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You know it's bad when the first thing the nurse says in report is that the patient is fine but the family....  Let's talk about difficult families.

They didn’t tell you about that in nursing school, did they!?  Nobody warned you!  I know, I know, no one warned me either. You know it’s bad when the first thing the nurse says in report is that the patient is fine but the family is freaking nuts and she needs a beer STAT. Difficult families.

Sometimes they seriously are nuts.  Sometimes they are freaked out because their loved one is sick.  Sometimes they’re jerks.  Sometimes they were a nurse/tech 20 years ago so they act like everything you’re doing is stupid.  Whatever the reason, it makes caring for the patient much more difficult.

First of all, when you hear that in report.. consciously step up your patience game.  You’ll need more patience with this today than a normal situation.  Don’t get pissed about it and dread it every time you have to go in the room, just accept that they kind of suck but don’t let it ruin your day.  Also, all of your interactions are going to have to intentional today.  You’re going to have to try harder with them than other patients + families because they need it.  Every time you walk in that room, walk in with confidence, having intentional conversations.

Uuuhhh what the heck is an intentional conversation, Nurse Eye Roll.. that sounds ridiculous…

Below is how I systematically and intentionally deal with this situation.  It was a little difficult at first, but now it’s like clockwork and I don’t think about it anymore.

I always go in the room and introduce myself to my patient first.  Everything is about them.  Family or no family, this person still needs your care and they should be the center of everything you do.

I tell them who I am, what’s going on today (scans, tests, transfer/discharge, labs, plan of care basics).  During this time, I’m speaking directly to the patient and occasionally look at whomever else is there.  When I’m done with that, I ask the patient, “so who is this (handsome or lovely) person you’ve got here with you today!?”  I always shake their hand and introduce myself to them after I’ve spoke with the patient directly.  It sets a professional tone.

Hopefully, that defuses them.  Maybe they hated the nurse last night and the doctor was short with them yesterday.  Maybe no one has really explained what’s going on to them and they feel completely out of the loop.  There’s a million reasons people are rude/overbearing/mean/condescending/etc.

You want them to feel safe and like their loved one is being taken care of.  Making your presence and authority known initially tends to make them feel better about leaving their loved one in your care.  You want them to trust you.  The more they trust you, the more they’ll let you do your job.

When you have that initial conversation at the beginning of your shift, let them know what the deal is for the day.  What we’re doing, what our plan is, when you can loosely predict the doctor will be around, etc.  (Use “we” terms, because you’re on the patient’s team, getting things done for them.)  Any plans/structure/routine that you can provide is reassuring to people.  Predictability is something that reassures scared family members; remember that as you’re interacting with them.  Even if you think you’re being redundant, go over the plan again.  You are in charge and it enhances your professionalism and authority.  It also makes them feel safe and taken care of during a scary and helpless time.  Their loved one is in your nursey hands and that probably scares them because they have no idea who you are and if you know what the heck you’re doing.

I try to keep things light as much as possible because patients enjoy that.  Typically, they’re in the hospital for something sad/serious/scary, so if you can make them laugh or talk about something not illness related, they light up.  If they see their loved one is in a good mood, that tends to rub off their grouchiness.

Have you noticed that families are typically more stressed than the patients themselves?  I get it; I would much rather be sick myself than see my husband in a hospital bed.  I’m nauseated thinking about it.   However, that doesn’t excuse behavior.

So I give families a little room to push my buttons, but just a little.  When someone is getting rude or demeaning.. Professional Nurse Eye Roll comes out.  My Nurse Face is on, and my matter-of-fact tone is out.

I have on multiple occasions told patients and families that have called me names, said I was stupid, didn’t know what I was doing, etc. something along the lines of :

It is not appropriate to speak to me that way.  I am your nurse, here to care for you, not to to be spoken to in that manner.  I’ll come back when you’re ready to talk.

Most times, the person feels bad right away and stumbles over their words to apologize.  It’s never about me, it’s about the situation and how they deal with whatever is happening to them.  I just remind myself that and then stand up for myself when they cross my Nurse Face line.

Know that line in your head.  Know when your Nurse Face needs to come out.  That line is different for every nurse.  The more aware of that line you are, the more control you have and the less frustrated/mad you’ll get when someone gets crazy.

I know nurses that get super offended every time someone is kind of rude.  They get stressed easily and it’s not worth it.  Just remember people are crazy, people get mean, whatever.  Give it very little power in your heart and mind.

Now these “it just got real” conversations never happen at the end of your shift.  They’re always 2 hours in when you have 10 more hours to deal with them.  Maintain your professionalism when you have additional interactions throughout the day.

An occasional joke goes a long way.  Don’t shun that person the rest of the day, it just creates more stress for you and makes caring for the patient more difficult.  Hook your patient up with some ice cream or a warm blanket or something.  If they know you’re still going to take care of their loved one, they usually chill out eventually.

I feel like I could talk about this forever, so consider this Part I of my two part series about dealing with rough families!

And check out my post on difficult patients.

Anatomy of a Super Nurse: The Ultimate Guide to Becoming NurseyAnatomy of a Super Nurse: The Ultimate Guide to Becoming NurseyDifficult People: Foolpoof Methods - Dealing with Difficult People, Mean People, and Workplace Bullying (Difficult People at Work, Passive Aggressive, ... Dealing with Difficult People, Negativity)Difficult People: Foolpoof Methods – Dealing with Difficult People, Mean People, and Workplace Bullying (Difficult People at Work, Passive Aggressive, … Dealing with Difficult People, Negativity)

 

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