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Managing Difficult Families

When I first became a director of nursing, the staff warned me about a “difficult” family member of a resident. My first thought was to wonder how long the resident would be with us? My assumption was that once the resident discharged, the problem would go away. I quickly discovered that when one “difficult” family member leaves, another one comes along. In other words, I needed to learn how to negotiate these difficult relationships and pursue a positive outcome for everyone. After all, that is what nurse leaders do: resolve conflict, build relationships, and improve the working environment.

Many, if not most, admissions to long-term care are precipitated by a health crisis. Families are frequently caught off guard by a fall, sudden illness, or emergency surgery and are adjusting to a new norm within the family. Family members may have been living in some denial regarding their loved one’s declining health, memory loss, or aging process. They are now forced to assimilate a new way of thinking that is not easy to embrace. Here are some tips to help nurse leaders build better relationships with families:

1.       First impressions matter. Several years ago, we had a resident admitted with a hip replacement. The first time she sat on the side of the bed, the bed rolled away, almost causing her to fall. Of course she was terrified, her daughter was upset and angry, and the facility staff looked incompetent. From day one, both the resident and her family complained about everything—no matter how hard we tried to meet their needs. It was an important lesson learned. First impressions matter. Ensure that new residents are welcomed upon arrival. Staff should introduce themselves when interacting with either residents or family members. Teach staff to never leave the room without asking, “Is there anything else I can do for you?” Check on new admissions frequently for the first 48 hours. Being newly admitted to long-term care can be frightening. Ensure that new admissions know staff are nearby and ready to help as needed.

2.       There is a little bit of truth behind every complaint. As nurse leaders we are quick to defend our staff, processes, and procedures, and even ourselves. Nevertheless, there are times when the family is right to complain. There is some truth in their concerns. Listen carefully to family complaints. Just listening can be helpful in identifying and resolving issues. Put yourself in the shoes of the family member. How would you feel if it were your own grandmother who’d ended up needing long-term care? Sometimes education is needed. There is often a knowledge deficit on disease processes, medications, and the aging process. I recently taught a class for family members of memory care residents. After the session, families came up and thanked me for the insight I had provided her on living in a nursing facility and how they could be involved in care. They all commented on how valuable the information would have been to them when their loved one was first admitted.

3.       Engage with families. When families get labeled “difficult,” it can be because we’ve failed to build a relationship with them. Oftentimes, when those difficult ones come to visit, we avoid them rather than engaging. These are the families that need our attention the most. Welcome them to the facility. Ask them if they have any questions. Let them know that if they have any concerns, you want to know right away—better that they tell you than post on social media for others to see! Teach staff how to respond to complaints. If staff are unable to resolve a complaint, ensure they know who can help. Phone families with good news. Too often, the only time a family member hears from the facility is for a report on a fall or medication issue. Call with good news! Give an update on resident progress, reduced falls, increased participation in activities, better sleep at night. This will let the family know you are actively engaged in improving their loved one’s quality of life, not just managing problems.

As I learned in my first DON role, difficult family members will come and go. As nurse leaders we need to be role models to our staff in resolving conflicts and engaging with family members. Be careful not to label family members; instead, seek to understand their situation. Having a loved one in a nursing facility is stressful and there are many dynamics involved. When we have good relationships with families it will translate into an overall more positive environment for both staff and residents.


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