getting too close to your patients?

  1. hello. just want your opinion on this. my patients and i always get alone great. i get compliments and thanks from my pts and their families every day either verbally or in a thank you card sometimes with cookies or chocolates. it keeps me happy to know that they found the comfort they were looking for. in about oct. of last year i had a pt three days on a role for 13 hours each. she is well known by everyone b/c she is admitted for CHF every 45to 60 days in average. she is on dobutrex pump at home and has gone over statistics that do not predict pt to live any longer than 6-12 months on this med. i had heard her name before as she sends donuts to the station each time she is in, but i had never been her nurse. Apparentle (as she expressed to me ) she was impressed w/ me b/c bla, bla, bla, a bunch of qualities that she donated to me and i am not sure i deserve them. before I went home the third day, she game me a card that she requested i did not open until i got home. i was a beautiful touching card and a gift certificate for her favorite restaurant. i called her at her room briefly thanked her and wished her well. about a month ago she was back and her husband saw me at the station and asked me to go say hi b/c she was asking for me as she had heard my name being paged. i did so and she asked me to write my address on a book filled w/ names. "i am making a party to thank my doctors nurses and family for their support and helping me survive almost a year with this pump that was not expected to give me so much longer, i want you to come" (again she went on and on with compliments). it was very sweet and i cryied when i read the invitation card, jusst to see what a wonderful human been she is and how sad the whole thing is. she invited 3 out of the many nurses who have been taking care of her for years, (i had her once) a few NAs were also invited as well as her cardiology group and medical MD. the party did not take place until Feb 07 b/c we had a snow storm on Dec. 11 when it was schedulled for. She was in twice before the party and i was not her nurse but went o visit for a minute. if i saw that she needed a pillow, transfer to the chair for a meal or any litle thing, i helped making sure at all times not to step on my coworkers toes. once in a while since i gave her my phone and address she calls me and i return her calls b/c she is lonely and she says that my voice injects her with the energy she does not have, she even said once that the day was dark and the sun came in when she heard my voice. i do not call her unless she does, i can't help not calling her back b/c i think "what if she needs help now, what if she is alone and the dobutrex pump is malfuctioning? she is lonely, i can hear it on her weak, sad voice and then when we talk she goes on and on as someone who need love, company and so on. ssshe tells me "you know you can visit any time you want" i know i am not suppossed but it breaks my heart. she has so many questions and fears about how she is expected to die and so on. after the party she sent me the most beautiful thank you car giving me all the credit for the gifts that my 2 coworkers and i bought for her. (it is true that i had a lot to do with it but she figured it out herself and put me in a very high place that i do not deserve. she called me the other day sounding soooo weak, i had to return her call, i mentioned that my daughter made me an amazing surprise party the day before for my birthday and i was telling her how special my daugther is/ today i got a birhtday card filled with compliments and a gift certificate for a restaurant. i love this lady and mostly it hurts me to know that eve with the great attitude she has, she will be deteriorating and will be dying. i try not to get attached but she loves me and feels that i can heal her just by talking to her. i feel guilty when she gives me all those compliments and i which i can tell her she does not need to do that. how could i possible had prevented this. the bottom line is she needs me and can't ignore that :uhoh21: OH God!!! monica
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  2. 11 Comments

  3. by   nurseygrrl
    Monica~

    I'm sorry that all this is going on. You have to do what's best for yourself and what makes you feel good. Do you like being friends with this woman? It seems as though you took on a big responsibility. Does she have family you can speak to about this? All you can do in any situation is your best. You are giving her a lot by calling her and seeing her occasionally. If this is something you want to do, then by all means continue. Don't feel guilty...you seem like a very sweet person. Good luck.
  4. by   wrkoutgirl
    i am so sure i am sorry that this is going on, i think that in the long run i will be the one to be hurt when she is gone, and i think being hurt is better than knowing that for some reason a human been feels comfortable with me and i am closing the doors to her b/c of some "ethical concerns or whatever" i think that as long as i just talk to her on the phone when she nees to and visiting her when she is in my unit, i cant be doing harm. i guess i can't be assigned to her now, and she has complaint about not having me the last few times she's been in. thank you for your reply i am really confussed, or... not? monica
  5. by   Gldngrl
    Sounds like a tranference/countertransference issue. It's nice that your patient values you, but you need to keep in mind that you established a nurse/patient relationship and that you need to remain professional. I know you're concerned about her loneliness and I wonder if this was addressed during her hospitalizations with social service. Perhaps talking with her physician/social service/chaplain about your issues would generate some ideas on helping your patient deal with her feelings and her chronic illness. Keep in mind that although your patient may be altruistic, she is subtlely manipulating you with gratuities and compliments and it's up to you to maintain the boundaries, while maintaining emotional support.
  6. by   wrkoutgirl
    upps!! there was typeoff on my previous reply. i meant to say "i am NOT sure i am sorry that this is going on. monica
  7. by   wrkoutgirl
    Quote from Gldngrl
    Sounds like a tranference/countertransference issue. It's nice that your patient values you, but you need to keep in mind that you established a nurse/patient relationship and that you need to remain professional. I know you're concerned about her loneliness and I wonder if this was addressed during her hospitalizations with social service. Perhaps talking with her physician/social service/chaplain about your issues would generate some ideas on helping your patient deal with her feelings and her chronic illness. Keep in mind that although your patient may be altruistic, she is subtlely manipulating you with gratuities and compliments and it's up to you to maintain the boundaries, while maintaining emotional support.
    HOW DO I DO THAT WITHOUT OFFENDING HER? SHE HAS TREMENDOUS FAMILY SUPPORT, HER HUSBAND IS IN CHARGE OF CHANGING THE IV DOBUTREX EVERY DAY, IS WITH HER AT ALL TIMES, PRIESTS, NUNS, FAMILY AND FRIENDS ARE ALWAYS IN CONTACT WITH HER. SHE JUST SEEEMS TO LIKE ME FOR A DOSE OF ENERGY AND OPTIMISM AS SHE CALLS IT. HMM!!
  8. by   Gldngrl
    Monica, you don't need to shout in your reply...as nurses we care for patients during some of the most stressful, troubled times in their lives and the fact that some patients feel very close with their staff may help them in their recovery. That being said, I think there is a very valid concern that nurses may unintentionally commit boundary violations and become overly involved with the patient's life. I think you should reread your posts because it's coming across of not only how this patient depends upon your friendship, but how you depend upon this patient as well, to be the friend that doesn't let her down. If she has her husband and a support system, I question then why she's lonely and needs to call you and offer you gratuities...I take it that you posed the question here because you wanted some opinions on the subject, but you must realize that you will receive a variety of opinions, some of which you may like and some that you don't. While there may be a concern that you'll "hurt her feelings", your duty as a professional dictates that you may address her emotions with respect and kindness, while reestablishing the boundaries of your relationship.
    Last edit by Gldngrl on Feb 20, '04
  9. by   wrkoutgirl
    Quote from Gldngrl
    Monica, you don't need to shout in your reply...as nurses we care for patients during some of the most stressful, troubled times in their lives and the fact that some patients feel very close with their staff may help them in their recovery. That being said, I think there is a very valid concern that nurses may unintentionally commit boundary violations and become overly involved with the patient's life. I think you should reread your posts because it's coming across of not only how this patient depends upon your friendship, but how you depend upon this patient as well, to be the friend that doesn't let her down. If she has her husband and a support system, I question then why she's lonely and needs to call you and offer you gratuities...I take it that you posed the question here because you wanted some opinions on the subject, but you must realize that you will receive a variety of opinions, some of which you may like and some that you don't. While there may be a concern that you'll "hurt her feelings", your duty as a professional dictates that you may address her emotions with respect and kindness, while reestablishing the boundaries of your relationship.
    gldngrl. i feel terrible b/c i think you tatally missunderstood me. i don't know where you got the idea that i shout on my reply. if it is b/c i used upper case letters i only did this to differenciate my wrting from yours to make it easier to the reader. sorry, i did not mean anything but that. i also appreciate your opinion and every one of them. this is why i posted this, i am also very opened for criticism and i am awared of the fact that there is always room for improvement on my side. i meant to ask you how can i set boundaries without hurting her, i know she seems me as a friend more than a nurse, as i said before, she just likes me as a person and feels comfortable with me. i don;t know, i really did not mean for this to hapen. please reply to this and forgive me if i came across the wrong way. thank you, monica
  10. by   Gldngrl
    Monica- don't feel bad, it's hard to see one's true emotions behind a post so things can be taken different ways. Just providing you with one opinion- I always remember to argue ideas and not take things personally.
  11. by   Noney
    Difficult situation. If you're not sorry to be in this case then stay her friend. Just don't be her professional. What I mean is during future hospital stays don't allow yourself to assigned to her.


    I would be very careful about excepting gifts from pt's, it can lead to a lot of problems. I would simply tell her that she doesn't have to buy you gifts to be youe friend.


    Noney
  12. by   heart queen
    I DOOOO understand why your heart and professionalism is torn, allow me to explain. As I had mentioned on a few posts I work on a heart transplant unit. These patients stay for months, similar to bonds being formed (I'm assuming) with long term care. We are not just nurses to these patients, anyone can pass pills and shoot swan #'s. We keep their hopes and inner spirit alive, celebrate anniversaries, birthdays, christmas, throw parties. We introduce them to each other with their families... they and their families have become surrogate families to each other. When they go home, they write, they call from rehab, they come to visit. Their family cooks dinners for us, buy's pizza, we buy take out for them (with MD orders) We mourn and cry and cry and cry with a death.

    So my long winded point is that I see it as natural to keep up relations and contact, provided it is a two way street. This is all very new to me, less than six months in but I have never felt uneasy, a need to post about the relationship. That being said, I'm being bold enough to state that although you appreciate their needing you and thinking highly of you, that this is not a good situation for you to be in. The money we spend on each other is NEVER singular. families recriprocate to the unit as a whole, which leads into the buying of attention that is screaming out in your case! I think you're feeling it too, it's just not right and yes, although uncomfortable you needed to have returned the "gifts" and reset the boundaries. Because you didn't ask for a gift does not negate the "bribe" by the patient, however seemingly harmless you try to justify it as, It's a BAD situation that you really needed to halt.

    So you asked, here it is... choose your comfort level and lay your boundaries. A home dobutamine drip is a home health nurse issue, not yours. We refer all questions and conversations like this to the appropriate people after discharge, thus eliminating any conflict, so they can be my surrogate family in my care in the hospital, stoping for a visit or calling me for an update. Once out of the unit, our concern is purely "how are you doing? Tell me about the grandkids. They told you only a few months left.... what do you have planned to make the most of it?".

    I hope I haven't offended you, definately not my intention. Understand that with my position, I understand completely how quickly your situation spiraled. You intentions are so honorable, I wish you could work along side me I respect your caring. But you need to fix this and I think you know what you need to do.
  13. by   wrkoutgirl
    Quote from heart queen
    I DOOOO understand why your heart and professionalism is torn, allow me to explain. As I had mentioned on a few posts I work on a heart transplant unit. These patients stay for months, similar to bonds being formed (I'm assuming) with long term care. We are not just nurses to these patients, anyone can pass pills and shoot swan #'s. We keep their hopes and inner spirit alive, celebrate anniversaries, birthdays, christmas, throw parties. We introduce them to each other with their families... they and their families have become surrogate families to each other. When they go home, they write, they call from rehab, they come to visit. Their family cooks dinners for us, buy's pizza, we buy take out for them (with MD orders) We mourn and cry and cry and cry with a death.

    So my long winded point is that I see it as natural to keep up relations and contact, provided it is a two way street. This is all very new to me, less than six months in but I have never felt uneasy, a need to post about the relationship. That being said, I'm being bold enough to state that although you appreciate their needing you and thinking highly of you, that this is not a good situation for you to be in. The money we spend on each other is NEVER singular. families recriprocate to the unit as a whole, which leads into the buying of attention that is screaming out in your case! I think you're feeling it too, it's just not right and yes, although uncomfortable you needed to have returned the "gifts" and reset the boundaries. Because you didn't ask for a gift does not negate the "bribe" by the patient, however seemingly harmless you try to justify it as, It's a BAD situation that you really needed to halt.

    So you asked, here it is... choose your comfort level and lay your boundaries. A home dobutamine drip is a home health nurse issue, not yours. We refer all questions and conversations like this to the appropriate people after discharge, thus eliminating any conflict, so they can be my surrogate family in my care in the hospital, stoping for a visit or calling me for an update. Once out of the unit, our concern is purely "how are you doing? Tell me about the grandkids. They told you only a few months left.... what do you have planned to make the most of it?".

    I hope I haven't offended you, definately not my intention. Understand that with my position, I understand completely how quickly your situation spiraled. You intentions are so honorable, I wish you could work along side me I respect your caring. But you need to fix this and I think you know what you need to do.
    hello heart queen. thank you for your rply. i agree with all you said and this is why i feel so uncomfortable.this pt thinks the world of me (if i showed you what she writhes about me on cards) it is almost embarrasing b/c i had done to her while i was her nurse the same thing i do for all my pt. she is just too appreciative. i wrote a thank you/ (no more) type of letter that i am putting in the mail today. it took me a long time to make that letter final b/c i don't want to hurt her feelings. it is possible that she does not raalize that it is making me uncomfortable. i am telling her that my caring of her as a nurse is and will always be unconditional and i am touched by her compliments and gifts (two), but that hey are not necessary. thank you again and wish me luck. monica

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