What do I do if the patient's family member is very fresh because I am a sitter?

[leogirl8]

I was sitting with a patient in the CCU. He didn't speak any English. He needed his oxygen mask or his sat level would drop tremendously. He tried to take off his mask at least 5 times every minute, and I am not exaggerating. He also tried taking his foley out, his leads for the ekg, and kept touching the central line area. It was a busy day for me which I didn't mind. However, about 10 minutes before my shift was over, the patient's wife and son comes. While they were putting on their isolation gowns, the sons tells me I could leave since they are here. I told them another sitter is coming in about 10 minutes and I will leave as soon as the sitter comes. I guess the son went to the bathroom and the wife came in. I gave her my seat. The patient took his oxygen mask off again a few times within those short few minutes. I was standing waiting for my relief and the son comes in and says, he is just trying to adjust the mask. I told him politely, that he isnt trying to adjust the mask because he takes it off. He then tells me with the biggest attitude that I can leave. I told him I would and I would tell the sitter when he/she comes and ask the nurse what to do, until then I would wait by the door. He tells me thank you in the most sarcastic way. there was another nurse in the room, the one who takes care of the patient's dialysis. I'm standing outside the door and that son asks the nurse, so the sitter is just here because my dad takes his oxygen off? and that nurse remained silent. i was just very angry. i know i'm there to do my job, but i was there to help his dad out. i wasn't playing around. I just feel like people think it's just a useless job.

[anotherone, BSN, RN]

it is not a useless job! this is comming from a nurse! i wish we had more sitters. i would just carry on with business as usual these comments and experiences are common enough with all employees in health care. if dad decided to yank out his foley and now needs a urology consult i am sure they would throw you under the bus in a second

[SuesquatchRN, BSN, RN]

Oh, honey, some family members think nurses are useless, too. Don't take it to heart.

[NeoPediRN]

I think the son was angry about a lot of other things, and projecting it on you. Try not to take it personally. Families seeing their other family members critically ill brings out the worst in them sometimes.

[NickiLaughs, ADN, BSN, RN]

I can assure you he had no clue how important that oxygen was. Next time mention there's always the option of restraints. I'm certain he would rather have you there than his father tied down in an even worse way.

I love sitters.

[canoehead, BSN, RN]

You should have had back up from that dialysis nurse.

I think I'd have said, "OK, let's watch." Let the patient take the mask off, with the moniter on, and give a play by play as you both watch the sats drop. Talk about the heart having to work harder, and lungs not being up to exchanging oxygen without a supplement. When the son looks shameful, or when you hit the low 80's (make sure you tell them beforehand what your goal sat is) put the mask back on. Watch the sats go back up. Discuss.

If the son insists on being a jackass you can then start the wheels turning for a supervisor to talk with him, document your teaching, or let him escalate and call security on him.

You night have to demonstrate twice, to prove the patient will not put the mask back on himself, duh. Talk about less oxygen going to the brain, confusion, agitation, and not being able to understand directions. Document again. Notify supervisor of results. The son has to either understand the necessity of a sitter, take over mask duties, or refuse the sitter knowing the consequences. Document, and get the charge nurse to witness/clarify with the son what he has learned, and what his choice is.

After all is said and done, make sure you move on mentally. You can't fix stupid, like they say, and jackassedness is just a big old boulder in the middle of some people's brains. They have to be right. Don't feel bad for the father- where do you think the son got it?

[DixieRedHead, ASN, RN]

That breathing stuff is not as overrated as some might think. Just because the son didn't have a clue is not reflective of the job that you were doing. Forget it.

[nerdtonurse?, BSN, RN]

Sonny Boy's a jerk.

Let "Legend in his own Mind" go be crazy on someone else's time, I wish we had more sitters; patient outcomes would be better! Not just for the person who's trying to take their mask off every 5 seconds, but for the LOL or LOM who's quietly dying and nobody notices because everyone on the shift is having to run into "Dad's" room every 5 seconds to put his mask back on, put him back in bed, put his IVs back in, tape his foley back down, etc.

[TriciaJ, RN]

There is also something I call "Guilty Family Syndrome". These are people who neglect their elderly parents. Then when someone gets sick, they show their "love and concern" by constantly harrassing and finding fault with the caregivers.

[leslie :-D]

the son needs education.

you and i know the value of what you're doing.

the nurse needs to have a 1:1 with family, explaining your role.

try not to take it personally and look at the source.

leslie

[AOx1]

The nurse should not have let this occur without comment. The son's ignorance could harm the patient. What if you hadn't understood the importance of your role and the oxygen, and had agreed to leave? If the other nurse stepped out for anything (ex-restroom break, new bag of dialysate, etc) and the patient pulled of the O2 without a sitter to catch it until the next shift arrived, the outcome could have been disastrous if the mask was off during this time.

[ProgressiveActivist, BSN, RN]

This is crude but very effective. Get the nurse to turn the volume as high as it will go on the monitor. When the patient removes the mask and desaturates the alarm will be very annoying to everyone and the family will up his ass telling him to keep the nonbreather on.

Also a high flow nasal cannula set up may be a lot more comfortable for some one like this.