Crossing a line?

Nurses HIPAA

Published

I work in a NICU, and I'm finding myself in a situation where I want to make sure I'm not doing anything that's going to get me in trouble.

There's a baby whose parents both died shorty after the baby was born. I was the first person to hold the baby because of this. I try to not get legitimately attached to the babies in my care, but this is a special case. I got to care for the baby quite a bit and feel like we've bonded (or at least, I have.)

My question is, is it at all appropriate for me to continue this relationship after the baby's discharge? The family member taking custody wants me to remain involved and I would love to, but I don't want to put my career in jeopardy. This is such a unique situation, I feel like more love will not hurt this little person...

Advice appreciated.

Yeah I think you might have to let this one go.

Sure you may calm the baby down quietly, but the adoptive parents need to learn that too. You were like a foster parent.

A hard part of nursing is letting go. Letting go of our patients and having no idea what happens to them once they disappear through the front door. I usually tell my patients "we loved having you but I hope I don't see you here again." It usually gets a chuckle.

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What I'm not sure that I've gotten across is how much this is a special circumstance. I've been doing this for quite a while, and I've always had the mindset of "it was great to take care of the baby, look how much he/she has grown...goodbye, send us a Christmas card" type deal. Even in less than ideal circumstances, I've never had the desire to remain in these babies lives after discharge. This is why I was having a little bit of a hard time and came here. I guess I'm just a little surprised that no one here has that one family that they still keep in touch with. Talking to my coworkers, so many of them have one baby that touched them the most and formed a strong bond with the family.

I would think it was inappropriate if it happened with a bunch of kids...like the nurse just wasn't ever able to let go, but this isn't that.

Yeah I think you might have to let this one go. Sure you may calm the baby down quietly but the adoptive parents need to learn that too. You were like a foster parent. [/quote']

They do though. I'm not taking anything away from them. When she was in the unit, they saw her way more than I did. And I didn't try to see the baby after discharge until I was invited to this ceremony, for that exact reason. I understand that THEY are her family.

I'm starting to feel a little defensive, so I'm going to stop now.

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Specializes in NICU, PICU, PACU.

I totally get where you are. And yes, believe me, we have all had those patients that creep in and make you want to take them Home. I work at a large trauma center and we get babies whose mom's have died in tragic ways or in childbirth or are completely devastated by a horrible twist of fate. The fact that you are defensive says a lot. It is hard to back away, but you have to. I think you will have a very hard time when the family begins to not send notes, pictures etc. this is our job, to get a family to be a unit without us. It is hard.

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If the people where you work at have no problem with it why care what the people here think.

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If the people where you work at have no problem with it why care what the people here think.

Exactly. So to me the fact that OP asked indicates he/she thinks something is a little off with the idea.

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Actually, I asked here before I spoke to people at work. I think I asked in the wrong forum...I can't imagine people outside of NICU having any idea what the situation is. Of course I wouldn't want to keep in touch with an adult patient, or a patient I only took care of for a couple of days.

And it's not about me having a hard time when they "stop sending notes," the fact that someone would even say that tells me I've completely misrepresented my feelings. I'm not surprised really, it's hard to put into words...especially to people who have no idea what it means to bond with a family during the hardest moments of their lives....for months and months at a time.

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Actually, I asked here before I spoke to people at work. I think I asked in the wrong forum...I can't imagine people outside of NICU having any idea what the situation is. Of course I wouldn't want to keep in touch with an adult patient, or a patient I only took care of for a couple of days.

And it's not about me having a hard time when they "stop sending notes," the fact that someone would even say that tells me I've completely misrepresented my feelings. I'm not surprised really, it's hard to put into words...especially to people who have no idea what it means to bond with a family during the hardest moments of their lives....for months and months at a time.

What makes you think that we have no idea what it means? You have no idea what backgrounds and experience we have. I have worked for years in child psychiatry, in settings where we had kids in acute inpatient or residential programs for a year or more at a time, and, while it wasn't a NICU setting, we did "bond with a family during the hardest moments of their lives ... for months and months at a time." We became v. close to most of the kids, many of whom had backgrounds that would break your heart (e.g., victims of horrific abuse). Many of them were far from their own families (because facilities closer to home had been unable to help them), and we were their family for a year or more. But we knew that it was our professional responsibility to maintain our objectivity in caring for these kids and, when they were discharged, it would be highly inappropriate to maintain any kind of contact, however much the kids and families thought they wanted that (and many of them did), and however much we wanted to. Easy decisions are easy; hard decisions are hard. The "rules" are there specifically for the difficult, painful situations and choices, and the rules are your friend.

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If your employer has no problem with it, you have no problems with it, the little one has no problem with it, and her family has no problem with it .... in all reality, is there a problem?

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Specializes in NICU.

I haven't been working in the NICU for very long, but I've already seen a few situations where this happens. We do primary nursing specifically to build a relationship of trust and if a baby is in our unit for a long time, the primary nurse often builds a strong relationship with the baby AND the family. It is not uncommon for these nurses to continue having a relationship with the families after discharge. I know one nurse who had a primary in our unit for over six months - she and the family exchange emails and she visits them. They even plan on the baby calling her "Aunt." Some nurses are Facebook friends with the parents though they have to be very careful about what they post. Most people gradually lose touch with these families over time.

The NICU is not like any other unit in many different ways, but I think it's hard for other people to realize sometimes. I don't think that it's wrong for you to stay a friend of the family as long as it's the family who initiates the relationship. By all means go to the christening if you want to. I don't think it's a violation of any professional ethics to stay friends with people you happened to meet at work as long as they are not dependent on you (which it sounds like they are not.)

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Specializes in NICU, PICU, PACU.

In reference to my statement about the notes, you obviously didn't read what I wrote. I have been a NICU nurse for nearly 30 years, I have taken care of kids that were in my unit for a year or more, so don't try to say that some of us don't get it or understand. I have taken care of babies whose mothers have died giving birth to them, parents killed in car accidents where we sectioned the mom in the triage room., a couple who Lost their mothers when the FOB killed them. So, do I still not get it? You are going to run into so many scenarios in your career and if you get deeply involved with each family and stay involved after discharge, it can lead to burn out. And when you stay involved always remember to keep it on a casual basis.

And remember, when you come to a public board, you will get a lot if responses, ones you like and ones you don't. You have to take them for what they are

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Specializes in ICU.

I think that as long as your boss is ok with it, it is ok to stay *cautiously* involved.

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If your employer has no problem with it, you have no problems with it, the little one has no problem with it, and her family has no problem with it .... in all reality, is there a problem?

My thoughts exactly. Why ask people on a message board what they think when she pretty much received her answer from the people who matter the most-where she works and the family.

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