What are the nurse's rights regarding difficult family members?

[Brekka, ADN, RN]

Well this post will be half advice seeking and half venting, I suppose I need both. I was a fortunate new grad, and started my first job as a LTC/Rehab nurse the end of August, less than a month after passing my NCLEX-RN. It was an environment in nursing that was so far beyond what I'd learned in nursing school, but I have adapted and made it through many of my 'firsts' there. One recent issue has thrown me off a little, and that's a difficult family member.

I have experienced many difficult family members in my short time as a nurse already - the overbearing, uneducated, rude, and sometimes just plain daft. I've so far been able to deal with these family members well enough to not only help improve their knowledge and comfort level, but to be told I was one of their favorite nurses. We recently got a new rehab admit with a family member who is beyond anything I've had to deal with yet. I'm told this new admit has been there several times already, and everyone hates having her there because of this family member.

This family member is present in the room with her mother from early in the morning to late at night, and makes constant demands on the staff. We're usually short staffed every shift, and just plain struggle to make it through the day with what we have without having to deal with this person, and the added stress is making it near impossible. This person has no difficulty getting right in your face yelling at you if things aren't done to her standards or on her schedule, she's been known to verbally berate and insult staff for little to no reason, throw things around and even at people, and one time even resorted to harshly pushing someone into the wall.

The first day of her admission she had one of my four CNA's in tears, and another nearly walked out on the job simply because of her. She has yelled, screamed, insulted, and even threatened myself and my CNA's. She's in the ADoN's office several times daily complaining about everyone and everything. I'm being told by my ADoN as well as some staff that has been there a long time simply to treat her well, basically giving her the royal treatment. We have already been bending over backwards trying to meet the needs of this family member, and still have been told we're doing a bad job of it.

I have tried every therapeutic communication trick in the book to try and deal with this person without any luck. I find it very difficult in trying to reward bad behavior like this. I would never let the actual patient suffer because of the actions of her family, but giving her family priority when I have 32 other residents/patients to care for seems very wrong to me. My first question was why she was even allowed back, since she's been like this the last four visits, and my second was why I had to make this person happy.

In the end, I'm faced with the difficult choice of how to deal with this person. I firmly believe that there is no excuse for this type of treatment, and that there's no reason I should accept this kind of behavior. I have come to the aid of my CNA's with this person, defended them, and even stepped in to take the onslaught to protect them. I carry a phone with me at all times ready to call the police if she chooses to get physically violent with anyone, I step in and attempt to talk her down when things heat up, and usually walk out after telling her, "I cannot talk with you when you're like this. When you calm down you let me know and we can talk about what's upsetting you so much."

I'm now told I may lose my job for not giving into her demands, for walking out on her, and even for considering calling the police on her. I'm frustrated that I'm expected to simply take whatever she has to throw at me and my staff, and that my employment is even remotely threatened by my desire to keep myself and my staff safe. I know the best way to deal with difficult family members is simply to do what they ask with a smile, but where do you draw the line? How far do you let things go before you stand up and say, "no more!"

[SweettartRN]

You and your fellow team members need to meet with your manager, explain the situation, and the nurse manager needs to call a family meeting to discuss this.

You can also always call the police if it gets too heated.

[uRNmyway, ASN, RN]

I would recommend that you document, document, document. Everything she says and does, objectively. Time, place, detailed description of event, who was present/witness, etc. Sounds like this is someone who might try to make your life difficult in more ways than threatening your job, especially if you threaten her self-entitled sense of power over you and the staff (ie having a phone to call police on her and all) This is not to say that you don't have EVERY RIGHT to protect yourself and the rest of the staff.

I completely agree with you in regards to not wanting to just bow down to this person. After all, we shouldn't just give in to temper tantrums performed by toddlers, so we sure as heck shouldn't indulge adults who should very much know better.

Have you tried to sit down with her, discuss WHY she treats everyone like this? I might be way off base, but from reading many posts on here it seems like there is a sense of loss of control or power that occurs with patients who are in and out of hospital, rehab, etc. It seems to also affect their family, especially if these people are the primary care givers. Maybe she had her relative in places where she wasn't cared for properly. Maybe she is trying to advocate for best care possible because she has heard countless horror stories that happen in the LTC setting. Or maybe she is just a sociopath with a God complex. Who knows?

On that note, if you do offer to sit down in a multi-disciplinary meeting, and either it does not help, or the meeting itself does not happen, I would start looking for more work. It is not fair to you to have to move on, but seeing as how your employers absolutely do not have your back and only want you to reinforce negative behavior, to the extent of threatening your job, I would move on. After all, at the end of the day, you need to worry about your ability to pay your own bills, not everyone else.

Just my 2 cents...

[Altra, BSN, RN]

What concerns me most is the part of your post where you state that you have been told you may lose your job. Is it your management who has told you this? If so, then they have made clear how this will go. But you can try ...

I would suggest that you and your coworkers, as a small group, ask to please see your ADON and discuss this. Do your absolute best to be factual, unemotional and professional. Stress the ways in which this person disrupts the care environment of all of your patients. Before this meeting, decide as a group which specific behaviors/demands you want the ADON to address -- demands for changes of meal times, care plans for meds/treatments/therapy ... whatever is most vexing.

It sounds as if this person's behaviors and the facility's response to them were set before you arrived ... and so this particular battle may be lost. In the future, when you have a new family member who appears to be ramping up, you might be better prepared to contain this from the beginning.

I wish you luck.

[CT Pixie, BSN, RN]

I had one family member very much like you described. Management was always getting calls from the patient's daughter. Management had incident report after incident report from staff that had been verbally abused by the daughter..some had even had the daughter being violent toward them (throwing things at staff, grabbing them by the arm and pulling them back, pushing and shoving etc) Document, document, document is what we did.

I did fairly well at not being verbally attacked by the pt's daughter for the most part and had never been physically attacked by her. When she walked on the floor it was like the entire unit sucked in their breath...we would wait for the tirade that was sure to ensue. She was known to search the room floor to ceiling and everywhere in between just looking for a reason to complain. She came out one evening screaming and throwing what was in her hand because the shade on the window was literally 6 inches higher than SHE wanted it (yes, she had marked the window frame exactly where she wanted the shade to be opened to at all times), she failed to realize that while SHE wanted it where it was, her mother wanted it higher up that evening.

One particular evening, she was in an even more foul mood than usual, which was quite apparent the second she walked on the floor. Within 3 minutes of her walking in her mothers room she came flying out toward where I was standing at my med cart. She came over screaming about a dress. I tried my best to calm her down and quiet her down so that I might understand just what in the heck she was talking about. Long story short nothing I said or did was calming her...she had her finger pointed in my face about an inch from my nose...all the while little droplets of saliva being shot into my face as she screamed within inches of me.. And backing up didn't help she only moved in closer and screamed louder.

I calmly told her until such time she could lower her voice and talk to me in a calm manner I would not be speaking to her. She shut up...and, calmly I walked away. Like a flash she had run up behind me, spun me around and pushed me against the wall screaming about how she would kick my *** as well as other threats of violence toward me. At that time the entire unit was aware of the situation. The nurse on the unit across from my started to approach. I looked the daughter dead in the face and somewhat loudly said, "Ms X let me ask you..if someone came into your business screaming and yelling, and then pushed and shoved you or your staff against a wall, would you simply tolerate it or would you do something?" She told me in some very foul, colorful language that she'd have the person taken out in cuffs.

With that I smiled sweetly and said "here is your ONE and ONLY warning, if you EVER put your hands on me again, I promise you, I will have you arrested for assualt and battery!"

I called the DON at home and told her exactly what happened. I also sent off an email to her, the ADON, administrator and the other powers that be stating that if this woman EVER came at me like that again, I would have her arrested right in the facility, as well as contacting my lawyer regarding my options of filing a suit against the facility for not keeping the staff safe. Since she was well known and it was well documented that she was not only verbally abusive, but like she did with me..a bit free with her hands.

big powwow was held with the patients son (who was the POA and who was mortified by his sister and her actions), the daughter and the head honchos. Guess it worked, Ms X was never again quite so liberal with her hands and throwing things in the remaining time her mother was a patient at that facility.

[Do-over, ASN, RN]

If a visitor attacked me physically, I would call the police. If a visitor threatened me, I would call the police. I would have done the same at any of my previous, non-nursing jobs. If it was my patient (who was alert and oriented) I might give them a warning first - but you bet your sweet fanny it would be reported to all and sundry.

Fortunately, I have not been subjected to anything like what is described here, and I have confidence that my current boss would not tolerate that type of behavior.

I am, apparently, an intimidating person. Or, can be, if the situation warrants. I honestly have not had anyone talk $hi& to me in a very long time.

[CapeCodMermaid, RN]

If a visitor threatened one of my nurses, I would expect that nurse to calmly walk away and call me so I could deal with it. If a visitor pushed, hit, pinched or put hands on one of my staff, I would expect the staff member to get to safety and immediately call the police. We are there to take care of people, not to be insulted or assaulted.

[VICEDRN, BSN, RN]

I'm going to tell you plainly: stop putting up with it. This person is doing what she can get away with. Call the police next time she threatens or abuses one of you. Priod. End of story. If this incident were to end in tragic violence, you would NEVER forgiven yourself.

[N.U.R.S.E.]

Run forest run if management feels that way run

[sandyfeet]

I'm appalled at the lack of support you are receiving. It is NOT acceptable for a family member to treat a nurse that way. No where in your job description did it say you have to be a punching bag. I see that you just passed NCLEX and this is your first job. I'm in the same boat as you, new grad and first job! But when I am threatened at work, staff come running. This kind of behavior cannot be tolerated. There is probably a reason you were assigned to her instead of the other experienced nurses--they are hoping you will put up with her behavior. I wish the best of luck to you.

[PRICHARILLAisMISSED]

I'm going to tell you plainly: stop putting up with it. This person is doing what she can get away with. Call the police next time she threatens or abuses one of you. Period. End of story. If this incident were to end in tragic violence, you would NEVER forgiven yourself.

I would completely agree with this, except that the OP was already threatened with the loss of her job after bringing this woman and her behavior to light. Even if she can't technically be fired for calling the police, what most likely WILL happen is that management will find another reason to legally fire her. This could be over a previous (however minor) violation that management can fan the flames over, or just keep an eagle eye out for the OPS next violation (again, however minor it may be).

Perhaps with supporting documentation of this pt's family members actions she can possibly sue her employer after getting fired for a variety of reasons (documented harassment at the workplace continually not being acted upon my management, unsafe work environment). But she will have to find a way to support herself in the interim.

[PRICHARILLAisMISSED]

OP, I'd follow the other posters suggestions and document EVERYTHING. And I mean every incident like this even if it is with a different pt/pt family. A long history of this not being acted upon will go a long way if you have to take your employer to court over a wrongful termination. To avoid courts altogether, you may even be able to threaten the use of this documentation as a way of not being terminated to begin with.

I'm not an attourny so I don't know. I'm sorry for your situation.