When family members are more work than the patient.

[snowfreeze]

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!!!

[Elvish, BSN, DNP, RN, NP]

99% of the time my patient is absolutely fine to deal with. Those accompanying them are the ones causing trouble. That said, the troublemakers on my floor are not as common as the lovely ones.

[NursePaula]

I just floated to another unit a few weeks ago, and 2 of my patients families were nightmares, and to make matters worse the patients shared a room so they were feeding off of each other, then in another room I had a patient that was intolerable....a man about 60 years old that actually called me into his room and said "I just pooped on myself and now you need to clean me up" When I asked why he didn't call me he just said "I guess I didn't know I was going" and laughed. I have to admit that I was in the middle of blood sugars and very sweetly told him that I had to finish them, give my insulin and then I would be in directly. I did my duties in less then 15 minutes, and then went in and took care of it. In the mean time his wife had showed up and she gave him heck!!! Loved it. But by the end of the day I was thinking I would rather be back to waitressing again...that passed quickly but I was sure frustrated on the way home.

:nurse:Paula

[UM Review RN, ASN, RN]

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.

This type of family member really makes me angry. When I get angry, I get very calm and very sweet.

I find myself saying, "Well, we can deal with X problem right this minute, but you do realize that I only have a certain amount of time to be here and I'm spending more time with you than with your mother, the patient? In other words, the more time I spend talking with you and resolving your problems, the less time I have to spend caring for your mother. OK?"

[bethin]

Fortunately, the nurse tells any family members in the room and the pt (and it's also in writing that they have to sign) that if they become intrusive, abusive, etc toward any employee or the pt we have the right to escort them out of the building per security. We also hold the right to ask them to leave for baths, insertion of foley's etc. unless a pt specifically asks them to be present.

They are given ONE warning. After that, it's adios. It may be cruel, but it does the pt NO good to have a hovering, abusive family member. I have seen pt's HR go from a normal 75 to 160 when abusive, irritating family members arrive. Luckily, most times after a warning they settle down.

Oh, and has anyone noticed how some far off family members who haven't spoken to their loved ones in years and live in far off places suddenly show up when their mom or dad is sick? They have NO clue what is going on and they seem to be the most difficult to handle. I don't know if it's a feeling of guilt or what, but they want to seem to take over their care when they haven't spoken to mom in 10 years.

[doingourbest]

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.

:wink2:Thanks for your expression of understanding. Unfortunately, everything that you said was done. She was spoiling for a fight. The only thing I had said to her prior to her being 2 inches from my face yelling was "I am so sorry she didn't get her vitiman drink this morning. Pharmacy hasn't delivered it yet and we don't have it in the E-kit. Would you like for her to have it as soon as it arrives?" She said no she didn't want her to have it because it says once daily BEFORE BREAKFAST!!!! She would not allow anyone to rectify any situation or console her. I understand her position. My dad was diagnosed with parkinsons 30 years ago and has since fallen broken limbs gotten MRSA multiple surgeries and lost a limb to MRSA. He has been in and out of multiple nursing homes, hospitals and rehabs. He has been at 3 of them I was working at while I was working there and even after I was working there. They need to be reasonable. If they want one on one care or 5 on 1 care they need to pay for that wherever they may go. We don't have that kind of staffing. Also, I have never seen a nursing home that had an in house pharmacy. They should be happy that all they were missing was a vitiman drink that next morning. Thanks to all of the arguing and pressure we had to put on pharmacy to get her meds there immediatelly, all of the other admits didn't get any of their meds that first evening, and very few the next morning. She had all of the other new family members so upset that they were very angry and nasty and running around causing trouble themselves. When I said to one angry family member while assessing her mother; "you seem very upset, and very angry, If you will tell me what I can do to help or to make you feel better about your mother being here, I will do everything I can to help." She said well my mother has been in her pajamas all day and had her meals in bed. And actually the mother had refused to get dressed and get up. She said that she didn't know how those girls thought they were going to get those clothes on her but she had'nt worn anything but a housecoat for months. She had also not yet been evaluated by therapy for transfers so I told the cna who asked what she should do that she could not make her get up if she was refusing, particullary if we didn't know if she could transfer or needed a lift. Well this family member said but it is not nearly as awful as what they have been through. When they had really been through nothing other than missing a vitiman drink and had caused everyone else to miss real medication that they needed. It was just crazy. I kind of wonder if they came there intentionally to create a lawsuit so that they can get money. The mother is there because she is weak and needs strengthening. No real skilled diagnosis. She could get strengthening through home health. They are harming other patients by being there.

[sugarsmom]

I always seem to get the families that are hovering and intrusive. We have this one frequent patient at the place I work and the pt has a home nurse and parents that are always standing and watching everything that you are doing. They are always telling us that..."we don't do it like that at home....or that isn't the time that we give that med at home." They have been spoken to numerous times by administration, but still the same thing with every admission. Then we have the ones who come to the nurses station instead of hitting the call light.

I like how families are so quick to criticize and give instruction but yet you see very few of them pitching in to help their loved one. I feel like some of them have unrealistic expectations of nurses...that we should come running into the room the minute the call light rings....no matter what else we are doin.

I have figured out that killing them with kindness is the best thing we can do. Just see if there is anything that you can do for the family member and sometimes that tends to help defuse them some.:stone:uhoh3:

[doingourbest]

Fortunately, the nurse tells any family members in the room and the pt (and it's also in writing that they have to sign) that if they become intrusive, abusive, etc toward any employee or the pt we have the right to escort them out of the building per security. We also hold the right to ask them to leave for baths, insertion of foley's etc. unless a pt specifically asks them to be present.

They are given ONE warning. After that, it's adios. It may be cruel, but it does the pt NO good to have a hovering, abusive family member. I have seen pt's HR go from a normal 75 to 160 when abusive, irritating family members arrive. Luckily, most times after a warning they settle down.

Oh, and has anyone noticed how some far off family members who haven't spoken to their loved ones in years and live in far off places suddenly show up when their mom or dad is sick? They have NO clue what is going on and they seem to be the most difficult to handle. I don't know if it's a feeling of guilt or what, but they want to seem to take over their care when they haven't spoken to mom in 10 years.

Cool. Where do you work? I mean not specifically; but hospital, LTC, Rehab?

[bethin]

Cool. Where do you work? I mean not specifically; but hospital, LTC, Rehab?

Hospital, specifically med surg.

[miko014]

This is the thing that sometimes makes me feel like I hate my job. I don't, I actually do like it a lot, but some days I feel like I just want to quit and never go back. And at least 95% of the time, it's family members or visitors who are the problem.

On one hand, I understad how they are feeling. When my family members have been in the hospital, I have spoken up a couple of times if things weren't going the way I expected them to. That said, I have always been nice, calm, patient, etc. I have never yelled at any HCP. But it is a very stressful time for loved ones as well as patients, so I can understand tempers that run a bit high.

On the other hand, though, if I was unhappy about something ANYWHERE, be it at a supermarket, a restaurant, etc., it would be completely inexcuseable for me to fly off the handle the way family members do. I think it's disgusting that we have to put up with things like that. But for some reason, a lot of people don't know what all we have to do, or don't care about any of the other patients. It's ridiculous, and I wish there was something we could do to make people understand what we do, and to make them realize that it's not okay to verbally abuse HCPs (or anyone else for that matter), and that what they are doing is, in fact, abuse.

My first line of defense for this type of behavior is to remain calm and smile, and "kill them with kindness". But when that doesn't work, I tell them how it is. I don't yell, I try not to get defensive, but I just tell them that they can't talk to me or anyone else like that. I did that the other day actually, and I think for that particular pt's dtr, that's what it took for her to realize that she was being unreasonable. She was very well behaved from then on. My boss always makes me take the difficult ones. One of these days, I am going to lose my temper!

I was going to say something else, but I forgot what it was...oh well, this post is long enough already!!! :spbox:

[snowfreeze, BSN, RN]

Thank you everyone who responded to this post, sharing simular experiences and how to deal with family members is reassuring. It looks like most facilities do care about staff and don't let families or patients bully anyone around. Before nursing school it was difficult for me to NOT react in response to confrontations (lost a burger-flipping job as a teen for punching a lazy mouthy co-worker) but all the training and aquired skills have me responding in a totally different manner. Even in the worse situations (like the shift I described) I feel like I am in control and even though I get a bit overwhelmed at times with everything that needs to be addressed in too short a time I get it done or find a solution.

[Dalzac, LPN, LVN, RN]

This is the #1 reason I retired. I got to where I hated families and it was becoming more and more difficult to keep from being nasty to them. I loved the patients and miss them terribly. But I had a gut full of families.

[bollweevil]

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.

Maybe she can get a volunteer or the chaplain to come and help with this family member if she personally does not have time for tea and sympathetic, therapeutic communication, which I agree are good things. It's just that we usually are too pressed by truly urgent matters to spend time in such a civilized way. I truly wish we could.

I made life tough for the staff when my mom was dying. They hated me but loved her. I tried to be kind and be grateful for their loving care of her and I was. But I was also losing my mom, furious with the doctors who had missed her dx and were now killing her with their poison, and was not nearly at my best. A lot of staff tried to placate me, which I think only angered me more because it gave me a chance to talk it all out again, which really didn't help. One was really angry and told me so. That didn't help. I was reporting staff left and right. It was horrible. Not much helped, truthfully. I had to deny my own pain so I could focus on my precious mom, I could do it only briefly, it was just awful. I guess the best approach would have been to tell me privately, calmly, in a kind but firm way that they wanted to help me and here was how they thought it best to do so. The approach would have included me keeping a journal, talking with a social worker and a chaplain, and I'm not sure what else. Just my thoughts.

You have to kindly set limits. We'll be in about every hour. We have 17 other patients that we also must care for and we just can't come in at a second's notice every time he needs something. Other patients's needs are sometimes going to have to come first, as a matter of health and safety. You might want to consider hiring private help and/or having your family members, if you are fortunate enough to have some, come help in your husband's care. Be honest and be frank. Let them get mad. Let them report you and have your boss mad at you. This is the truth, plain and simple.