When family members are more work than the patient.

[snowfreeze, BSN, RN]

Last night I spent as much time charting on and finding resources to deal with a very tired and inappropriate family member as I did charting on 3 patients and an admission near the end of my shift.

I am grateful for all the assistance I received from co-workers and VERY happy with the cooperation of my charge nurse and last nights supervisors positive response to this situation.

The extra work started about an hour and half into a 12 hour shift. Four hours into my shift I had this family member in hysterics being consoled by another nurse who was caught up on her assignment so I could start my med pass an hour late.

Patient incontinent frequently, everyone helped with the code browns.

Family member verbally abusive to staff while they are trying to care for this patient. (We don't care, we shouldn't be working here if we dont care, we never come in the room when call light rings, why do we work if we hate our jobs) I suspected the family member would escalate in behavior near the beginning of my shift and told the Tech to get me or someone else to go in that room for any patient care. I had this patient a few nights ago and had told the Tech to get myself or someone else to go in that room for care that night too as the family member was demanding but also hovering over patient and would be in the way and make a single staff member wait to care for patient needs while family member vented and wiped brow, fluffed pillows, pulled sheets up, pulled sheets down to show incontinent BM etc, etc, etc. Usually a 5 minute ordeal of dealing with family member (teaching nursing 101 in laymans terms) before dealing with patient. And yes the family member is staying in the room with the patient. (another vent all together on media portrayal of bad care everywhere..families feel they need to supervise trained medical staff 24/7)

Documented all family member behaviors in patients chart, finally family member at breaking point, very inappropriate and demanded that the Tech not care for this patient anymore. Family member apparantly perceived the Tech asking the patient to please stay on his side while she cleaned him as being nasty toward the patient. Ok so now I have to get the Tech from the other side of the unit for the frequent needs, pull up in bed, repositon, clean up incontinence.

All attempts to try to reorient this family member to the fact that every hour or less someone has been in this room caring for patient and family member needs.

Charge nurse now in the mix, made aware of the need for that Tech to not enter the room again this shift and what happened.

Social Worker consult placed, more charting.

Meeting with Supervisor and all staff involved and write statements.

Case Management and the docs involved with this patient will be informed of events that happened this shift.

A meeting with this family member will be arranged to help resolve issues and investigate unknown and unvented issues on their part.

I am exhausted but feel like I might have made a difference, staff should not have to deal with things like this, a toxic environment. I documented everything and am so Glad to work with such Good people.

I am a travel nurse and this is my first week at this facility!!!

[UM Review RN, ASN, RN]

Wow, sounds like my unit.

No, really, some of the family members are way worse than the patients. We have to do our best to keep them happy, but it really chaps my hide that the incontinent, nonverbal, total care in the next room (or even the next bed!) cannot get the same degree of care because we're too busy doing CYA stuff for the squeaky wheels.

The good thing is, usually we have no problem at all getting these patients discharged as soon as humanly possible because the docs get tired of listening to it as well, and they realize what a strain on the entire unit's resources these people are.

If they only knew how hard we all pulled together to get that patient out of there, they'd stop the complaining and the patient might actually get better.

You have my sympathies. All I can suggest is trying to get the doc on board with D/C as soon as the condition permits and getting all your ducks in a row for that blessed day.

[UM Review RN, ASN, RN]

Another thing you might try:

When the call bell rings excessively and the patient doesn't really have an urgent need, try looking at the family member with the humblest, kindest, most sympathetic face that you can muster, and say (when you can get a word in edgewise), "Oh dear, what a terrible strain this must be on you! Tell me, are you getting enough rest? When is the last time you've had a hot meal?"

Family members are just not themselves when a loved one is sick. They're distraught with fear and worry. If you show concern for their emotional needs, they'll often realize how on edge they've been and if they can vent a little bit about it, they can calm down and act more normal.

So sometimes a sympathetic ear and a cup of hot tea works wonders.

It helps them bond with you and see you more as a concerned person rather than a cog in the healthcare machine. I've had repeat patients whose families have come back to thank me for taking the time to do that. The 180-degree change in their attitudes is often nothing short of astonishing to me.

Hope that helps.

[snowfreeze, BSN, RN]

Thanks for the support Angi O'Plasty. Getting the docs on board seems to be the issue here...Case Management can handle that I hope.

[snowfreeze, BSN, RN]

Angie, that worked two nights ago LOL

[snowfreeze, BSN, RN]

Unfortunately my other patients were kinda busy too, one discharge finally at midnight and a CT scan around the same time and restraints finally ordered a few hours later on another one.

[snowfreeze, BSN, RN]

Plus the admit a few hours before end of shift made for no time to deal with the family members issues properly.

[ICRN2008, BSN, RN]

I feel for you- it sounds like you handled the situation pretty well.

I dealt with a parent today who was in a similar state. He had a history of swearing at the staff, being inappropriate, etc. Today, he pretty much stalked me in the hallways every time he perceived that there was something I was not attending to fast enough. He stopped me as I was going into a patient room to tell me that he needed formula instead of using the call light. He yelled at my charge nurse when she tried to talk to the patient (1 year old, very cute) in the hallway. He came and found me outside another patient's room to let me know that my IV pump was going to beep. He stood over me (1 foot away) while I programmed the IV pump or did assessments. He chewed out the kitchen staff for not having the right flavor of baby food. In essence, it was a unnecessarily stressful day because no matter how hard I tried I could not get this parent to see that his behavior was inappropriate. I did everything I could not to escalate the situation. I worked with him the whole shift and by the end he was being decent with me. But, I'm sure that the next nurse had to start all over again. When will parents learn that we care about our jobs and that harassing the nurse will not get you anywhere?

[CHATSDALE]

so days/families are like this, tomorrow the sun will come up, these people will go home, and we are keeping our fingers crossed that their replacements are not worse

[Ms Kylee]

I HATE when this happens... and I've dealt with it frequently lately.. I just smile and nod... They usually settle down when they see I'm not going to take the bait.

OTOH, a patient's wife told me it "wasn't fair" that I was the only one that would clean up the patient after a very large BM. Then she told me she could never be a nurse because of always having to clean patients up. I told her it was just part of the job, and dug in. Fortunately, she seems appreciatiave of everything I do for her husband.

[doingourbest]

We have the same kind of issues. I work in a skilled nursing unit of a long term care facility. Last night we had five admissions. One of the five had family that was on a rampage from the minute they arrived.:argue: They also recruited the family of another new arrival in their quest to destroy. This family was still on a rampage this morning and actually getting in our faces and yelling at us. They were directed to me after a coworker was trying to assist them in finding out if their mother had received her vitiman drink this morning. The family member was yelling at him that she did not receive it and the medication aid with 60 residents to pass to and 5 new admits said that she didn't remember for certain if she had gotten it but that she did not sign it so it probably wasn't there from pharmacy yet. The nurse was just looking to be certain. Then she said so you ar telling me I can't beleive anything my mother says and that she is lieing. We got a whole rampage about that and despite his protests that that was not what he meant at all, she proceeded to tell everyone she spoke to after that that he told her she couldn't beleive what her mother said. She insisted on having all of her mothers medication records right that minute and insisted that I go get the administrator from his office right that minute. I told her I would call him and tell him she wanted to speak to him. Before I had even went from her room to the nurses station, she had marched off around the corner to his office herself. Fortunately, I am at a facility where the DON and the administrator are more than willing to tell them that if they are unhappy with our services they are welcome to go somewhere else and that we will provide transportation. Unfortunately they didn't take the invitation and are taking turns with other new resident's families pressing the call lights for no reason and timing how long it takes for it to be answered. They even said that is what they are doing. They have got every one in the facility so busy explaining and proving things and giving them information that they are actually causing delayed care for their family member and everyone elses. Hopefully they will just leave so that we can actually get back to the business of taking care of people.

[chase4myheart]

In my LTC facility, we deal with many family members like this. I think that it's because they are feeling guilty that they can't take care of their loved ones at home. Because of this, they scrutinize every aspect of their loved one's care, looking for faults. Psychologically this gives them a feeling of control over a situation that they have completely lost control over. I know that there are times that you just want to tell them if they can do the job any better then just take the resident home and care for them theirselves, but, of course, we can't say that. I have found that giving the family that little bit of extra attention, inquiring about their health, and showing genuine concern can go a long way in turning these families around. I also keep these families very informed. For example, such and such person, ate 50% of their supper, was up in their wheelchair for activities, rested very good tonight, heat was kept on in room with extra blankets for patient, etc. goes a long way to assure them that we are taking care of their loved ones. I also call these family members and let them know immediately about any new orders, lab draws, etc. Again, this gives the family members a feeling of control again. I realize that this takes extra time, but if a little time spent doing this can prevent a night of complaints involving everyone from the CNAs to the DON and the Administrator, then it is definitely worth it. I actually had one family member thank me yesterday when I called to tell her about a change in medication for her mother. She said that she just wanted to thank me and the facility for the loving care that we showed her mother. I just wanted to print her statement out and frame it in the nurses station. Compliments like that remind me of what nursing is all about. Again, just remember that these family members are having a difficult time accepting the sickness of their loved ones. They are scared and taking it out on the people in their line of fire. Then grit your teeth, bite your tongue, and go to work doing damage control. Believe me, I feel for you and walk in your shoes every night.