The patient's family members

[Foxfour]

My brother was a nurse a few years before I had started nursing school. He told me numerous times that he wanted to leave the floors because of the family members. I didn't fully understand the gravity of his words until I started working the floors. A few days ago, one of many incidents, a daughter walked out of her elderly father's room ranting and raving about why her father had been laying in bed with a soiled diaper. I explained to the daughter that I was in that room approx 15 mins ago, and he did not have a soiled diaper at that time. I had just finished a bladder scan. Which resulted in the need to do a in/out cath. I changed his diaper at that point. He was aphasic due to a CVA, so he couldn't add to the conversation. If he could have, I'm sure he would have told his daughter what good care he was receiving from me. I'm not trying to say I'm wonderful, but I know that I'm not lazy. "Oh well, let him lay in his own feces. I don't care." That's ridiculious. I would never williingly allow that. I'm sick of those family members who assume the worst. The statistics for me are approx one "ranting and raving" incident/shift. Calgon, take me away!!!

[PCUSheryl]

It is so GOOD to see that I'm not the only nurse who's having a tough time dealing with these family members.

Why do they so many times assume that we are hellbent on neglecting, abusing or at least determined to give poor care to their family member, the patient? I don't understand this. Why not just as easily assume that we're going to give good care? This happens so many times, I don't understand it. I meet the family member for the first time (who has been in the pt's room all of 5 minutes), and they have an attitude with me, they are on the defensive, they are on the offensive, and the whole time I'm wondering "why are they behaving this way towards me....", I'm then trying my best not to be offended and to respond in such a way that they will not be able to tell that i'm offended. It takes so much mental energy to deal with these situations all day long.

And has anyone noticed a recent increase in the number of uneducated, unlicensed, but EXPERT nurses, and even physicians out there? These family members think they know so much more than you, they need to tell you what to do, when and how. I'm really tired of putting up with them. It's so hard not to tell them off sometimes. I want to ask them how they could be so arrogant as to think that they know more about nursing/healthcare than someone who has sacrificed 5 yrs of her life to study, and then has been immersed in patient care, nursing, studying on a regular basis, always seeking to improve skills and build knowledge. I'm not talking about the family member who has genuine concerns. I'm talking about the family members who are complete and total control freaks and think that things need to line up with their perception of how things should be. Their perception not actually having anything to do with REALITY.

Nursing is a sacrifice, I cannot believe that some people actually do it for money. We don't make enough money to do what we do!

Now that I've vented a little.....now i'd like to know if anyone else can give me some advice on how to deal with people like this without becoming upset. I work on a very busy stepdown unit and most of our patients are very acutely ill with one foot in ICU (so to speak), yet we have 4-6 patients who are all telemetry, many are on cardiac drips.

When I encounter a family member who gives me attitude for no good reason, I have recently found it harder for me to control my feelings, although I have controlled my actions just fine. AFter the negative interactions, I have usually either gone to the bathroom and cried or prayed, usually both. I have been feeling like I want to leave nursing, or maybe just go to a different type of nursing, such as recovery, surgery or something where the family members are not around.

Any suggestions?

[MarySunshine]

When I'm stressed and frustrated I'm not rude and obnoxious to other people. I don't know why we are trying to make excuses for that behavior. I agree that therapeutic communcation is important in those circumstances, because it would be unprofessional and unhelpful to stoop to their level. However, what they're doing is flat out wrong.

[RoxanRN]

When dealing with 'in-your-face' family, I've found it quite helpful to have a strong confident aire about me and to go about my assessment and care with a 'no-bones-about-it' attitude. Their intent usuallly seems to be using intimidation to get their way (whether good or bad for the patient). I do not intimidate easily. I answer questions factually and to the point. Usually, by the end of visiting hours (restrictive ICU visiting), the family has calmed down and are actually smiling and joking. They've realized they don't have to control every issues as their family member is in capable hands.

[cc08]

I always have a "planned" response to a patient or family member's ranting. I say "What can I do to make you feel better about the care we're providing?" This FORCES that person to evaluate whether or not their complaint is legitimate or if it's picky or if it's absolutely constructive. (i.e. if my daughter whines "MOOOOMMM, this commercial is tooooo long!" I respond, "What would you like me to do about it?" That usually shuts my daughter up because she realizes that's a dumb thing to whine to ME about!). This works with patients and family members, too. I had a lady to was complaining, complaining, complaining about how long she had to wait (that's our biggest complaint, actually!). Instead of making excuses, I acknowledged her frustration and asked if there was anything I could do to make her wait more comfortable. (I never asked her if there was anything I could do to make it shorter! That would be stupid, obviously, I can't do that! That made her feel stupid, really, for complaining to ME about the wait...I had NOTHING to do with it, and she knew it. She was just whining, just like my daughter does, and I knew it and she knew it.) At one point when she got REALLY frustrated and asked, "What ARE we waiting for?!!!!" And I responded, "The surgeon." And she said, "What IS he doing?!!!!" And I responded, "He's operating." That shut the patient up pretty quick, because it made her realize that she wasn't the only person on this planet getting operated on that day! (and I got her to realize it without actually coming right out and saying, "Hey, princess, you are not the only patient in this facility...you know, we don't have all this staff running around like chickens with their heads cut off just for YOU, Miss High and Mighty!" ....although I'd like to sometimes!)

Sometimes, I do have patients who just CAN'T STAND to wait, and they end up leaving. I even had one lady pull out her own IV, get dressed and walk out of the pre-op area. The receptionist happened to catch her on her way out and we were able to talk to her before she left. She ended up rescheduling, and I INSISTED to her that she make it for a day when she could be the first case of the day, and she was happy as a clam.

I guess the point of all of this is that people who feel helpless NEED to feel like they're doing something....so they lash out at whoever is closest. God forbid if they ever yelled at a doctor! Geez! Just look them right in the eye, have a PLANNED response (that way you won't walk away and 5 minutes later think of the perfect thing that you SHOULD have said), try to do your job, give all the compassion you can muster, and MOVE ON! Don't take it home in your head! Some people are just not good under stress and others are just plain jerks! If you've done what you can, then MOVE ON, MOVE ON, MOVE ON!!!!

[milky]

If I had a dollar for every time I said "I could do my job so much better if family members would stay out of my way" , I would retire right now!!

[grentea]

When I'm stressed and frustrated I'm not rude and obnoxious to other people. I don't know why we are trying to make excuses for that behavior. I agree that therapeutic communcation is important in those circumstances, because it would be unprofessional and unhelpful to stoop to their level. However, what they're doing is flat out wrong.

:yeahthat:

Also, I have to as that I am always as pleasant and helpful as I can be. I would never outright say this to a family member but I feel really insulted when I get the attitude that someone just assumes I'm giving shoddy care. I'll never be able to fully understand how it's ok for people to lash out at the person working hardest to provide good care to their loved one just because they're frustrated, upset, or angry at the hospital or life in general....but I guess I'm kind of over it. I really do move on the best I can and I guess I take cc08's approach to things by asking people what I can do to help their problems. It usually helps.

[cardsRN]

marysunshine- i don't think anyone here is advocating being rude or unprofessional... just firmly stating (in a professional manner) that some behavior is inappropriate and won't be tolerated. and some ppl here just need to vent when they feel they've been treated rudely, ya know? :)

[dorimar, BSN, RN]

yes. No matter how stressed or tired (and you wouldn't know it because you don't know me, but I am a true patient advocate), but there is NO excuse for abuse. And I have found, after so many years of nursing, that the majority seems to think for some reason, that it is acceptable to treat nurses like dirt on the bottom of their shoe. I think that is entirely ironic now days, as I see 2 types of nurses left: A, The one who really cares, in which case throwing a fit is NOT necessarry, and B, the one who DOESN'T care, in which case throwing a fit is not necessary.

[Bruce RN]

One solution I have is to start writing the time and date on the diaper when it was changed. We do it on dressings of wounds...why not the diaper?

Then when a family member wants to come in and start some yelling, they won't be able to.....because there it would be....the time and date of 15 minutes ago where he had been changed and cleaned.

Your solution is not a bad idea at all so please don't think that I'm cutting it down.

I do not, however, believe that nurses should be resorting to such tactics as dating diapers just to prove to a family member that we were in the room 15 minutes ago. Instead, we need to be addressing why visitors are allowed to act this way at all in the first place.

A lot of the disruptive family/visitor behavior that I've seen over the years would cause me to be arrested if I were to act like that to a flight attendant on a plane because I didn't like the food served.

Or if I screamed and pounded my fists on a hotel front desk to a hotel clerk the way I've seen many visitors scream and pound fists on a nurse's station, I'd be escorted off the property by hotel security and not allowed to return.

Let's say I abused the flight attendant and hotel clerk because a close loved one is dying and I'm having trouble dealing with it.

Does that make my behavior acceptable and/or excusable?

I have a dying loved one, so now I'm no longer responsible for my own behavior?

Like a few others here who mentioned it earlier, I too, am tired of nurses placing diagnostic labels on family members in an effort to excuse their behavior. "Poor coping skills" and a few other labels only go so far before the behavior can no longer be excused and should not be tolerated.

[natrgrrl]

there were daily screaming matches, insults to staff, physical contact- slapping our hands away...

I am a pre-nursing student, so I don't know how things work on a floor but in these circumstances, shouldn't/couldn't a nurse call security?

[snowfreeze, BSN, RN]

I have told family members that they are inappropriate or being inappropriate when that is very obvious. I have also told them to take some time to calm down and we can discuss the issue. This is usually while holding their hand or with my arm around their shoulder. I have done this more often with the frequent fliers that everyone hates to have as a patient due to the unreasonable family members.

I have also told family members that it is more their job to visit with the family member than it is to harass our unit secretary with requests. Personal requests, like I need coffee or I need a pillow or I need to order a lunch for myself.

[burn out]

These are the reasons that I believe so many nurses burn out and there is nothing you can really do to stop it..it is almost like being in an abusive relationship the only thing you can do is leave.