Unhappy family members

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

What do you say to family members when obviously they show you no respect and begin yelling at you in the middle of a hallway for 10 minutes plus. Do you walk away, do you call security what does every one else do. I am a well known doormat on my floor this is what happened to me last night.

I had a patient that was admitted with colitis that wasn't doing well with the antibiotic therapy that he had recieved a few weeks before and was now in the hospital on failure to thrive issues. This woman was extremely anxious. (I don't give meds to people freely, but this woman definately needed medication because she was throwing herself in a tizzy and becomingly increased in Dysp. r/t talking so much.) So I got an order for Ativan 0.5 and gave it to her. She was slightly confused in ramblings but was oriented to direct questions. Three hours later.... I get a note from a staff member stating that the family has questions and wants to speak to me. The staff member tells the family that I had just gotten an admission and that it would be a few minutes. I was walking out of my admissions room p 15 minutes and was on my way to see them when another staff member came up to me and said these people want to talk to you. Again it was the family I was going to see. There in the hallway they let me have it. I tried to move them into a more private area but they wouldn't budge. They bantered me with how LONG THEY HAD TO WAIT to talk to me. PLEASE. Then they wanted to know about the condition of the patient, what was wrong with her, why was she so incoherent (not anymore than she had been before). They wanted to know why a diagnosis hadn't been made. (she had been hospitalized less than 24 hours). Then they start saying to me, WHY ARE YOU THE ONLY NURSE THAT IS TAKING CARE OF HER????????????? Hello, what planet are these families from. They wanted to know what the other nurses were doing sitting at the desk and why they couldn't give them any information. Not only that but when this family was up at the desk they start yelling at a doctor who just happened to be up at the desk. I told them that they were not going to get any information out of me unless they stopped attacking me. "We aren't attacking you"they yelled. Then comes "how do we helicopter her out of here, we want her transfered to mayo. Or do we have to take her by car. ON and on this went for over 2 hours. The doc comes in and calms them down and the family says "well I guess you are doing all the right things and we can't expect anymore right now.' PUKE

Where do these families come from?

Then as a side note, 1 hour later after they left, the patient crashes with end result being sent down to icu. The family says to me "well I guess we were on the right track in thinking about sending her"

My bad- I said sure but she would have crashed on you in the back of a car or ambulance.

What would you have done. The family was comprimising the care that I was trying to give to my other patient in multiple ways. Thank god I only had 3 other patients that night.

[cargal]

I commiserate with you. A family was the last straw for me on the skilled unit. A skilled unit has LTC staffing with up to 17 on 3-11 which is BS because of the age and acuity of most of the "residents" which are really patients. I was assigned to an end stage liver patient who was slated to go home. I never had her during her 5-6 day stay. Her daughters were nurses in the ER of that hospital. The patient told me the doctor would be in to discharge her. I gave meds, assessed her etc., and prepared her for discharge. This was all at the beginning of my shift. Her lovely family was in, kids, teenage girls, her nursing daughter, who pulled me aside and said that she noted dried blood on the toilet seat. I asked if her mother had used the bathroom recently. Yes, she had , was the reply. I checked the toilet seat and there was a minute amount of streaked dried blood (like from a mosquito bite scratch). The roommate had gone to ICU right before I came on duty-her bed was still unmade. I brought the woman into the bathroom and examined her, and used toilet paper to check for the presence of blood. (Remember, this was my first nursing job after graduating at the age of 40). There was absolutely no sign of blood, bleeding fresh or old. I told the daughters and the patient that it was probably either menstrual blood from a teenage visitor or from the previous roommate that had gone to ICU. There was no presence of blood in the patient's underclothing or chair where she was sitting. The family seemed satisfied and I went on with my day. The MD came in and told the patient that she misunderstood and she would be discharged the next day.

Well.....I come on 3-11 the next day and her darling daughters got me out of report to scream at me at the nurse's station that I did not document on this (I had put it in report, but forgot to put it in the nurses notes- very uncommon for me). I stated that there was no presence of blood and she was screaming "This is my mother" and that the blood in the urine can go undetected-duh! They called the Wicked Administrator from the West on her cell phone and she in turn called me and reamed me. I did however really p*ss her off when she asked me if I like nursing and I said "sometimes". Whoa she hit the roof! I guess she expected me to say oh I love the crap , the stress of having 17 patients, giving IV Push Lasix and Morphine for my pts and the LPNs when we never even gave them in school etc.... Don't get me wrong...I do love my patients , but I hated that job. Enough is enough. My charge nurse questioned me and told me my interventions were appropriate, and I just forgot to document, just do a late entry. This was one of the only acts of kindness from the nurses on that unit.

The administrator said "Don't go near that chart." Screw her , I did a late entry. Can you believe these daughters that were nurses? The thing is the woman was stable and going home and their was never a sign or symptom of perineal bleeding. We sent her home with a pad on and a box of pads with instructions to wear them for at least a week- no bleeding.

Families wouldn't be so bad if management wouldn't let them get away with it.

I suffered from alot of lack of self esteem because of that job. No wonder there is a nursing shortage.

So the answer to the question is e) I quit!

[CoachCathy]

I TOTALLY understand about crazy family members. I, too, work in long-term care. Many nurses at the hospital turn up their noses at LTC nurses, but truly the stresses are of the same level, just a different category. There are SO many psycho-social issues to deal with - ineffective coping, frustration, guilt - and that's just with the families!! So many times (99 of 100), when a family member is expressing THAT much frustration, it usually has a basis in guilt. It is so easy to let the family members get the upperhand when they begin their tirade. If, in the back of your head, you think of them as feeling guilty, it helps to allow you to keep the upper hand. This, I am sure, would also apply to the hospital patients. Families that feel that they had been taking excellent care of Mama, and suddenly Mama ends up in the hospital, will feel all sorts of guilt and will blast out at whomever is convenient. Things to remind those crazy families is that you - as a nurse- do not order/prescribe/diagnose anything. Those would be things that the doctor (who gets paid much, much more) would be responsible to do. You, as a direct care nurse/charge nurse/ whatever, do not get paid enough to also act as a social worker/therapist. When a family member begins to spin out of control, I try to become more calm and talk even softer. I parrot back their concerns, and let them know I will alert the doctor/ nurse manager (if it is about staffing)/ dietary manager (if it is about food) etc. I don't try to discount their problem, and I don't try to run away from it. Moonshadeau- sounds like your family really needed to speak with the MD to have their questions addressed. I don't know how it is in your facility, but with confidentiality and all, we aren't allowed to discuss the patient's condition with just anyone. That's when we refer them back to the doctor. Concerned with the medication side effects? We'll let the doctor know. Want to know what the diagnoses are? You'll need to contact the doctor, as he has not made round - if you like, I'll leave a note that you'd like to speak with him when he comes in. Good luck, keep a strong spine, and have faith in your decisions/ assessments - don't let them displace THEIR guilt onto YOU!! :) Cargal - I am so sorry to hear about your Psyco-***** administrator. Administrators should back up their staff, at least to the families. What you did was certainly appropriate. At our facility - we chart by exception. You went to look for the causes and found nothing. In most cases, that would constitute normal - no need to chart. Sounds like you're a conscientious nurse - someone we need in LTC. I hope that you aren't completely disillusioned that you won't find a better, nicer place to work! We have a prior nurse as our administrator - she is tough, but fair!! Take care-

[BadBird, BSN, RN]

Well, we have all had families from hell, I would have told the family let me page the doctor and you can ask your questions as I can not give out results to family members also write down the doctors phone number so the families can call themselves, you could also offer to leave their phone number taped to the front of the chart so the doc can call. (Not that they ever would but it does appease families) I would also page the nursing supervisor and have the supervisor speak with the family. My feeling is that I don't get paid battle pay, let the doc's and supervisors deal with it. If none of that works then by all means page security especially if they are interferring with the care of other patients.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

The nursing supervisor didn't want to deal with this. The doc did come in and make everything better for awhile. But it didn't stop them from bantering at me until the doc got there 45 minutes later. I don't think that I am paid enough to pyscho analyze the underlying feelings of these families. My big question is : what does the general population believe that the role of the nurse is? Are we handmaidens, are we the venting source for doctors and families, does our nurse practice act state that we are responsible for the patient when other disciplines fail to complete a task. I am not really frustrated with the situation, I think that I earned my halo last night. Even when another doctor was discussing a different patient and not my own, I relayed a request from the nurse.. obviously he didn't like the request of the other nurse and asked why it needed to be done. i told him it was hospital policy and he could go ahead and yell at me too if he wanted but I was only going to sit back and smile and really not care. He laughed. What is wrong with us as nurses that we have to put up with so much bs. No wonder no one wants to be a nurse anymore, it is chronic abuse.

[canoehead, BSN, RN]

I'm a supervisor and frankly I think that bedside nurses have enough to do. If a family goes ballistic I WANT to be called. I am happy to take them aside and deal as best I can, and have almost always found that the nurses have been doing their job, and that there has been a miscommunication, or that just someone who can sit and listen can ferret out the real problem and it is usually resolvable. Unfortunately for some people it can take a couple hours of listening to everything that has built up before the real issue comes out.

As far as yelling in the hallway, ask them to move to a more private area, if they refuse walk slowly to the nearest empty room beckoning them to come along, and listening to them all the way (nod, concerned look, reflect etc) They will either continue to yell at an empty hall -not very satisfying for them- or follow you.

Be sure to let them stand by the door if they seem relatively sane. If they feel out of control my experience is that they will storm off, and I don't want to be standing in front of the door if they need to do that. But I always stand by the phone. Always.

And if they sit you sit, if they are standing you stand, it equalizes the power and also is a way of reflecting feelings. Keep reflecting what you think they are trying to express until they stop yelling. If you have reached the core problem they will calm a bit and it is pointless to do problem solving until then.

And if you are expecting a blow out make sure your coworkers know where you are and who you are with, so they can keep track of you and that you are safe. Our hospital has panic buttons that we can carry in our pockets that summon the police. We have no security (security? that's the nursing sup...) so we depend on each other to watch out.

Hope this helps.

[P_RN, ADN, RN]

No offense Canoehead and I haven't been a supervisor in quite awhile

BUT......the last angry family member I dealt with screamed at me, cursed me, grabbed me and shoved me into a doorframe.

There is NO WAY in HEL* that I am going into a room with some angry family member. Maybe the end of a hall but *I* am going to be the one who is nearest the getaway zone!!!

That guy I called security, the nursing director and the police department. Then after work I went to the police department and swore out a warrant.

What I would advise is make an occurrence report EVERY time anything like this happens. Keep a copy for yourself and a copy for the risk manager. YOU are the one being assaulted and if they touch you....that is BATTERY.

And as someone earlier said.....tell 'em

"I CAN'T HEAR YOU WHEN YOU SHOUT SO LOUDLY!"

And as far as the mosquito blood streak toilet seat....make a report about that too.....in five years it's going to be "covered thickly with blood and HIV is crawling all over it!!!"

Oh and let's call saracorbett's attention to this post too.

[StaceRacer1]

I have found that " FAMILY " is the hardest part of my job!!!!

It does not matter how far out of your way you go, they still are UNhappy with something!!

I get the biggest kick out of the family members that choose to call during report (around 7am, 3pm, or 7 pm) and want a prompt answer to their questions. I have been that "family" member in an acute setting. I worked around the nurses. I asked them to call or find me when they had a moment.

As a nurse, I have tried to ask family members to call back at a better time, but most of the time they get even more anxious and start to think that maybe we are hiding something from them about their family member, when all along it is really that we ARE too busy taking care of their LOVED ones to sit and chat like they want to!!!

ARGHHHH!!!

[canoehead, BSN, RN]

P_RN if I thought about family physically attacking me I would lose my nerve altogether.

Where I work we are very vulnerable as sups, the pharmacy is right in the line of traffic when ER patients go to get a snack, and if a sup was stuck in pharmacy no one would miss her for hours- just ***** that we don't answer pages. I am also paranoid about the freezer door when I go to get popsicles, ice cream etc.

I worked on a crisis phone line for a few years and have got a little confidence in being able to handle nuts from that. And I think that if I look afraid of an aggressive person I am more vulnerable to attack, so sometimes have had to push myself a bit, and so far I have been lucky. (knock wood)

Is that episode where you got your back injury? And they are giving you trouble about benefits? No wonder people get angry when they have to deal with bureaucracy.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Was I ever a nervous wreck. All I could think about was how the family was going to sue me, even though I racked my brain and really couldn't think of anything that I had done wrong. Apparently she had a necrotic bowel that was causing her to go into the septic shock... The sepsis part I knew about from her sudden drop in B/P and loss of a perfusing rhythm. I found out later today that the family all of a sudden had a change of heart when as they were wheeling her off to surgery, the basically crashed. I hear though that the family was offered an autopsy, but declined. I documented 3 pages of narative on this gal, I should be covered, I hope.

[wonderingwhy]

I work at a LTC facillity and we have to deal with family members on a daily basis. I have learned to just calmly tell them that I understand that they are upset but until they calm down and allow me to help them then there is nothing I can do. I also add that when they are calm and would like to discuss the problem like adults that I would be glad to sit down in private and see what solutions we can come up with. I have found this to be the best reply to their ranting and raving because it lets them that I am willing to work with them and at the same time lets them know that I will not put up with their behavior. I have found that after I leave the room it usually only takes a few minutes for them to calm down apologize and be ready to talk. Granted this does not work with every one their is always the ones you can't please no matter what. With them I send them to my administrator and make sure to have perfect documentation of the care the patient recieved that shift That way there are no questions as to weather or not I am doing my job.

[thisnurse]

we had the best one tonite...a family member called one of the nurses and said...

you tell me about my husband and if you dont then i am going to CALL THE DOCTOR!!!

lmao

we voted for calling the doctor...lol

ive not had many problems with family members. im very good at calming them down. its kinda like a gift i have. i have had some that just wont listen to anything you have to say and just keep on *****ing...they are the ones with the "us against them" attitude. i just call the nursing supervisor.

she gives them a continental breakfast and a mint on the patients pillow...lol