Bending and Breaking the Rules in Nursing

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    I readily admit I have either bent or broken some rules that nurses are supposed to stringently uphold. However, I hope I'm not alone when I say that some of these rules seem so cold, bureaucratic and alien. If breaking a rule will make a patient's day a little brighter, if only for one moment, I will toss bureaucracy aside and do something that is normally forbidden.

    I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone’s day.

    Billie is a pseudonym for the septuagenarian nursing home resident whom I first met seven years ago when I was a brand new nurse in long term care. She was a strikingly pretty model during her youth, and even as an elderly woman with a terminal prognosis, she still maintained a whimsical cuteness and a stylish flair through tasteful choices in makeup, haircuts, clothing and jewelry.

    Billie received hospice services because her physician did not expect for her to live another six months due to advanced congestive heart failure. Although she barely stood five feet tall and weighed no more than 100 pounds, her lower extremities were chronically wet, weepy, heavy, discolored, swollen, and resembled crude elephant legs. Diuretic medications did not help to pull the extra fluid off. Neither did pressure wraps, sodium restrictions, or keeping the legs elevated. Keeping her comfortable was an uphill battle.

    She suffered from mild cognitive impairment, but was very well-versed regarding her dietary restrictions. One day she asked me, with the impression of defeatism stamped on her face and a sense of sorrow prominent in her tone, “Will I ever be able to eat a hamburger again?”

    My dark brown eyes made contact with her pale blue eyes. I realized some of the things that I, a young and reasonably healthy adult, take for granted are small pleasures that many elderly nursing home residents will never enjoy again. Most, if not all, of these people will never take another vacation to a faraway city, state or country. Some will forever lose the ability to walk. Others will be robbed of their ability to talk after having a stroke. Still, others will never be able to enjoy a tasty meal due to dysphagia, feeding tubes, pureed textures, restrictive diets, or the notoriously bland foodstuffs commonly served to institutionalized elders.

    I did something I should not have done. I broke a rule. During my lunch break I visited a local fast food joint and ordered a hamburger with extra tomatoes. Since Billie spent the vast majority of her time in her room due to depression, smuggling the burger to her was an easier feat than I had expected. Her eyes lit up with joy and anticipation.

    “Thank you, thank you, thank you!” she exclaimed. She kept her door closed and picked at the burger for several hours, eating the fixings individually before finally polishing the sandwich off. This was the first hamburger she had eaten in several years.

    Billie died a couple of months later. She passed quietly, serenely, on her bed in the nursing home surrounded by the hospice nurse, a nursing student, and myself. She had two attentive adult children who visited frequently, but they did not want to be present during her final hour.

    I broke a rule by supplying an elderly resident under my care with an unhealthy food item. But if it alleviated some of the bleakness of her existence during her final days on earth, I feel no shame for doing what I did. To every rule there’s an exception.
    Last edit by Joe V on May 1, '13

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  2. About TheCommuter, ASN, RN

    TheCommuter is a moderator of and has varied workplace experiences upon which to draw for her articles. She was an LPN/LVN for four years prior to becoming a registered nurse.

    TheCommuter has '9' year(s) of experience and specializes in 'acute rehab, long term care, and psych'. From 'Fort Worth, Texas, USA'; 33 Years Old; Joined Feb '05; Posts: 28,506; Likes: 41,981. You can follow TheCommuter on My Website

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    57 Comments so far...

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    So glad you were there to give a well deserved and cherished treat. Besides, what's the saying? Oh yes, rules are made to be broken. Indeed. I dearly hope and pray that when it is my time to raise a ruckus in a nursing home, there is someone like you around to supply me with a chocolate cream pie so I can go out blissfully happy, face down in dreamy cocoa delight, blowing bubbles in the whipped cream with my last breath. It's detailed in my living will and everything. Btw ...welcome back. Maybe it was my own short attention span, but I missed you around. Hope all is well. Cheers! ~~CP~~
    Last edit by CheesePotato on Jan 29, '13 : Reason: two words: double shift.
    tofu-tofu, bigsick_littlesick, LTCNS, and 19 others like this.
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    Haha, yes! That poor woman had a little bright spot at the dreary end.
    VJHG, MahzieLPN, brian, and 5 others like this.
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    The only reason the hamburger was "forbidden" was because she was in a LTC facility. Had she been at home with hospice or in a hospice residential unit she could have had a hamburger or any other food item she desired.So sad that is not the case with all hospice patients regardless of setting.
    LTCNS, richnurse828, MahzieLPN, and 20 others like this.
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    Brava!! Well done!
    God help the nurse who wont let me have the same!!!! I will haunt that person for rest of their days!

    After my dad stroked and was on a progressive downward spiral, he would still sneak a cigarette and/or drink. Seldom finished either and I was glad to let him do it.

    Miss my dad for sure, each and every day
    Live.&.Learn, VJHG, MahzieLPN, and 10 others like this.
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    this is awesome !! thank you for writing it
    RJmanuone and GradyGramNot like this.
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    We are very liberal with diet and our hospice and palliative care residents.Maybe it's time for your facility to update it's policy and procedures (in her honor) Do some research,write up a proposal,bring it to the admin
    LTCNS, uRNmyway, Live.&.Learn, and 11 others like this.
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    I applaud you!! And isn't that what its all about-the resident??? You did nothing wrong and I admit I've done it myself! Especially with someone on hospice-the special diets should go out the window! I've been known to sneak in a few "special requests" for residents, even though we aren't supposed to give them anything we cook at home, I just couldn't resist a resident when she had a hankering for some New England clam chowder but couldn't have it because it was "too chunky." Well, I brought her some and I sat right by her every minute and she didn't choke once! And the thanks I got far outweighed the chastising I got from the Speech Therapist who thought I was just horrible to "tease" the resident with the chowder, knowing she could not have it again. But if she asks me, I'll bring it in as many times as she wants!
    LTCNS, richnurse828, Live.&.Learn, and 6 others like this.
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    Thank you for breaking a stupid rule...
    LTCNS, lorirn58, chevyv, and 8 others like this.
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    What a great deed you did for your resident! When I graduate from RN school I hope I am able to remember stories like this as I go about my day and am able to touch people's lives like you have. Well done and God bless.
    sallyrnrrt and MahzieLPN like this.

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