Two months orientation. How can i handle family members???

[ccrn2b]

I feel so much intimidated by family members of my patients. Once they find out that i'm new, they start asking me how long i've been working,what does this medicine mean, what does it do, how many mg....I tell them anyways.

While some are just merely curious and just want to talk with you, others are just looking for ways of actually putting you down.

Question: do i just ignore those looking for trouble or do i just answer their questions in a bid to be good? I feel so intimidated. Last week was my last week of orientation and i had quite a bit. Throughout my orientation it's like i had at least one or two families like that in a month. Bottom line is, pls i need hints on how new grads should handle these kind of family members/friends and even patients who gets them intimidated.Any advise would be appreciated.

[UM Review RN, ASN, RN]

A lot of questions can be answered by using body language. Make yourself available to the family, as they do have a lot of valuable information about the patient and most of them just want to help.

Some of them really can. For instance, they might know that Aunt Sally always gets weepy and confused when she's sick, even before she gets a temp, so you'll have a heads-up on a possible infection from her behavior.

When they ask a question that's way over your head or out of your area of expertise, DONT say, "Gee, I'm a brand-new nurse and I just don't know the answer."

Some answers are too complex to give people without giving college credits along with them. So you go home and practice giving a one-line down-and-dirty answer. Like, "Aunt Sally cannot have fluids even though she's thirsty because her body is not processing them right." If they press for that complex answer, refer them to the doc.

Not that you couldn't answer, you probably could. It's just that you have a million things to do and you simply don't have an hour to spend gabbing in the hall with anyone about anything, catch my drift?

If they know a little bit and want to impress you with their knowledge, and then have a question, just look at them like they're the most brilliant mind since Einstein (never mind that you learned this stuff in Nursing I) and say, "Wow, that's a great question to ask the patient's DOCTOR. Let me know what he says!"

Repeat prn with other questions that you can't answer.

You can answer some of the med questions by saying something like, "We try to warn patients and families that sometimes the doctors will change meds or dosages while the patient is in the hospital. Because obviously since the patient is here, something wasn't working right, was it?"

But be open and be cautious about this, and make sure that they're not trying to tell you that Aunt Sally takes Lasix 20 mg TID, not daily. You want to clarify that the home dose at least starts out as correct between the family and the doctor.

Offer to write down their phone number in a note to the doctor that explains that the family needs to talk to him/her.

I recall one extremely aggressive family member who literally followed me to the nurse's station to ask all kinds of questions--that sounded more like demands--and had me completely rattled, so it can happen to the best of us.

In a case like that, offer to have the family wait in the Lounge until you gather the necessary data, and then have your Q&A session.

A lot of families have been reading books that tell about the terrible hospital care, and they are just trying to assert and reassure themselves.

Bottom line: Get the patient comfy and cared for first! Then answer questions or refer to the doc.

[NurseyBaby'05, BSN, RN]

Also, work a lot of nights. That's partly why I do. It's not just the families though. On daylight everyone wants a piece of you and there's just so much that is able to be spread around. At night you may have the extra minute or two to give a little more in depth info. Never do you have half an hour to explain things in depth like you did when you were in school and didn't have a full assignment. Those days are over.

[MIA-RN1, RN]

I don't tell anyone I am a new nurse unless I want to share it. If they ask, I hedge. "How long have you been here?" I'll say something like "Oh awhile now. I've seen this before" (If asking with specific question about patient.)

Or if its a med question I don't know, I will say something like "You know, thats a really great question! Let me go look it up to be sure I give you all the information (or let me look it up so I can be sure that I give you the most up to date info we have). They don't need to know that inside you are shaking wondering what the heck medicine it is anyway lol. Or sometimes I will say that I will call the pharmacy about it, to set thier mind at ease. and yes, I really do call the pharmacy. THat's how I learn too.

I will also offer to page the doctor for them, and I have done that too. I tell the doc that the patient/family has questions that I can't answer and that I need them to come and talk. (Note I don't ask the doc lol)

Sometimes I will tell someone I am new, but it is never right off the bat.

Oh, and pretend that you are a seasoned nurse. Pick one of the nurses on your unit that you look up to, and pretend that you are them when you are in an uncomfortable position. What would that person say? How would that person react? Then do it that way. Sounds kinda corny, but it works until you find your feet. The people who do find out I am a relatively new grad are across the board surprised.

[MIA-RN1, RN]

I forgot to add that I tend to have family members participate in care--it really helps them refocus on their loved one and less on you as the nurse.

I have dad tickle baby's feet to keep baby awake while mom is nursing, or ask dad to get washcloth or whatever needed to help with mom or baby. Or simply ask who is on diaper duty when I find a messy diaper. Then I smile at dad. While he changes diaper, I assess mom, talk with her and get my work done that way. Helps with grandma's and aunties as well.

[traumahawk99]

i give family members explanations that are too technical for them to understand, but i do it in a way that seems so sincere they're not offended. then i've established that i'm the one with expert knowledge, and i'm giving them the medications the doctor has prescribed, etc.

all in all, family members are a pain in the ass, but i'd rather see a patient with family members and friends than a patient no one comes to see - which is all too common.

[lilypad2424]

Wow, angie o plasty! What a superb post. You immediately made me change my perception after reading that thread.

[augigi, CNS]

Families mostly want to be reassured that you know what you are doing, and that their family member is safe and getting good care. Working in ICU, we get families that ask about every beep, or change in the monitor, and "what are you doing now" etc etc. It is exhausting to answer constantly or justify what you're doing.

I generally explain that I am happy to keep them informed, but that the more time I spend with them, the less time I am spending with the patient. I frequently arrange family conferences with the docs to answer questions.

I used to constantly get the "you don't look old enough for this" when I started out, to which I would just reply that I was indeed old enough and my face cream must be working well - it's none of their business how old I am, and I found that answer let them know that in a friendly way.

In general, you need to build a relationship whereby the family trust you to look after their loved one. That is harder with some people, but it's rare that you can't do it. Act confident, be friendly but firm, and don't get put off by pushy people.