How do you quit a case, and do you feel guilty for it?

serotas · Jan 9, 2016

I have done private duty for 26 years but now I work in the office with scheduling . More often that not, the family doesn't care for the nurse and I have the awful job of explaining that she/can't return to the case. I agree though..no lies !! I think it depends on the case whether you want to tell the family yourself or you would prefer the agency to handle it. Personally, I prefer to tell the family myself.

Kitiger, RN · Mar 28, 2016

This may sound unfeeling, and I don't want to sound like I don't care, but I am not indispensable. If I were to leave, they would probably miss me for a while, but - a year from now - they won't even think about me except maybe once in a while. My shift will belong to another, and they won't miss me. Life moves on.

Your life also moves on. What was right for you, what was a good fit then, might not be a good fit now. That's OK.

I'm always honest, but that doesn't mean that I have to explain that which is really my own business.

rnrg · Mar 29, 2016

I want to quit a case that my agency sgain, is begging me to stay on because I'm a high caliber nurse, and the bottom line is NO ONE ELSE WANTS TO DEAL WITH THE CHILD'S PARENTS. I texted my on call tonight and told them I've just experienced the straw tgat broke the camels back and I want off this case immediately.

The parents are bullies and disrespectful to me, especially in front of other nurses or adults. Go ahead, find someone to work your crazy hours snd fulfill your REDICULOUS requests. See if I care. Only one I do care about is the chikd. Hopefully if someone else picks up my shifts they are competent enough. The child is pretty ill.....

OrganizedChaos, LVN · Mar 29, 2016

I want to quit a case that my agency sgain, is begging me to stay on because I'm a high caliber nurse, and the bottom line is NO ONE ELSE WANTS TO DEAL WITH THE CHILD'S PARENTS. I texted my on call tonight and told them I've just experienced the straw tgat broke the camels back and I want off this case immediately.
The parents are bullies and disrespectful to me, especially in front of other nurses or adults. Go ahead, find someone to work your crazy hours snd fulfill your REDICULOUS requests. See if I care. Only one I do care about is the chikd. Hopefully if someone else picks up my shifts they are competent enough. The child is pretty ill.....

I quit a case not that long ago & I never looked back. Once you start getting emotionally involved is when you should pull back. I know it's tough because we work 1:1 but we are nurses, we are there to do a job. If the family is making your job that difficult,

the office/supervisor has been notified then I would drop the case.

Flatlander · Sep 4, 2017

When I quit or request to be taken off a case, I'm not shedding any tears over my agency being inconvenienced, but I do feel a tremendous amount of guilt for (some) patients. Sure, there are the wacky new assignments you never accept again (Mom running around the house naked talking to ghosts, one family decides to turn off the AC in July, maybe a case feels like a big fat lawsuit waiting to happen, etc), but what about the ones you've had for awhile?
If I'm leaving a case because it's gotten stale or because I feel like I'm being involuntarily sucked into the family dynamics, I usually never tell the family. The agency is informed well beforehand, but I feel like the family would take it as betrayal if they knew I was voluntarily leaving, and possibly retaliate in some way. So, I smile big, wave, and never come back.
I'm torn because I'm having elective surgery (weight loss surgery) and will be out for six weeks. I'm agonizing over how to break the news to my patient's family, and whether I should say anything at all (or simply lie about it being some other surgery). I've been the only nurse staffing their case for almost two years, and given their rural location and complexity of the patient, I know they will have a hard time replacing me. I *have* to do this for myself, my health, and my future, but that doesn't help the crushing sense of guilt I feel for abandoningâ€ my patient (whom I adore like my own niece). The family has received a series of devastating blows in terms of the patient's health over these past few weeks, and I figured I'd drag my butt to the AN forums to commiserate.
What is your MO for quitting a case? Do you tell the family, or do you high-tail it out of there without a word? Do you ever feel guilty for moving on? Anyone have any stories?

Thanks for posting this, Nekozuki. I just left a case I was on for a year and 10 months. I had an injury that required me to be off work for 2 weeks following an almost 2 week vacation. When I asked to go back to work, my shifts had already been covered for the whole next month. At that point I had to request a new assignment, which fortunately looks like a "go." This agency pays no vacation or any other paid time off until after FIVE YEARS ! of service.

Anyway, yes. I don't feel guilty, but I miss my client very much and worry that she will feel abandoned and confused about my unexplained and abrupt departure. I asked the agency to explain why I accepted another assignment, but I was discouraged by my supervisor from making contact myself.

I have a master's in counseling psychology and one of the things always stressed in that program was the importance of preparing the client for termination. It was also considered important to recognize that after a long period of working together, both parties will have feelings about ending the relationship. The work at the end was to allow both parties to process and come to terms with issues and feelings that arise and the acceptance that it cannot continue as a friendship because of the professional boundaries. That is the reality.

I believe it is okay to feel sad at the loss of that person. I believe it is okay to miss them. I think it is okay to tell them that you will miss them, and they may miss you, but they and you will move on and get over the missing in a fairly short time. I believe it is important to explain your leaving face to face, if possible, and if the reason would be hurtful, to not explain fully. It is always possible to find a grain of truth and to hold back anything that harms rather than helps.

I don't feel guilty, because it is the agency's responsibility to get the shifts covered and find a good fit for the family.

In my case, I think I'm going to send a brief note to my patient and another to the patient's family to briefly state that I enjoyed working with them, have made a change that will work out better for me, and hope they are well and remain so.

I am interested in what you decide to do. Keep us posted. I relate to some of the issues others raised about agency differences in this area.

smartnurse1982 · Sep 4, 2017

My agency says to me that we now need to give 2 weeks notice before coming off a case.

I do not think that is fair,because things could happen during those 2 weeks.

What if the family tries to retaliate?

I could see many things going wrong there,plus if the family does not want the nurse there,the nurse does not get a 2 week notice.

he or she is taken off the case immediately.

smartnurse1982 · Sep 4, 2017

Can someone explain becoming too "emotionally involved"?

I feel there is one such case where the parents get mad if you do not eat their food and attend the child's birthday parties(I have been on the case for 6 years).

Problem is I am looked at as the "unfriendly,non-caring nurse" because i will not attend parties,eat the food,and refuse to receive pics of the client on my personal cell phone.

JustBeachyNurse, LPN · Sep 6, 2017

In my case, I think I'm going to send a brief note to my patient and another to the patient's family to briefly state that I enjoyed working with them, have made a change that will work out better for me, and hope they are well and remain so.
.

Why would you do this if you don't feel guilty? The family & client has likely moved on at this point and now your note may reopen old feelings. Especially since your agency told you not to, in my agency this could be grounds for termination.

Two weeks notice may not be for the family SmartNurse it can be for the agency to cover shifts. I did two weeks notice for leaving. I was explicitly told to not discuss it with the family as the mom rarely took rejection well.

As far as food. Being a vegetarian with a food allergy (I rarely reveal my specific allergy) those offers stop quickly without insult. I work nights so not much of an issue. Unlike others that there are photos of nurses drinking wine as they work a child's party...i don't do parties. I may do a thoughtful card. I manage to have shifts or other obligations during the parties.

LilyRN99 · Dec 8, 2017

You have to do what is best for you. If I was changing jobs or leaving to go to school, I would probably tell the family if I felt comfortable. They don't need all the details. You don't need to feel guilty. They will find another nurse. And don't they have caregivers (parents or other family) when the nurses aren't there? If I was leaving because I didn't like the case I wouldn't say anything. The agency doesn't even need to know all the details. You aren't comfortable working on that case. That's all they need to know.