[smartnurse1982]

hi. i posted on other boards about the same problem but have gotten no response. i had been an lpn doing pedi pdn for 4 yeas before becoming an rn 2 months ago. i have accepted a position in a nursing home since only because every one else said i need acute care experience. however, i am finding it extremely hard to leave my case because, well, i love him and feel awful about leaving him. i want to be there to see him and actually feel guilty about calling out. so what would u suggest(the shifts clash so doing both is not an option) also, to go off the subject, how do u pdn deal with other health care professionals who think u are the home health aide even though client clearly has a trach and gt? I state that i am the rn and they will still say something like "ask the aide?".--as if they have not heard of private duty nurses.

[caliotter3]

When you do private duty, home health and hospice nursing you have to learn how to say goodbye to your patients when you can't work with them any longer. Don't take it to heart. You can't remain on a close relationship basis with every patient you ever work with. The opportunity for problems are too many. A good example is when the patient's family doesn't respect boundaries when you have (mistakenly) provided your home phone number. Even if the patient or family are not taking advantage of you in some manner, then you are doing a disservice to yourself by not providing a more professional boundary. Don't feel bad, most nurses do it to some extent. You just have to realize when you need to pull back. As far as the problem with third parties not being able to distinguish the difference between a home health aide and a licensed nurse, all you have to do is to explain it one time and after that let it go. Unless you are being asked to perform tasks that you are not there to do, there really is no problem.

[ArwenEvenstar]

Could you take the nursing home job, and then just work a day here and there on the PD case (as a prn/per diem)?? I left a PD case after 2 and 1/2 years. I missed the little girl I took care of but it was time for me to move on. But I still pick up a day here and there on the case if someone is sick or on vacation or whatever. So it is nice that every so often I get to see her again. Ya know?

Maintaining a strong and firm professional boundary when doing private duty is
absolutely imperative for so many reasons. For both the family and nurse. Of course, nurses are only human and we will form some attachment to our private duty patients even if we make a strong effort to maintain a professional boundary. It is normal to feel sadness when leaving a long term PD case. Like said, I missed the little girl I took care of. However, you mention feeling guilty. If you are feeling guilty, I fear you perhaps crossed the line of professionalism? Remember, the child is ultimately the family's responsibility. The family is not guaranteed nurses. You should not feel guilty. If it is time for you to move on, it is time for you to move on. Good luck!