The Childish "I Wuv You" Act

[LittleTwinStars]

Once in a while, I'll have patients who will tell me that they love me and try to hug me, or tell me that they love me with big Bambi eyes if they think that it will get them out of perceived trouble or gain my favor.

I only want someone to hug me if I have known them long enough to know that they mean no harm, that I don't mind touching me, and that I have given some form of okay to hug me. In the ER, I rarely encounter people who fit these criteria. Furthermore, I am a healthcare professional, not their buddy. My first instinct is to step back and put a hand forward to keep the person at arm's distance, which I do not think is an inappropriate reaction. What I'm wondering is how to verbally set limits and explain why it is inappropriate without seeming punitive. I also want to keep it short. In the past when I didn't anticipate it, I'd simply say, "No thank you."

When I get the Bambi-eyed, "I wuv you," (yes, sometimes in baby talk), I either said, "Thank you," and moved on with whatever was occurring before the attempted distraction, or simply moved on with the conversation and actions. How should I handle the declaration of love?

Yes, I know that some people have mental retardation, are emotionally stunted, or have developmental disabilities that mean that their mindsets are that of children. I don't fault them, but I also want to explain to them why I have the right to be touched only when I want to. Pediatric or psych nurse advice would be great for this.

[Altra, BSN, RN]

I'll tell you my secret. In my urban ER environment I'm considered to be quite "touchy feely" ... because I've mastered the art of touching people who need/can benefit from touch up to the elbow. When I gently clasp the hand/wrist/forearm of a frightened elderly patient in both of my hands I'm clearly providing a lot of hands-on emotional support ... without the intimacy of a hug.

You've gotten some excellent suggestions for wording from several posters in this thread -- I especially use "thank you - what a nice thing for you to say!"

I also find it helpful to remember that if a patient is saying something like "I love you" to me, their ER nurse ... it's likely verbage that they use often. This makes it less personal, and therefore less invasive/intimidating. It's not about you, so perhaps you don't need to be quite so quick to perceive it as a threat to your personal space or professional boundaries.

And don't let the ER environment grind you down to where you don't recognize positive human emotion when you encounter it, even if it's not expressed in the way you would prefer. That can be a challenge -- but it preserves your humanity in the long run.

[redmielita]

If they're mentally disabled, it's not always an "act", they often truly don't realize they're being inappropriate. In these cases, it's fine to gently block or step back and say "Please don't do that/I don't want you to do that" or something of that nature. My folks with MD all want to know what the "right" social behaviors are, and would prefer that you let them know how you'd like them to behave with you. It's not being mean (well, assuming you don't shriek "Ew, gross, get away!" which I'm assuming you weren't planning to!) and the majority won't be offended. The minority, well, it's not your job to please everyone.

[JustKeepDriving]

People like you shouldnt be a nurse or any health care provider for that matter. Care givers should be loving and nurturing as well as good at what they do. You can have the tool and know how to use it but your a cold rod. My opinion. Im entitled to it. Old people children or "retarded people" like you call them, are all one in the same as a you and I. If your one to not want to be touched then find another job. This is not for you. Again my opinion. But you should reconsider. Maybe get a desk job. Or be a nurse advisor over the phone for a health insurance. But I wouldnt want any of my family members being personally cared for by any healthcare provider that has that mentality. I took offense to what you said and how you went about saying it. Like they have cooties or something. I have hugged a homeless man that was filthy. And you know what that was probably the first human contact he had in years. its how we express yourself. Its an act of appreciation. You should feel happy that you are that appreciated. I dont mean to offend you. I apologize. But I really had to speak out.

Good boundaries are one of the best things you can have as a nurse. Not all of our patient's are sweet little old men/ladies looking for comfort. I work as a forensic psychiatric nurse - my patient's are criminally insane, with crimes ranging from rape to murder. Should I just go up and hug them? We have patients that smear themselves down with feces. Some of my patients are quite old and look very sweet and innocent... and are known for coming up to unsuspecting staff minding their own business and trying to choke them to death from behind. Hugging these people would be dangerous.

Usually, when a patient tries to hug me I tell them, "That's inappropriate behavior, you need to maintain arms length distance between staff and your peers." Or I will say, "I'm glad you appreciate my help, all of us at the facility are dedicated to your well being, however hugs are not appropriate here."

These same patient's end up in the ER. Both from my facility and off the street. So should the ER nurse have to hug them? Professional boundaries are very important, they keep you safe, keep the patient safe, and are key to a therapeutic relationship.

[Blue Roses]

When I get to know my patients really well I might exchange a hug here and there because I'm genuinely happy with their progress.

A few weeks ago though I had a lady who had told me that she thought I was the best thing since sliced bread. She called me her 'angel'. I cared for her very well. But the day of her discharge I went to remove her PICC line and she told me she wanted to keep it in so when she needed further blood draws they wouldn't have to stick her veins. She had no reason at all to have the PICC in and the doctor had ordered it to come out. When I explained this, suddenly I was the devil's spawn and she yelled and insulted me. She was known for being manipulative with other staff, but I was silly enough to believe she and I had an understanding. As soon as I didn't let her have things her way, she hated me.

Sometimes patient's use touch and affection to manipulate us. It's a good reason to mantain both emotional and physical bounderies.

[CapeCodMermaid, RN]

I run a skilled nursing facility. Some of the patients are there for a week or two, some for a month or two, and some for years. Some of these people have no families. We are their substitute familiy. I have no problem accepting a hug or kiss on the cheek from a 94 year old lady...I have no problem hugging her back or holding the hand of an elderly gentleman. I WOULD have a huge problem hugging someone I'd just met in the ER...there is a difference.

[ckm2]

people I am from NYC where people respect boundaries (its crowded) and a french Canadian descent the non touchers.

To Touch or not to touch is a cultural habit which should be respected from both sides of the patient clinician relationship.

I do hug patients in dire conditions its rare but I ask them, I sense you need a hug because words are not enough.

For those of you who feel hugging is mandatory I guess you never worked in NYC during the aids crisis. We are clinicians not martyrs.

[boogalina, ADN, ASN, BSN, MSN, LPN]

It's important to be conscious of one's own physical safety when caring for patients. At least on the floor or at LTC they are a known quantity (sometimes), but a brand new ED patient? Who knows?

It's best to stay at arm's length as much as possible. Personal security is the most important thing...it doesn't take much for a hug to become an assault.

Does your facility offer Pro-Act courses? It's an excellent program for enhancing staff physical security while maintaining patient-centered care.

[TheGooch]

Similar thing happened in the ED when I was a tech except it was scabies instead of lice!!!

And let's not forget about bedbugs-they also like to hitch a ride on people.

[jadelpn, LPN, EMT-B]

people I am from NYC where people respect boundaries (its crowded) and a french Canadian descent the non touchers.

To Touch or not to touch is a cultural habit which should be respected from both sides of the patient clinician relationship.

I do hug patients in dire conditions its rare but I ask them, I sense you need a hug because words are not enough.

For those of you who feel hugging is mandatory I guess you never worked in NYC during the aids crisis. We are clinicians not martyrs.

And what in the WORLD does the Aids crisis have to do with touching?! That is a HUGE myth!!

[SWM2009]

In my non nursing career, I work as a DSP with a population of developmentally disabled adults. Most are so sweet and friendly and love to touch, hug, and hold hands. For most of them, trying to explain why I don't want to be touched would be a waste of time as they would not understand. Instead, I have found that finding something else to replace the hugging sometimes works. I will offer to fist bump, elbow bump, or do a little hand wave or something of that nature and that seems to work most of the time.

[LittleTwinStars, ADN, BSN]

I love high fives!

[Veronica.c]

People like you shouldnt be a nurse or any health care provider for that matter. Care givers should be loving and nurturing as well as good at what they do. You can have the tool and know how to use it but your a cold rod. My opinion. Im entitled to it. Old people children or "retarded people" like you call them are all one in the same as a you and I. If your one to not want to be touched then find another job. This is not for you. Again my opinion. But you should reconsider. Maybe get a desk job. Or be a nurse advisor over the phone for a health insurance. But I wouldnt want any of my family members being personally cared for by any healthcare provider that has that mentality. I took offense to what you said and how you went about saying it. Like they have cooties or something. I have hugged a homeless man that was filthy. And you know what that was probably the first human contact he had in years. its how we express yourself. Its an act of appreciation. You should feel happy that you are that appreciated. I dont mean to offend you. I apologize. But I really had to speak out.[/quote']

I agree with your reply. The OP sounds rude and unloving. If people gross you them out that much, they're in the wrong business.