Venting

[MissyF_RN]

this may be long but i just need to vent. i had this one patient a couple of nights ago that i just knew the family would give me the run around all night. he was a stage four lung cancer patient that the family was in denial about and refusing hospice when the doctor had consulted them. when i walked in at 1930 to do my assessment on him before i even laid my stethoscope on him they were asking me a ton of questions, "when's his next breathing treatment" "when is is next pain pill" "what's his oxygen" you get the picture. when told that the treatment was scheduled for 1900 they proceeded to tell me it was 1935 and where was respiratory and he needs his treatments on time. i reassured them that he was going to receive his treatment and that the therapist should be on their way. after i completed my assessment and answered all their questions the patient wanted to be put on a mask because he said he was not getting any oxygen through his nasal cannula. of course he was breathing through his mouth, so i instructed him to breath through his nose and his oxygen was on. they still insisted i put him on a mask. so after i put him on a 24% venti mask he said it was not enough so i put him on 30% then that was too much that the air was blowing in his face so i put him back down. of course he wanted it up more. i politely explained it was either one or the other. once he was satisfied with his oxygen i left out the room to assess my other patients. at 2040 they came to the desk to ask for his pain medication. i was talking to the doctors at this moment and i would be there as soon as i could. i go in the room 10 minutes later and gave him all his regular night time meds along with the pain meds. ok they are fine. i walk back into the med room where i proceed to dispense narcotics for one of my other patients and the family member comes to the desk to ask for him to be put back on his nasal cannula. i told him i would be in as soon as i could. i was going to bring my other paitient her pain meds and i was going to go straight into his room to change him out. i was out in the hall gearing up to go into my other patients room, that patient was in isolation for positive mrsa cultures. now i'm in the hall in the yellow gown gloves on and another family member walks out of the hall and demands to know when i was going to shange his oxygen. i had to explain again that i was going to go change him out as soon as i was done with that other patient. of course she left in a huff, i wasn't particularly worried because his oxygen sat was fine and he was on o2. as soon as i left out of my other patients room i went and change his oxygen back. of course i got the 3rd degree when i went in there. they were asking me why i didn't go in there when they came get me to change his oxygen. i had to explain to them i went as soon as i was done with my other patient. they seemed ok with my explanation. later that night one of my other patients was practically drowning in is own secretions he could not cough up on his own. i was going to our clean supply room to get a suction cath for him when the family member came and asked me to tape down his foley cath. i asked one of the other nurses to help me out by taping his cath to him. i don't think they liked that either but i had a more critical patient at the time and could not go in myself. the rest of the night passed with no other incidents. in the morning, one of the other family members, who was not there the whole night, and did not see his oxygen episodes, asked me why his o2 was on 4 instead of the 3 1/2 l he was on the day before. i explained to her that he was going to be fine and the o2 was increased because he could not feel it (i mean 1/2 l come on now really!). i left with no other questions from them. the next night i was brought into the charge nurses office because they said i was rude and they did not want me as the nurse again. of course i was left wondering what i did to offend them. the day nurse told me the family was following them like puppies telling her i did not go into the room until 0300 (complete lie) and i did not address his oxygen when they asked (another lie), and i turned up his oxygen to 4 l when he was only supposed to be on 3 1/2 l (really 1/2 l more). the patient was absolutely fine with me it was the family that was angry. anyway i was not his nurse that night which really didn't bother me any. that just meant that i didn't have to put up with the family again. that night every time i passed next a family member they just stared at me with the meanest look. sorry this was so long i just needed to vent!

[CathiP, ASN, RN]

I sympathize with you 100%. I've had that family!! Most of the time, after the patient finally transfers to the "Unit of Eternal care", the family can relax and they realize it was them, not you. That doesn't make it any easier while you're getting trashed but everyone deals their own way with death. These are probably the same family members who haven't seen the patient in years and are feeling guilty but taking it out on you. Don't take it personal. Just smile at them when you see them and ask how the patient is. Don't know if it's your first crazy family but I'm betting it won't be the last!

[cherrybreeze, ADN, RN]

I'm sorry, Missy...some families are like that, and it's so frustrating. Their family member is your only patient, as far as they're concerned, and no matter what you do for them, it's never enough. Have faith that you did the best you could, and let it roll (I know it's hard!). You could have jumped at their beck and call all night long, and they would have found fault, I promise you that. Be glad that they didn't want you any more, lol, that gave you a break from them!

The patient had no issue with you, and that's what really matters. Keep doing what you're doing.

[iNurseUK, RN]

:) Feel better? This stuff is hard to deal with. The family won't ever accept that whatever you do it won't save Pops at the end of the day and no miracle will make the cancer go away which is what they really want from us.

All we can do is grin and bear it. The tiny details are all the family have to cling to. The slightest deviation in the timing of physical therapy/radiotherapy/chemotherapy is enough to provoke a storm of truly spectacular proportions even if all these treatments are palliative.

I also have these "headdesk" moments so hang in there sister:)

[katkonk, BSN, RN]

All I can say is I understand. At the bottom of all the feelings of the family and the patient is just fear. Any time people are that agitated the bottom line is fear. The family is trying to get their head around the fact that their loved one is going to die, and they just want to do what they consider to be taking good care of them. The patient is afraid because they are having trouble breathing and are afraid to die gasping for air and in pain. With a hard-to handle family and patient like that, sometimes the best way to handle the problem is to "cut to the chase" and address that fear. But, you probably would still have been accused of being rude, as it seems like you did offer explanations of your actions. Re: when you did or did not go into the room, your nursing notes would have reflected the times you checked on the patient, hopefully.

[onetiredmomma]

One advantage of wearing staff locaters is your manager can access the system and prove to the family when staff is in a room. that said, I too am sorry you had to do this. I have a bit of an onery side and the few times this has happened to me I always smile and say good morning when I pass families who have "fired" me. Just remember, you know what you did, you did your best for ALL your pts and come here to vent when necessary!

[mamamerlee, LPN]

I almost didn't read your post because of the PINK ink. Very hard to read.

But I concur with everyone - these people are anxious and they made you the focal point of their inability to cope. If you see them again, just smile and nod your head as you pass them in the hall. They will complain about anyone who doesn't jump to their beck and call.

Sometimes it helps when you first enter a room to ask if there is a delegated spokesperson for the family. Then they can discuss who will be responsible for that shift so you aren't accosted by a different person each time you are visible.

You will always have families like this. Ask for an inservice on dealing with difficult families, or ask someone who seems to be very good at this how she manages. For some reason, male nurses are rarely targeted like this.

[Ruby Vee, BSN]

some families are just plain toxic, and there is nothing you can do to satisfy them. the excuse that "they're just afraid" or "they feel helpless because they know he's dying" is an excuse, not a reason for bad behavior. be happy that they "fired you" so you don't have to deal with them again. (and yes, smiling and saying a friendly hello every time you encounter them in the hall will probably drive them nuts.)

i will, however, second the notion that the pink ink is difficult to read, and paragraphs would have helped as well.

[SpringerCab]

Years ago when I was complaining about a patient and family members to my sister she got a little upset at me and said "you nurses need to understand that they patient is not at their best when they are in the hospital." I was upset with her and stopped telling her about the situation. I thought about it later and realized she is right. Although being in the hospital does not give anyone the right to treat us the way this family treated you, we might want to remember the patient and family are not at their best and try to understand how they might feel. Just my 2 cents.

[mauxtav8r]

Hang in there Missy. I agree with the above post that regardless of how the patient is doing, the family has no right to lie about your work.

[wooh, BSN, RN]

Patients/families tend to either LOVE me or HATE me. I feel like I've been "fired" way more times than my coworkers, but luckily my management has seen me chill out the truly crazy families, and they know I get assigned the crazy families because I usually can chill them out, so my "fired" episodes are more often because I'm taking up the slack for my coworkers. (When the family that hates everyone and has called all the way up the CEO to complain then absolutely LOVES you and says everything is fixed as long as they have you, it earns big brownie points.)

There are some people you absolutely cannot make happy. As long as your manager understands this, things are ok. If you work for Press-Gainey obsessed managers, then when you get a family like this, you need to make the charge nurse aware of everything and maybe at shift's end let the manager know in an email or something similar. Whoever gets their story in first tends to be the one that's believed. Now that I have good managers, I just let them know room 999 is a royal pain in the backside, and maybe they can stop by to make them feel "listened to." When I had crappy management that always felt the nurse was at fault, I'd phrase it in the all-caring angelic way of the poor stressed family that's having difficulty adjusting to the pt's unfortunate diagnosis.

I've learned to make it very obvious when I'm doing that little bit "more" to make the patient comfortable ("Let's get you comfy in this bed! Oh how I wish the beds here were easier to get comfy in!) Apologize for my delays ("I'm SO sorry it took so long for me to get out of the other patient's room") before they can complain about it. Don't feed into their complaints about the previous shift. Tell them upfront your plan for making them comfortable at the top of the shift.

But in the end you can't please everyone, you can only do your best to cover your butt.

[cicatrixx15]

This is not related to nursing at all, because I am not a nurse yet, but it reminded me of a funny story. I used to serve and bartend, and some people just can't help but be nasty to people. I don't even think they try. It's just the way they are. It's like they are the only people in the world who matter.

I had this one guy one time who came in and he was a weirdo, I could just tell. He ordered a Ribeye med rare with no side. Instead he wanted a soup AND a salad. Wow, this was 4 years ago and I still remember.....anyway, he wanted his soup and his salad at the same time....okay weird, but I'll oblige. So I brought out his salad and soup out asked him if he needed anything (of course he wanted crackers) and told him to enjoy and I'd be right back. When I came back the man says "Miss, my soup is too hot" I smile and say "Sir why don't you eat your salad first and let the soup cool down?" I MEAN HE HAD THEM AT THE SAME TIME COME ON!! Well, he smiled at me and I said his ribeye would be right out. Before it is even done, he has flagged down another server and told her that I never check on him and he didn't want me as his waitress anymore! HAHAHAHA! The other server was ****** because she had to wait on him then. I didn't even care. I just walked by and smiled. I think he wanted it to bother me.

P.S. He also had to pick up 3 silverware rolls from the front. Don't ask me why he needed 3 silverware rolls. He also grabbed a stack of beverage napkins on the way to the table, and he wanted two drinks. There were probably 5 tables in the whole restaurant. I think I could manage to refill his drink before it ran out. I was a darn good server if I do say so myself:)

Like the others said, just smile as you walk by and don't let it bother you. Some people are just high maintenance, without caring about inconveniencing others.