6 Tips for Dealing with a Patient’s Difficult Family Members as a Nurse
You’re about to start a shift report for your first patient, and you sigh heavily when you hear the nurse from the previous shift say, “The patient in room 3 is the nicest, but just let me talk to you about the family first.” You know it’s going to be a tough shift when most of the report is spent discussing the patient’s family members, instead of talking about the patient themselves.
During my decade of working in the hospital on a surgical ECP, my patient’s family members were mostly all amazing and wonderful. Many brought candy, coffee, flowers and thank you cards for the nurses on our unit, acknowledging the amount of hard work we do and continually expressing their sincere gratitude.
But I’ve also had my fair share of difficult family members over the years. A difficult family situation can strain your entire shift and make it much more difficult to safely and effectively care for your other patients.
You may encounter family members who are verbally aggressive, inappropriate, or even come to the bedside clearly drunk, causing all sorts of mayhem. Then there are those family members who just can’t understand 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 STAT doctor for a stool softener because it’s not an emergency , but as we have discussed it several times this morning, I will discuss it with him when he arrives for his daily rounds”.
There will also be family members who see you juggling trays of food, supplies and a handful of medicine and think that now is the best time to tap you on the shoulder and ask for another warm blanket NOW.
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It’s hard enough for a nurse to keep track of all of your patients’ needs, care plans, medication lists, allergies, vital signs, lab results, and medical histories; as well as using your critical thinking skills and constantly assessing complications. Now add a difficult family situation, and your change has gone from difficult to really, REALLY difficult.
Take a deep breath, remember you can do anything for just 12 hours, and try some strategies I’ve used to get through my long shifts with some “high needs” home situations.
1. Be honest and set realistic expectations.
As soon as you are done receiving the report and know you have a family member with higher needs, plan to check into that room first.
Be honest 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 arise with one of your patients, and you have far 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’m going to spend the next hour or two going through morning meds and doing assessments on the rest of my patients.” I plan to contact you again after that. If you need anything before you see me again, please press your call button and we’ll send someone to help you.
Phrases like these give your patient’s support system very clear expectations of you as a nurse and leave them with less to worry about if they haven’t seen you in an hour.
2. OVERcommunicate and plan to spend more time communicating
When I finished my report knowing that one of my patients had slightly more needy family members, I always started my day in this room and planned to spend a lot more time than usual doing my medications and my morning assessment.
First, take a look at all your other patients and make sure they are stable, safe and keep them updated as well. Next, gather your meds, supplies, put your computer on wheels, and head to 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 also write them on the whiteboard. (Yes, it helps!). This way you are prepared for doctor visits and avoid unnecessary medical calls throughout the shift.
This extra communication and time spent goes a long way and will hopefully reduce those call lights as you put the family at ease by providing plenty of information at the start of your shift.
3. Talk a bit and get to know them
I have always really enjoyed this part of bedside nursing. Show the family you care by spending time throughout your shift getting to know them. Ask them about their favorite sports teams, questions about the patient, if they want to share special memories or funny stories, ask about their pets, hobbies; anything really to help them forget about 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 can be scared, nervous, and many have no medical training. As a nurse, you can help set the tone and keep things light and less scary.
4. Bundle your care and try to multitask
This should be something you aim for with all patients on every shift. But it’s a great strategy when you also have bossy or anxious family members. Coordinate or consolidate as much care as possible for this patient throughout your shift
Do as much of your medications, wound care, walks, baths, and whatever else you can at the same time. Add lots of additional training and more care plan updates during this time. It will also help your patient and family to rest throughout the day.
5. Set your limits
Unfortunately, there can be situations with family members in the hospital where lines are crossed, verbally or physically. Be firm and set limits for yourself and the rest of your team. Maybe some bedside visitors are making inappropriate comments about you, being aggressive, insulting you, or insulting you.
It’s understandable that people sometimes need to vent their frustrations and vent. But that doesn’t mean you have to be a punching bag or cursed all day trying to take care of your patients.
When you find yourself in a situation that crosses the line, learn to respectfully communicate your limits. Try saying something like, “I won’t let myself be treated and/or talked about that way. I try to protect your loved ones and take care of them. I understand that 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 close at hand if you need anything in the meantime.
When in doubt, always seek help from co-workers, nurse managers, house supervisors and hospital security if you need help communicating in these situations or if you don’t feel not safe.
6. Involve the family in patient care
Relatives of patients may feel helpless and stressed about not knowing how to help their family during the hospital stay. This is where you as a nurse can choose to spend that extra time teaching and empowering them.
Even small tasks are important. Try assigning them things like elevating their legs with pillows, making sure their headboard is raised to the proper level, and helping them order their meals for the day.
As your patient gets closer to discharge, try to educate the family about patient care tasks they can do at home, such as wound care, feeding tube flushes and the use of their incentive spirometer. Remember, the more the family can do during the hospital stay, the better! The patients will go home with them, not you. For this reason, it is very important to start involvement early and frequently.
Ultimately, you and the patient’s family members should have the same goal. Both of you are there for the patient and care about their safety and well-being first. Family is an important part of your patient’s life and healing process. Take these difficult family situations one day, one hour, one minute and one shift at a time. Try to put yourself in their shoes and remember that they probably have the best intentions. And remember, you can do anything for just 12 hours.