to know "why" or "how" there could possibly be any stress involved????? If the patient were in a hospital, the families certainly wouldn't be telling them how to do their job, would they? Yet, let them come to LTC, and the families behave as if we are nothing more than glorified babysitters. Nevermind the education, continued education, shifts worked on holidays, doubleshifts, etc.

Time and again, I have heard families demand to see the RN. LOL!! Usually the RNs are only around during day shift, and then usually in an office tucked far away from any actual patient care. Shhhhh.. don't tell anyone, they are still counted as RN hours worked on the census report. Nevermind they don't actually touch or see patients. Oh the State Licensure Boards know this, administration knows this, and the nursing staff know this. The people that don't KNOW are the very ones that should. Let's hear an admission person tell a family just once..."oh yes, there are eight RN's in the building during the day... now they don't actually go out on the floor, they don't actually have any patient contact, they don't get vomit, blood or poop on themselves, and they get an hour (sometimes more) for a lunch break."

I have tried to educate family members, give explanations as to what I do and why... all to no avail. This same person will be waiting either for the DON or administrator to come in the next morning asking the same questions again. Even when families sign a DNR or ask for HOSPICE care, they still want intervention for that family member. What is not understood about a DNR? Have any of these family members ever actually witnessed a "code" being performed? Especially on an elderly frail person? They should all have to watch a film with an actual code being performed. It's not the "movie of the week" they think it is.

Family members want someone to "blame" for the condition of their loved one. Often times that anger pours over to the nursing staff, the very people that are there to HELP and care for the patient. I would love to have family members walk down that long hall with me just once.... if HIPPA were not an issue.. and look in the room of a patient that has stroked many years ago.... no speech, little if any recognition, tube feeding, incontinent, and contractured. Eyes that plead... "why"? I go outside the room, shake my head, ask how any loving family could condem anyone to this type of living hell... and go to the next room.

kermitlady · Jan 4, 2009

FrustratedLPN ~ THANK YOU!

I was just looking to vent here; I was not looking for advice. You summed everything up perfectly.