You’re just about to start a shift report for your first patient, and you let out a big sigh as you hear the nurse from the previous shift say, “Patient in room 3 is the sweetest, but let me just tell you about the family first”. You know it’s going to be a rough shift when most of report is spent discussing the patient’s family members, instead of talking about the actual patient themselves.
During my decade working in the hospital on a surgical PCU, my patient’s family members were mostly all amazing and wonderful. Many brought treats, coffee, flowers, and thank you cards for the nurses on our unit, recognizing the amount of hard work that we do, and continuously expressing their genuine gratitude.
But I have had my fair share of difficult family members throughout the years as well. A challenging family situation can take a toll on your entire shift and make it much harder to care for your other patients safely and effectively.
You may encounter family members who are verbally aggressive, inappropriate, or even come to the bedside clearly intoxicated causing all kinds of chaos. Then there are those family members who just can’t comprehend what the nurse’s workload is, and will hit the call button with another question every 5 minutes; prompting you to repeat responses like these and inevitably fall behind on patient care tasks: “No ma’am, I won’t be calling the doctor STAT for a stool softener as it’s not an emergency, but as we discussed repeatedly this morning, I will speak about this with him when he gets here for his daily rounds”.
There will also be family members that see you juggling food trays, supplies, and a handful of meds and think this is the absolute best time to tap you on the shoulder and ask for another warm blanket NOW.
It’s hard enough as a nurse to keep track of all your patient’s needs, care plans, med lists, allergies, vitals, lab results, and medical histories; as well as using your critical thinking skills and constantly assessing for complications. Now add on a challenging family situation, and your shift just went from hard, to really, REALLY hard.
Take some deep breaths, remember you can do anything for just 12 hours, and try some strategies I have used to get through my long shifts with some “high-needs” family situations.
1. Be honest and set realistic expectations
As soon as you’re done getting report and know you have a higher-needs family member, plan to check in with this room first.
Be real with them about when they can expect to see you, and how many patients you have. Set expectations but keep them broad. You never know when an emergency will come up with one of your patients, and you have way too many variables to be able to accurately predict your day down to the minute.
When you leave the room, try saying something like ‘I will be spending the next hour or 2 passing morning medications and doing assessments on the rest of my patients. I will plan on checking in with you again after that. If you need anything before you see me again, please push your call button and we will send someone in to assist”
Phrases like these give your patient’s support system super clear expectations of you as the nurse and will leave them with less reason to worry when they haven’t seen you in an hour.
2. OVER communicate, and plan to spend more time communicating
When I would finish report knowing that one of my patients had some slightly needier family members, I would always start my day in this room, and plan to spend much more time than usual doing my morning meds and assessment.
First, peek in on all your other patients and make sure they are stable, safe, and keep them updated as well. Then, gather your meds, supplies, get your computer on wheels, and head into the “difficult” room first. Take your time, educate, explain what you are doing and why. Review labs, pending tests, doctor’s orders, and give them a tentative plan for the day.
Write down a list of their questions and requests and write them on the whiteboard too. (Yes, it helps!). This way you are prepared for doctor’s rounds and avoid unnecessary doctor calls throughout the shift.
This extra communication and time spent go a long way and hopefully decrease those call lights, as you will be putting the family at ease by providing lots of information for them at the start of your shift.
3. Make small talk and get to know them
I always genuinely enjoyed this part of bedside nursing. Show the family that you care, by spending some time throughout your shift getting to know them. Ask them questions about their favorite sports teams, questions about the patient, if they want to share any special memories or funny stories, ask about their pets, hobbies; anything really to help take their minds off the scary situation at hand.
Don’t be afraid to bring out the sarcasm and crack a joke or two to help everyone relax. Family members might be scared, nervous, and many are not medically educated. You as their nurse can help set the tone and keep things light-hearted and less scary.
4. Cluster your care and try to multitask
This should be something you strive for with all patients every shift. But this is a super great strategy when you have some overbearing or anxious family members also. Coordinate, or cluster together, as much of this patient’s care as possible throughout your shift
Do as much of your meds, wound care, walks, baths, and anything else you can at the same time. Throw in lots of extra education and more plan of care updates during this time. This will also help give your patient and their families opportunities throughout the day to rest.
5. Set your boundaries
Unfortunately, there may be situations with family members in the hospital where lines are crossed, either verbally or physically. Be firm and set boundaries for yourself, as well as the rest of your team. Maybe some bedside visitors are making inappropriate comments towards you, being aggressive, calling you names, or cursing at you.
It is understandable that people need to express their frustrations and vent at times. But this doesn’t mean you have to be a punching bag or cursed at all day while trying to take care of your patients.
When you find yourself in a situation that is crossing a line, learn how to respectfully communicate your boundaries. Try saying something like, “I will not allow myself to be treated and/or spoken to this way. I am trying to keep your loved ones safe and take care of them. I understand you are upset. I will leave the room now and come back later when you are ready to speak to me in a calm and respectful manner. Your call light is in reach if you need anything in the meantime.”
When in doubt, always call for backup from your co-workers, nurse managers, house supervisors, and hospital security if you need help on how to communicate in these situations or feel unsafe.
6. Involve the family in patient care
Patients loved ones may feel powerless and stressed that they have no idea how to help during their family’s hospital stay. This is where you as the nurse can choose to spend that extra time teaching and empowering them.
Even little tasks are important. Try assigning them things like elevating their legs with pillows, making sure their head of the bed is elevated at the appropriate level, and helping them get their meals ordered for the day.
As your patient gets closer to discharge, try educating the family on patient care tasks that they may perform at home, such as wound care, feeding tube flushes, and using their incentive spirometer. Remember, the more the family can do during the hospital stay – the better! Patients will be going home with them, not you. For that reason, it is super important to start the involvement early and frequently.
Ultimately, you and the patient’s family members should have the same goal. You are both there for the patient and care about their safety and well-being first. Family is an important part of your patient’s life and their healing process. Take these challenging family situations one day, hour, minute, and shift at a time. Try to put yourself in their shoes, and remember they most likely have the best of intentions. And remember, you can do anything for just 12 hours.