By Betsy Todd, MPH, RN, CIC, AJN clinical editor
Illustration by Eric Collins. All rights reserved.
Nurses are not always comfortable when a patient’s family member is also a nurse. In AJN’s January Reflections essay, “The Tables Turned,” a critical care nurse describes her attempt to navigate the role change from nurse to family member when her sister is hospitalized with multiple injuries after a bike accident.
Her sister is in obvious pain, but pain management is complicated by a low blood pressure. The author asks her sister’s nurse about alternative analgesics. She writes:
“The nurse, perhaps caught off guard by my question, answered abruptly: ‘I don’t think so. We don’t do that here.’ There was a pause. ‘Don’t do what?’ I asked. ‘We don’t do IV Tylenol,’ she repeated. She did not offer an explanation, an alternative, or say she’d ask another provider… I felt helpless, both as a critical care nurse and as a sister.”
As if to reinforce that the patient’s sister is not welcome to participate in care discussions, the charge nurse soon comes by and suggests that the author “step out to get some rest.”
Of course we don’t know the nurse’s side of the story; perhaps she had already fielded questions from many families that night. In stark contrast to the situation depicted in this essay, when my friend Stella was recently hospitalized after anaphylaxis and cardiac arrest, I was kept well-informed by a terrific team of critical care nurses. They treated me like a colleague, offering detailed updates about my friend’s progress and always listening to my concerns. I felt respected and supported, both as a nurse and as Stella’s friend.
Many of us have had experiences on both sides of the caregiver/family member divide. As caregivers, does our own reaction to nurse family members reflect our level of confidence in our nursing skills? Frustration with aggressive visitors? A lack of empathy? A toxic work environment?
The author notes that this episode, an exception to the otherwise excellent nursing care her sister received, caused her to rethink her own interactions with families. Read about how this experience shaped the author’s caregiving in this month’s AJN. Reflections essays are free.
It was 1992, I had been a Nurse for 14 yrs at the time. Dad had an M.I. and we received a call the night before my husband and I were to travel on vacation. Waiting with my Mom was arduous. Watching the nursing care was stressful. To combat my anxiety, I wrote an extensive poem (with haiku and prose) called “Matters of His Heart” in 1992 when my Dad had an M.I., TPA, & angioplasty (they didn’t stent at the time) 7/92, then a failed angioplasty and ultimately double bypass 11/92. It was extremely therapeutic and cathartic to write down my feelings while he was in the O.R., and then reflecting and writing the significant events since the heart attack. The poem is in my book “Poetic Expressions in Nursing…Sharing the Caring” (out of print). Incidentally, his ticker is fine except for a new problem.
The tables were turned for me last night as I stayed with my 91-year old grandmother in the hospital following her CVA. The night nurse never assessed her, but undoubtedly charted clear lung sounds and normoactive bowel sounds. She wore no gloves and did not bother to clean the hub of the hep-locked IV before inserting the tubing. As an RN, it was difficult to watch, and I finally drew the line when she tried to attach IV tubing that had hung on the pole for hours uncapped after my grandmother’s IV started leaking. As a caregiver/RN I can tell you it was a difficult night.
Sorry about the delay in approving this comment for posting! Technical glitch. What a troubling story. Thank you for sharing it.
Can present quite a dilemma if communication is impaired by either an uptight, overworked or insecure team or a dysfunctional family which by definition describes many families dealing with critical illness …it takes much finessing and strong open communication between staff and family and certainly professional respect when working with medical professional families
It was very difficult for my family when our parents became sick. With 3 sisters
as nurses, 2 as MD’s, and 2 brothers as MD’s too I understood how stressful
It was on both sides. We delegated 1
Spokesperson to deal with the questions so as not to overwhelm the
Staff members. This is the time when our chose. Profession comes too close to home. Family and patient centered care brings some light to this dilemma,
It lessens conflicting emotions and we can refocus back to the center of
attention, the patient. There has to be a medium of understanding to reach a common goal. Use available resources
for help, other than figures of authorities, a chaplain, the personal
MD or a designated trained liaison
Staff to calm both parties down.