What do you do when you are the friend/family member and not the nurse?

[starsgirl78]

I was visiting a friend in the hospital yesterday. She had surgery the night before to repair a compound tibia fracture. Whenever I walk into a situation like that, I never go in letting the entire world know that I am a nurse. I know how it feels to walk in to see a pt and have the family member start out the conversation with "I'm a nurse. . ." and then grill me on everything that I'm doing. I would rather stay back and let the other nurses do their jobs.

Anyway, while talking to my friend yesterday I noticed a few things that really bothered me. Her leg was propped up on a pillow with a chux pad underneath and she had a lot of drainage that had soaked through the dressing and the ace wrap. it had soaked the hem of her gown and had dried at some point, so her gown was stiff and crusty where it touched her skin. I asked her if they had helped her change her gown since she got there because I knew it had to be uncomfortable. She said no.

Then I noticed her foley bag was full to the point that it was backing up into the tubing. I asked her when was the last time that they had emptied it and she said that it was several hours before. Then she told me that she thought she had peed herself earlier. I asked her what she meant and she said that the bed was getting wet underneath her so she called the tech to come in. The tech said that her foley bag was completely full, emptied it, and walked back out. The nurse came in soon after that and she told the nurse that she thought she might have been leaking. The nurse said that was impossible. My friend put her hand down there and brought it up to show the nurse that it was wet. The nurse said, "Oh, you're just sweaty." My non-sweaty friend knew it was urine, but dropped the subject. (I didn't know until I talked to her again today that they never changed her sheets and just left her on the ones with urine. I just assumed they had. If she had told me that part yesterday, I definitely would have done something then.)

When her tech came in, I asked her to please empty her foley bag and she did. The nurse came in shortly after with her next dose of pain meds. She also brought her a foam wedge to use instead of the pillows for propping her leg. When the nurse was positioning the wedge she took the old nasty chux pad out and replaced it with a new one, but then she wadded it up, dropped it on her bed along with her dirty gloves, and walked out of the room.

It was getting later and I had to get home to get my daughter fed and put to bed. As I was leaving, I put on some gloves and cleaned up her nurse's mess. I refilled her water then offered to get her another gown and help her change, but she said she was ok and just wanted to sleep because the meds were kicking in. Had I known before this morning about the pee-sheets, I would have changed them myself! I let her rest, but left pretty upset about her situation.

We're all nurses and we all know how busy things get, but I feel like there are some things that are so basic to nursing that they shouldn't be overlooked. I understand that we may be too busy to spend all day fluffing pillows and chit-chatting, but these things seem so basic to me. They are such small things, but the impact they have on a pt is HUGE. It's demeaning to be left in your own bodily fluids with no way to clean yourself. It's demeaning to wear a garment so dirty that it could stand on it's own accord. It's also demeaning to have the bed you are confined to treated as a garbage bin.

In spite of that, I feel like I would have been crossing the line if I had called the staff out on what they did. In hindsight, I am so mad at myself for not marching up to the station and giving them the what-for. Part of me still wants to write a letter. This is supposed to be the "nice" hospital. This is the "Look at Our Awesome Magnet Status" hospital.

How do you handle it when you are not the nurse in charge? What would you do in the same situation? I am so angry that my friend was treated this way and I am very disappointed that I didn't do more to fix it. Thoughts?

[tablefor9, RN]

I'm so sorry this happened to you, and more, to your friend. I'm always reluctant to lay down the nurse card, too, unless absolutely necessary.

I would have probably asked for a gown and linens when I found out abt the need. "Hey, could I get a gown & linens, I know you guys are slammed, and I can take care of this to help my friend," and just changed it myself. I've had shifts where, honestly, I could not change a gown or sheets in a timely manner, either. I honestly appreciated it when the family/friends were willing to do that for the patient.

Had I been there when the nurse assessed and said it was sweat...I'd probably have asked her to either change the chux or allow me to so that if she leaked again, it would be easy to assess. And I'd have put it that way, perhaps without coming right out and saying, "I'm a nurse".

I only escalate as the need to becomes apparent, and, to me, it's kind of like a patient crumping. You know it when you see it. So, whether I said anything right then, or not, would have depended on alot of factors all living in my gut.

I will say that I'm not above stirring it up with the staff, letter writing to the hospital, or placing a call to the marketing or nursing admin departments, nor do I think we should be. Things change, mainly, when not changing is made more uncomfortable.

[sunnycalifRN]

I also do not tell the staff that I'm a nurse. I've had similar experiences when visiting relatives in the hospital. On one occasion, the foley bag was so full that it looked like a basketball; I did ask staff to please empty it because my relative was uncomfortable. If I see something that needs attention immediately, I will point it out to someone. But, I don't go out of my way to critique the care since I know how busy it can get.

[RNrobert]

I got called out by the mother, who was a nurse, of my patient recently. She did it in a respectful manner and to be honest she was 100% in the right. We all get busy, forget how are actions are perceived, and need to be reminded of what we are there for sometimes.

[Purple_Scrubs, BSN, RN]

I also hate to pull the nurse card, but when you have to, you have to. My hubby had surgery last summer and his day shift nurse did not assess his lungs even ONCE, and I was there the whole time. He was on heavy narcotics and his O2 sats were dropping occasionally, and still no one ever put a steth on him. I felt like either my mom (another RN) or myself had to be with him at all times just for safety! I kept quiet at the time and just kept an eye on him myself, but I did speak to the unit manager at discharge. She was appalled and said it would be handled. I hate to get anyone in "trouble" but if she was charting lungs CTA and she never once listened to him, there is a big problem there!

[kool-aide, RN]

I also hate to pull the nurse card, but when you have to, you have to. My hubby had surgery last summer and his day shift nurse did not assess his lungs even ONCE, and I was there the whole time. He was on heavy narcotics and his O2 sats were dropping occasionally, and still no one ever put a steth on him. I felt like either my mom (another RN) or myself had to be with him at all times just for safety! I kept quiet at the time and just kept an eye on him myself, but I did speak to the unit manager at discharge. She was appalled and said it would be handled. I hate to get anyone in "trouble" but if she was charting lungs CTA and she never once listened to him, there is a big problem there!

That's awful!

[llg, PhD, RN]

I prefer to let people know that I am a nurse -- but I am quick to say that "this is not my specialty" and I just want to be a family member, etc. Then I try to show respect for their expertise and be considerate of their time, etc. I find that showing a little respect and courtesy goes a long way towards establishing a good relationship -- and a "common bond" between me and the caregivers. I try to approach it with a "We're in this together" attitude -- and if they do their job, I will play my part well and try not to be a bother to them.

However ... I don't let bad care go unreported. I ask my questions and make my requests in a polite way (and not a "b****y, demanding way) and give them reasonable leeway in how and when that care will be provided. But I do expect to receive good care and will speak up if it is not given.

[TheMrsRN]

You don't have to play the "nurse card." Even a non-nurse knows that your friend was receiving terrible patient care. Maybe the floor is understaffed and the nurses are too busy to provide appropriate care. If that is the case, the nurses can't do anything about it, but management can. I would ask to speak to the nurse manager and address all my concerns with her. If they receive enough complaints, maybe they will change things. When we (the nurses) complain about something not working well at work, nothing gets done. However, if patient complaints are made regarding the same issues, management jumps on fixing them. I would for sure go back and ask to speak the the nurse manager.

[canesdukegirl, BSN, RN]

Oh man, I know exactly what you mean. It is so difficult sometimes to keep a lid on it when you KNOW that the care is sub-standard.

My BFF had a microdiscectomy and the nurses did not empty her foley bag once. I quietly did it myself and recorded the I&Os on the sheet that was taped to the bathroom door. She did not have any assistance when she was OOB for the first time (it was about 1800, right when things tend to hit the fan), so I did this with her. I worked at the hospital that she was admitted to at the time, and the nurses knew me. I was at first a little taken aback that they just assumed that I would provide nursing care for my friend, but the unit was horribly understaffed and was known in the hospital as a crappy unit. I did feel bad for the nurses, but I also felt that if I wasn't with my friend all the time, she would be sitting in her pee because the foley hadn't been emptied, that she would not be OOB, or that she would not get her linens changed. I saw the nurses only when my friend pressed the call bell and asked for meds.

I don't know if I would have done anything differently. Although I did not let everyone know that I was a nurse, many of the nurses recognized me and commented that since I was in the room, they could focus on other patients. This attitude not only short-changed my friend, but also worried me to the point that I didn't feel that I could leave her.

Tough call.

[ktwlpn, LPN]

I would be upset, too but I would encourage my friend to speak up for herself. I wouldn't feel it was my place to speak for her. Apparently it didn't bother her as much as it did you. If the patient was somone I was very close to I also may have gotten a clean gown and linens and gone ahead and cleaned her up without asking her permission however I have plenty of good friends and relatives who would be uncomfortable with that-as I would be. I'm not debating that the care was lousy but isn't it a patient's /consumer's responsibility to demand the care /service they deserve?

[thehipcrip]

While I agree that it would be best if your friend felt able to speak up for herself, she clearly didn't have the energy to be a strong self-advocate after just having surgery. That's why having friends and family on hand to do what they can to be helpful, which includes advocating on behalf of the patient if/when s/he is unable to do it for him- or herself. You don't need to announce you're a nurse or become *that* friend or family member to express your concerns that a patient, for whatever reason, has been left on soiled sheets and in a dirty gown, that her nurse left trash on her bed(!), and that her Foley back was so full urine was backing up into the tubing.

These aren't nitpicks like not getting any ice at the same time the patient in the other did. Dressings soaked through with drainage are breeding grounds and conduits for bacteria to enter the surgical site, and if left in place for long enough can cause maceration. Being left on urine soaked sheets after the urine has been pointed out is disrespectful, disgusting and unsanitary. The Foley leakage may not be the result of an overfull bag -- it could mean there's a problem with the catheter position or that the patient is having bladder spasms.

I know you can empathize with overly busy nurses, but I think it's a mistake to not at least bring these matters to the NM's and/or the Patient Advocate's attention in person because you assume it's just staff having a busy night.