We’ve all been there...getting report when the oncoming shift finishes up and whispers to you that the patient’s family member is a nurse. How do you feel? What is your initial reaction? Do you change your approach to the patient? To the family?

It always made me a little nervous when a patient himself or a member of his family was a health care professional, especially when I was a new nurse. Would he be watching my every move, ready to pounce if I hesitated or didn’t have an answer to a question? Or would he be helpful, offering information and advocating for himself or his loved one?

There was one particular patient* that I cared for when the dynamic of a family member who was a nurse was particularly challenging. I don’t recall the specifics about the patient, only that he’d been transferred several times to different hospitals as a “challenge to wean” patient, meaning he was having difficulty weaning from the ventilator. His sister, a nurse, was his power of attorney and very involved with his care. The issue was that the patient appeared to be in severe pain from contractures and pressure ulcers. He was noncommunicative when he arrived at our hospital, but would have significant changes in vital signs and become diaphoretic and tense his muscles with nursing care. His sister requested that no analgesia or sedation be administered so as not to interfere with his ventilator weaning. 

The team caring for this patient was perplexed. We didn’t feel comfortable not treating his pain, but also were being influenced by the wishes of the patient’s sister. Our hospital’s ethics committee was consulted and a careful balancing act was employed to treat his pain adequately while allowing him to be awake enough to wean from the ventilator.

It was challenging to care for him. His sister would check medication doses and keep track of dosing intervals. It was a stressful time for the staff as we all worked together to provide the best care for the patient while being so closely observed. 

Of course this is only one example. More often, health care professionals who happen to “cross over” into the patient or family member role leave their scrubs or lab coat outside the door. In my next post, I’ll share my own experience being on the other end of the stethoscope. 

*Any identifying characteristics are purely coincidental.