Unreasonable requests

Regarding the "comfort" of ICU beds, they are actually notoriously uncomfortable for those with bad backs, as a general rule if it gets to the point where I'm having to medicate a patient just to tolerate the ICU bed then I switch it out with a standard floor bed, so I would respond that they aren't any better off in an ICU bed (for a number of reasons).

As for the extra tests a family might want I point out that this is why we have doctors; to determine what tests are medically indicated. If they really want to push it then I'm not opposed to pointing out the importance of being good stewards of our very expensive healthcare resources, and they are free to pursue non-medically indicated tests but they are on their own in doing so. I also remind them that unnecessary tests are more likely to result in unnecessary treatments causing more harm than good.

For the family wanting additional tests, that is between them and their physician. I would not have called the doctor for that but would ask the family to speak to the physician at rounds. I would alert my charge nurse and management if needed be.

I've learned there is too much F&*#ery with families. If for whatever reason they're unhappy, I escalated to management and let them handle it while I actually CARE for my patients. It's the little unreasonable and unrealistic crap that burns you out.

When I worked MedSurg, we had bright orange "communication sheets" allowing all disciplines to communicate non-urgent queries, requests, et al.

This is an example of something I would leave on that sheet. I always did midnights, so this isn't something worthy of a page or phone call.

I would tell the family that I will leave a message for the physician to speak with them and would try to connect them. For beds, I've never needed an order for that. You can also talk to your charge nurse or manager to help you out with family requests/complaints.

I tell pts that hospital beds are made to function and are not made for comfort.

As as far as asking for tests...I too would have referred them to when the MD's round.

Even though management may not necessarily like this, even when I'm the charge nurse, I remind pts and families that they have a choice in their health care providers. They are more than welcome to leave and go anywhere else in the area that does not have the same resources and specialists that we offer but that they think will meet their needs better. Bah-Bye!

I first try to refer them to when the doctor rounds, especially for unreasonable requests. If they are still in my face I give them the office number, where they can request to speak with the doctor (and the given office will usually tell them the same thing I said, possibly with a timeframe of when they will be rounding).

I will call if it's something that is reasonable and shouldn't wait all day, but many of the doctors where I work also have a resident doc assigned to the patient-they are better about being called-and I work day shift.

The most common time that I get these requests are with new admissions where the primary or specialist hasn't even had a chance to see the patient. Usually, a simple explanation that the doctor needs a chance to evaluate the patient first before ordering a bunch of tests will get them to relax a while.

We have a recommendations portion of the chart where we note family requests. I also write notes on the patient white board to help remind patient to ask.

I tell families that they are welcome to bring from home every pillow, blanket, etc. they might like, just they better be washable, chemically cleanable or thrown away after discharge. Regarding tests, although it is physicians' job, I take time whenever I can and speak with patients/families about what they want and why. The vast majority of them have not the slightest idea what they are actually talking about, they just want to see "if mom's kidneys work all right". As we humans get 95% of information by vision, they logically think that CT and MRI are better for that than CMP because CT or MRI gives a picture of those kidneys and CMP only gives "just some numbers". They do not know what information a test can and can't supply and do not realize that a picture of something is not an equivalent of how the real thing works (I like to explain it by showing a real $1 and a picture of it). After they start to understand things better, get some trust and not scared out of their minds any more, their unreasonable requests usually stop.

I make a list, and tell the family that I will pass it on. That's after I've given all the teaching about health and policies I can come up with. If I have to, I call the doc and let them know up front that I have a list of requests from the family. They sigh and then are generally good natured about responding, even with long lists. If the family is still unhappy, I say the doc is the person to talk to, and they will likely have better luck speaking one on one to him. I will leave a message that they want to speak with him, and get their cell.

Some families think that if the doc says it, we have to do it. We are a nonsmoking campus, and I won't be escorting anyone out for a cigarette. Also can't fix the TV, or create a private room, no matter how many orders are written. A little reeducation and the phone number for patient complaints would help in that case.

What do you do when a patient or their family makes unreasonable requests for tests or procedures?

I had a patient family load me up with requests the other day. I at least went through the motions of trying to please them, but they had a request for additional tests. I knew there was no way these tests would be done, and I said that to the family, but they started to get angry with me, so I deferred to the Dr. I paged him and he yelled at me. I mean YELLED. Would you have phoned?

How do you handle a family with unrealistic expectations? Let me give you an example..we all know hospital beds are uncomfortable, yet they are where patients have to lie. There is no getting around using a hospital bed, but they said they read online that beds in the ICU were "different" and they wanted one of those. AS IF.

That was just one in a long stream of "requests", all of which were unreasonable. They were setting me up to fail by asking for things, and I am still upset over being screamed at trying to keep them happy.

Your first scenario, if the family was adamant about the tests I would have called too. If the Doctor would have proceeded to yell at me, we would have had a conversation about that so he was aware that it was not OK to talk to me like that.

A lot of the unreasonable requests such as your bed scenario, a lot of times patients just want their grievances to be acknowledged. The bed being uncomfortable is probably one of the most common complaints in an ER. I am very real with my patients. I will tell them "I hear you, the beds are very uncomfortable, I remember first hand. Unfortunately the nature of the ER is we have to be prepared for anything, so we have smaller beds and they aren't very comfortable, they are made for efficiency not for comfort. Trust me, if something were to happen and you needed CPR or to be rushed to a scan or another room, these are the beds that will ensure we can treat you promptly and efficiently.It sucks I know, especially when you're stuck down here for a long time. But hopefully you can understand why. Maybe I can try and find an extra pillow to help."

When I do things like that, keep it real and keep it honest but acknowledge their grievance, I very rarely have anymore problems. I can honestly say that I have always had a good rapport with 97% of my patients and their families or been able to change things around if they had gotten ugly. And I can assure you it's not because I kiss rear ends or cater to them. I just know what it's like to be on the other side and I feel it helps me to be better nurse because of it. I think the way we handle the situations and our attitudes determine a lot of how our shift will go and the demeanor of our patients.

Not always though, sometime I just have to stand there with my WTF face and will say "Seriously???" and walk away.

Several of my patients that are "mostly" grandmothers and mothers alike are trying to be a match-maker for their granddaughters and daughters "alike" and would ask me if I'm available!

I would jokingly get back at them by saying:

"I'm sorry. But that's just very inappropriate! "

(Followed by a few nano-seconds of "dead-cold" silence).

Then with a blurt....

"Is it ok if you and I would go out on a date instead?!

Is this considered an unreasonable request or unrealistic expectation?