Torn apart in PDN

[doodlebuttRN]

Hello, my fellow nurses. I have been thinking for weeks whether or not to post this, so I appreciate your thoughts and any help.

I have been a nurse for over 10 years, in PD for about 2.5. I had never worked peds (I never wanted to work peds) until I started in private duty. For over 2 years, I worked mostly exclusively for one patient, and grew very attached to him and his family. Now I thought I knew all about boundaries and was maintaining mine until, for reasons I still don't know, my agency dropped the case. I was totally devastated. I cried for weeks. And due to a nasty legal battle between the family and the agency, I couldn't visit my patient at all. His parents called me several times wanting me to come to their new agency, but due to a 90 day non-compete, I could not. It was hard for them too; at times I think they were so desperate they made statements about 'nursing ethics' and 'was I following the law' as far as advocating for my patient, etc. I believe they feel that I did not stand up for them or for my patient in the face of these legal issues; but I was told to just stay out of it; that I didn't know all the details. As my dad said, "you don't have a dog in this fight." I was advised to protect myself and my license; and I am glad I did. Knowing what I know now, I could well have ended up in a court room; no matter how I felt about my agency dropping their case.

Well anyway, the 90 days has passed, and the family has said (repeatedly) that they would love to have me back with them. So I signed on to their new agency and am now working 2 jobs. But it isn't working out like I had hoped.

In my absence, they of course got a new set of nurses, with whom they are very happy. One in particular, mom made it clear that "she is now (the patient's) favorite nurse." And I am getting some very passive aggressive vibes from this nurse; the way she behaves; I don't want to go into details but its like she is letting me know that the patient is "hers now." And the family seems to think she is great. I think she is a good nurse; I don't know about her as person though. And I feel like everything I did for them for over 2 years (coming in early, staying late, coming in on days off, etc etc) means nothing in the face of this new person/ agency.

I know I need to distance myself, be professional, understand that this is just a patient; etc etc. But HOW?? It is tearing me up! I love this child, cared for this child 40-50 hours a week for 2 years! I want to be able to work my shifts there and just not care about how things have changed; but I can't.

I hope this post is understandable; I am getting emotional right now. I just don't have any nurses in my life right now that I feel comfortable talking about this issue with. So I am coming to my colleagues at AN; I hope someone with more experience than I can offer me some advice. My heart is being torn apart; how do I distance myself or just have a more professional attitude when my emotions have already been invested? Please be nice.

Thank you in advance for your responses.

[JustBeachyNurse, LPN]

Honestly you need to walk away. Clearly you realized there was much more to the story with the legal battle between the agency and family than you were ever privileged to know.

You are way to emotionally involved based upon your reaction to the new nurse/patient/family dynamics. The family did what they felt was best for them and the child and they have moved on.

Did you stay late/come in early or work on days off without pay? I hope not!!! Even if paid, if you did so without going through the agency first you overstepped boundaries.

IMHO you need to move on. Take other cases with your primary agency though I will strongly caution against working full time with one child. Kids are stable until they are not and then you are stuck without hours if the child ends up inpatient.

It's easy to get attached they are adorable and we are human. Don't give families your private cell number.

[caliotter3]

I think you already know the answer to this. It is the only way you will be able to regain your peace of mind.

[LadyFree28, BSN, LPN, RN]

I don't know if my response would be "nice"; as someone who has enjoyed most of my cases and has never gotten attached-even as the primary nurse or secondary go-to nurse, maybe my opinion you may not want to hear, if so, so be it.

One of the caveats in PDN is that parents do have the "power" to have favorites; according to you, you are not the "favorite" anymore.

Personally, I don't know how that feels and additionally, nurses who I worked with that were that way on cases, I never gave them a second though because I thought they were "too involved," and my focus was that if I wasn't giving excellent, competent care, I would be outta there; and I would find another case anyway; I'm there to guide safe effective nursing care, promote milestone development, and meet their needs-that's it...that doesn't mean I don't engage with the family, but professionalism is paramount and heavily so because when you walking into a PDN case, you're getting into family dynamics and a whole boatload of other things that can blur lines, and possibly garner so many ethical dilemmas that could put my license in question. I know you are aware of this; I'm just sharing my approach of being a PDN nurse that I had-I did it for 8 years, and it has given me a great skill sets-understanding family dynamics, pt teaching and empowerment, thinking outside of the box and empowerment to handle acute situations effectively.

I think moving forward that you can collaborate with the new "favorite" nurse; educate her on your knowledge of the pt and family, and collaborate with her on what's going on. In the meantime, you will have to start building the professional boundary line, remain assertively friendly, but understand that this was a great lesson to be learned; if you went over that boundary line, you could've ended up in a bigger situation, possibly with your license on that line, and I'm SURE you didn't want THAT.

Because of that situation, it's best to stay professional and put in less time there; who knows WHAT the legal issue is...to me, that's a red flag, and you don't want to be a part of that.

[eeffoc_emmig]

Walk away. Period.

[ceebeejay]

LadyFree28 said a lot of truth. I would add, seriously evaluate your perception of the other nurses attitude. Are you projecting that onto her because you have been away for a while and feel out of place? Could she be acting strangely because she feels threatened by stories of wonder she's heard about you? In the end, if she is being a passive-aggressive snot, then lay that back on her. It's not your problem.

Always remember that the families will always look after their own best interest, as should you.

I have some darn adorable clients, who hug me and try to smooch me. I play and kibbitz around, but I always, always remind myself that they are my clients - not my children, not my family. It is hard not to just fall into their world, but you have to keep a professional distance. The families text me pics of the kids, but I reply and delete.

Take care of yourself because you will burn out fast if you get emotionally invested to the point that it's following out of hours.

(((hugs)))

[brillohead, ADN, RN]

You already love this child, so it's kind of hard to "pull back".

I think the biggest thing to do is fix it in your head that the whole "favorite" thing doesn't matter in the least.

Go in, love the kid while you're there, do your job, and leave at the end of the shift. Period.

IMO, the new "current favorite" nurse is simply feeling threatened -- you have the experience and the history, and she doesn't, plain and simple. Over time, hopefully she'll see that you're not trying to "replace" her with the family -- you just want to care for the child during your scheduled shift. And if she doesn't change, that's on her, not you.

[doodlebuttRN]

LadyFree, and all; thank you.

Being fairly new to PDN and peds, I guess I really didn't know what I was in for, working with a single child for so long. I have none of my own, if that matters. I let my emotions get the better of me; something I (think that I) have been careful not to do in other areas of care... you are all right, and I thank you deeply for your thoughts. I want what is best for the child, but the change in family dynamics seems to be beyond me. Like LadyFree said, being the 'favorite' is far less important than delivering the highest level of care possible.

In facility and hospital work, this kind of thing was never an issue for me; I did my job to the best of my abilities; didn't worry about what people thought;not to this degree.

Brillo and ceebeejay; thank you. I think you have also helped me put this in perspective. I think I needed to hear from another nurse what you all said.

Bless you all. Thanks again for your words.

[brillohead, ADN, RN]

And for the record, you're not the only one who has become attached.... my guy was hospitalized for a week, and I went to visit him twice. (And while I was there I cleaned around his Mic-Key, brushed his teeth, helped the RT with the percussion vest, shaved him, etc.... PDN has turned me into SUCH a nursing snob! "I can take so much better care of him all by myself than this whole team of staff can!" :) )

It's hard NOT to care... we're with them for several days a week for long periods of time, performing very intimate tasks. They depend on us, and in many cases we bring happiness to their day/night, which in turn provides happiness right back to us.

IMO, it's okay to care, as long as it doesn't interfere with your ability to provide quality nursing care.

[systoly]

And for the record, you're not the only one who has become attached.... my guy was hospitalized for a week, and I went to visit him twice. (And while I was there I cleaned around his Mic-Key, brushed his teeth, helped the RT with the percussion vest, shaved him, etc.... PDN has turned me into SUCH a nursing snob! "I can take so much better care of him all by myself than this whole team of staff can!" :) )

It's hard NOT to care... we're with them for several days a week for long periods of time, performing very intimate tasks. They depend on us, and in many cases we bring happiness to their day/night, which in turn provides happiness right back to us.

IMO, it's okay to care, as long as it doesn't interfere with your ability to provide quality nursing care.

spot on

when my guy was in the hospital and i wanted to visit, i called my agency to check

if they thought it would be appropriate

they said they thought it would be a nice gesture and quite acceptable

of course you become attached - one smile from your patient and you're hypnotized

my advice, love your patient with all your heart, because when you love someone

you'll only want the best for them without regard for your own gratification

realize the patient depends on continuous care and no one person can provide this

so strive to help build the best team possible and you will have truly done a great service

to your patient

[CloudySue]

Yes, it is hard not to care, to fall in love, to feel like you are part of the family. I always have a corner of my mind remembering that any case can go south in a heartbeat, and families can throw a nurse under the bus if it suits them. I haven't experienced that but I know it could happen. That said, I do allow myself to feel personally involved. I find that it makes me a better nurse, plus it enhances my job satisfaction. I miss my one little trachie girl who was decannulated and no longer needs me, but I keep in touch w mom and we plan to continue our friendship. I cannot imagine not being in this little girl's life, after spending 2-4 nights with her from the time she was born until she was 2 1/2. I told them I want visitation rights!! ;D