Tolerating Abuse from Grieving Families

[evelynkarirn, BSN, MSN, RN]

Hi Everyone,

I've been working as an on-call hospice nurse (Fri 5p - Mon 8a, 63 consecutive hours) for just four months and had a real crisis this past weekend on two death visits. The previous weekend I handled six without incident.

Last Saturday I was treated disrespectfully (abusively?) by two separate families, one family verbally ganging up on me, throwing my bag across the room, yelling, complaining about the case manager, not answering questions about desired post-mortem care, and finally escorting me out of the house in a huff stating they never should have called me and refusing to make arrangements for body release. The other yelling/screaming, telling me to stop calling (it was my only call to the son of a SNF patient to inform him of his mother's passing), refusing to respond to questions concerning mortuary wishes, and hanging up on me without saying if he would be coming to say good-bye.

I was probably emotionally fragile this day having just returned from seeing my terminally ill father, BUT, after the visit when they threw my bag and verbally harassed me for almost an hour, I cried all the way home (short drive, but still...).

Hospice nurses know people are at their best/worst while grieving, but are there limits? How much is excusable? If they call you names? Tell you your agency must only employ idiots? Physically push you out of the way while you are caring for the body (I was d/cing a foley)? Tell you to get out of the house before you've completed providing care for the deceased and managing the logistics of the death?

Would love to hear from others if they take everything short of physical abuse and how they keep it from breaking their spirits. And where does your agency stand in terms of supporting you? Would especially love to hear from on-call nurses from med-large organizations since I fall into this group and am often unfamiliar with the deceased - wondering if families are more harsh with "unknown" RNs (aka on-call).

Thanks!

[oceanblue52]

Not a hospice nurse, but I have dealt personally with hospice. Yes, it is normal for families to be upset and in denial about death, and that can manifest in all sorts of ways, including being hostile and very critical of nursing care. But it is absolutely NOT acceptable for the family to be throwing your belongings and physically push you. I hope you documented everything thoroughly and notified your supervisor.

Sorry to hear you are also going through this personally, it must make the job challenging, even when families are considerate. Be sure to take time for yourself. It's totally okay to be emotional in the car, as long as you can keep a professional front. *hugs*

[evelynkarirn, BSN, MSN, RN]

TY Oceanblue52. My leadership's response was supportive, encouraging me to focus on positive interactions, reiterating what I know about grieving, etc. But I was blown away by the executive director's initial response - "So we can expect a negative rating from this family?" Um, yes. As documented by every nurse that interacted with that particular family over the days (3) that she was on service.

[K9lover, ASN, RN]

Throwing the bag across the room. Sorry about their loss and all but patients and families already get a pass on way too much abuse. I would call the cops and have the offender arrested for assault.

[catsmeow1972, BSN, RN]

I'm not in hospice and i believe it takes a very special person to be able to do that. I don't even do funerals well at all. I get that grief exhibits itself in all sorts of ways. That being said, hands on me or my stuff in anger? Absolutely NOT.

I wonder (maybe not a realistic idea) if when it has been repeatedly documented that the family edges towards hostile, it might be a good idea to go there in pairs.

[allheart3]

I am a palliative care nurse and I have experienced abusive behaviour from patients and their family members before. It's really tough because the compassionate side of you tries to reason and defend their inappropriate behaviour, and the other side of you feels hurt and conflicted. It's important to remember that your personal safety comes first, which includes emotional and physical safety. What I have learned over time, is to remind patients and their families of my professional expectations for them the first time I meet them. I create a safe space by reminding them of the team approach--in order for us to move forward as a team and to provide the best comfort care and support for all parties, I expect everyone to be respectful. If a party becomes abusive towards me, I have the right to a safe work environment and will leave. If there are any red flags that a safe visit plan should be in place, I document that and bring it forward to management so they can support all staff if ever an unsafe situation is to arise. In any case, dealing with difficult families is never easy and requires a lot of open communication and awareness of personal boundaries. It's important to note that if you must act upon the safe visit plan or leave because of explosive behaviour, to leave promptly, report the behaviour to management and if it's appropriate, let the family know another staff member can come back later when things have calmed down.

[tampanurse2000]

Hello Evelyn-sorry that you experienced this "aggression r/t grieving". Maybe giving the family enough space/privacy to grieve should be a priority for you, then explain that you need to complete your required care. Also, learning de-escalation communication tools can be helpful in a situation like the ones you've mentioned. No one has the right to intimidate you or become physically aggressive with your person. Always use your best judgment, and your company management chain of command to assist you in handling these situations so they do not become confrontational. My prayers for your Dad, and best of luck to you.

[Kooky Korky, BSN, RN]

Throwing the bag across the room. Sorry about their loss and all but patients and families already get a pass on way too much abuse. I would call the cops and have the offender arrested for assault.

I understand your feeling, but that response is overboard unless they physically abused the nurse. It sounds like they did push her, but she really should have just left, no matter whether she was removing a Foley or whatever other task she was performing, and it doesn't sound like they hurt her.

I think I'd have just left and not gone back. I don't think I'd want to involve police unless they were really shoving and pushing like they meant it. Had they asked her to wait but she plunged ahead with postmortem care anyway? Or were they just all drunk, high, jerks, etc.?

OK, I guess she could have called the police, bt she'd no doubt get fired for doing so. Kind of a tough call.

[evelynkarirn, BSN, MSN, RN]

I wholeheartedly agree. Unfortunately, as the weekend on-call nurse, I am often visiting them for the first (and last) time as it's typically a death or other crisis. The "case manager" hospice nurse(s) see them regularly. Also, many hospice patients will only be in our care for days because they don't believe they are "that sick" and wait till the 11th hour. Hospice is a very different kind of nursing, that's for sure. Thanks for your supportive comments.

[evelynkarirn, BSN, MSN, RN]

Hi All, As a former acute in-patient psych, ED, and correctional nursing RN, I'm pretty tough and don't frighten easily. I never feared serious bodily injury - it was more about being treated disrespectfully (way more disrespectfully than even the ED!) and as though I was villainous or malicious. Don't even know if this makes sense - any hospice nurses ever been treated like they're the enemy?

[Brightideas9]

One of the ways I deal with volatile families or people I perceive as adversarial or negative towards hospice is I tell them "I know as a nurse you are not used to seeing me in this role." That statement alone can help change thinking. Also I like to educate families about the dying process being a "labor". There is a labor coming into the world, there is a labor going out. It helps a lot to change the thinking and diffuse the negativity as many of these folks do not understand how any of this works. That's not their fault. It's that dysfunctional grieving that we need to head off. People often times stop being scared if you listen to them as long as it takes and teach them about what to expect. Use your social worker, use your chaplain, too.

[evelynkarirn, BSN, MSN, RN]

One of the ways I deal with volatile families or people I perceive as adversarial or negative towards hospice is I tell them "I know as a nurse you are not used to seeing me in this role." That statement alone can help change thinking. Also I like to educate families about the dying process being a "labor". There is a labor coming into the world, there is a labor going out. It helps a lot to change the thinking and diffuse the negativity as many of these folks do not understand how any of this works. That's not their fault. It's that dysfunctional grieving that we need to head off. People often times stop being scared if you listen to them as long as it takes and teach them about what to expect. Use your social worker, use your chaplain, too.

I love this! Thank you so much. I've attended many deaths, and had not run into this type of vitriol. I will use these words and concepts in the future. I did pull in the chaplain and social worker, but the family declined visits: However, I benefitted from the chaplain's words and thoughts. My co-workers are pretty great.