What would you have done?(longish)

registerednutrn, BSN, RN · Jun 7, 2008

This is a tough situation. Many times dealing the families of patients is the hardest part of nursing. No matter what you do you can not please them. It sounds like you did all that you could do.

morte, LPN, LVN · Jun 7, 2008

1) why didnt patient have a foley? (mva)

2) sister should have been escorted out of the building, by police if nec.

3) shouldnt have been allowed to move furniture out of room either.

Altra, BSN, RN · Jun 7, 2008

Questions:
1. Would you have explained that the sister was more than welcome to stay in the solarium, and we would keep her informed of any changes? (offered, but refused)

Yes. And if this had been the only incident, at 30 minutes past the end of visiting hours, after giving several q 5 minute reminders that she needed to be out of the patient's room, security would have been called to escort her to the solarium.

2. When the sister slapped the arms out of the way, would you have explained that this is technically battery, and you would be calling security to remove the sister from the facility for the remainder of the shift?

No. I do not "explain" to people that they are committing battery -- I take immediate action to ensure everyone's safety. The tech would have pulled the patient code button or whatever mechanism you have in your patient rooms that signals help is needed from multiple staff RIGHT NOW, security would have been called, and the sister escorted off of hospital property with the "explanation" that if she returned and interfered with patient care again, there would be police involved.

3. what else could we have done? (short of finding a construction crew to add a room to the floor?)

If you're asking what more could be done to attempt to meet the sister's demands, nothing. Even if you had (inappropriately) moved patients she would have continued to make unreasonable demands. It's hard to say whether some more firm verbal limit-setting shortly after the sister's arrival would have changed the course of this scenario. I always stay the course -- patient care first, families after that.

patwil73 · Jun 7, 2008

As a supervisor this is what I would have done:

1) Apologize for the inconvenience of having to share a room during this trying time. Unfortunately we don't have anything open to move to, but I would certainly move them once a room become available.

2) (after catching her trying to dump urine). I realize you are trying to be helpful but please call the nurse before taking on any tasks. It is very important to your sister's recovery that we have accurate information on which to help treat her.

3) (on sleeping on the floor - assuming no other reason for sister to remain in room such as patient dementia, etc) I realize you want to remain close to your sister during her hospitalization, however we need to move around the room for patient care. You can, if you want, sleep in our waiting area. I realize this is an imposition - but it is necessary for us to take care of both our patients.

3a) If she refuses - I am terribly sorry for the necessity, but we can't have you sleeping on our floor. We will come get you the instant anything happens, but it will be much more comfortable in our waiting area.

3b) If she still refuses - Again I am very sorry and understand that this is difficult for you - you want to be by your sister. However, sleeping on the floor is not an option. You can sleep in our waiting area or you can leave the hospital. The choice is yours.

3c) If she still refuses - Call security and have her escorted out. Inform her that for failure to follow hospital policy she will be prevented from returning until she speaks with the manager of unit (thus relieving me of having to continue to talk to her)

4) Slapping. Talk with the aide and determine how she/he felt about the situation. If he felt strongly enough, I would call security and ask the sister to leave. If the aide didn't feel that strongly about it, I would have a talk with the sister essentially stating if she laid hands on one of my employees again she would be taken out by police.

I have had these conversations more often than I wish to remember. What I would like to say is - I am sorry the Hilton was full, next time you should call for reservations before suffering any injury/sickness that needs a room. Until you can do that, please don't complain that we are not up to 4 star service - we are keeping you alive and healthy - anything else is icing on the cake.

Oh one day I will say that, probably my last day on the job - but it will be so fun.

On a side note - I did have a patient complain that her quality of care was not good enough and she wanted to leave and go to a real hospital. I handed her a taxi voucher and an AMA form and said sign and call. Remarkably she decided we were not that bad after all and decided to stay.

Pat

talaxandra · Jun 7, 2008

We don't have a solarium, and visitors are only allowed to stay overnight if the patient's dying (and at nurisng discretion, but we don't advertise that!). So "visiting hours have ended, all visitors are requested to leave the hospital".

TazziRN, RN · Jun 7, 2008

I don't care if the sister says she's the representative......no signed DPOA, no rep. Everytime she said "My sister wants" I would be checking with the sister first.

Slapping the tech's arms: I wouldn't care what the tech said, I would be reporting it to security and letting the sister know that if she does it again then the cops get called. Many people will not make a big deal out of it to keep the peace, but no one deserves to be slapped.

Sleeping on the floor: "I'm sorry, but there are no private rooms available to move your sister into. Because there is a roommate, we do not allow visitors to stay all night unless the patient is a child. You are welcome to stay in (name quiet area) and check on your sister if you like."

If she refused to leave I would be calling security and having her escorted off the premises after a warning that this would happen.

Teleflurry, DNP · Jun 7, 2008

1. Patients family should not be allowed to stay in room and sleep especially in a semi-private.

2. Haul her orifice outta the hospital, you dont hit people...period.

3. Nobody should be speaking for this patient if they were oriented.

4. Snoring? No room change, all we can do is offer it in the morning if a private room is open by then. Moving the other patient..the response that I've seen always set it straight it , "NOT AN OPTION. NO."

locolorenzo22, BSN, RN · Jun 7, 2008

Thanks all for all the replies....

My personal opinion? sister had something to hide, or the family has "money" and is used to getting their own way.....I firmly believe that by the time I come back on monday...NOTHING will have happened. family will be in a private room with patient, the supervisor did not go that route, but I was firmly suggesting it...

IMHO, as a CNA/nurse, we are there to provide CARE, not be their personal waiters....and I'm sorry that they are not happy with it, but that's the facts of life...

Thanks for reaffirming to me that I was not in the wrong with the way I was leaning....and I firmly believe that had I been the RN on duty, I most certainly would have been fixing this situation in the above described manners....Thanks again!

bagladyrn, RN · Jun 8, 2008

I would have insisted that the sister leave the room at the end of visiting hours if the pt. was not critical as I am sure that her presence, talking, slapping and hauling around furniture was at least as disturbing to the roommate as the roommate's snoring was to the patient. If she refused, I would have called the supervisor and if she was unavailable would have told her I was then calling security myself.

As for hitting the aide - that would have had her removed - I do not allow anyone to be hit in my presence - staff, or family members. I've informed laboring women who struck a family member on several occasions that if that behavior continued I would remove all others from the room for their own safety.