A Definite Over Stepping of Boundaries

[scribblerpnp]

Let me start out by saying that I am a HUGE proponent of Hospice and the Hospice philosphy, and I am sure that my recent experience is FAR from the norm. But I still feel the need to share as both an education to others and as a way to deal.

Recently I have had a close family member die while in the in-patient services of Hospice. During that time she and the immediate family received the best of care. The husband of the woman (married for 45+ years- seemingly happilyy) is obviously going through a dysfunctional grief process (AEB recent events). The husband became very close to the nursing staff due to the length of stay (approx 60 days). After the wife's death, the husband had a very strong need to reach out to one nurse in particular for comfort.

Here's the cincher:

Within less than one after the death of the spouse, the Hospice nurse (single and 20 years younger than the new widower) gave this man her home phone number and agreed to meet with him for dinner and a movie on a weekend evening to "talk" (about two weeks after the spouse had passed). Hmmm, sounds like a "date" to me.

OBVIOUSLY this is a no-no. I have made the director aware of the situation and am hoping this RN receives some re-education and I plan to continue to go further if the RN continues in this behavior.

Also obviously this has caused family conflict at a time when family interpersonal relationships need to be at their most open.

So, what policies/in-services does your Hospice facility provide to the staff about boundaries and appropriate termination of the nurse-pt/family relationship and these types of situations?

It totally sucks that I have to deal with this now too, as it was totally unneccessary. What sucks even more is that I will never forget it, and it will always leave that sour taste in my mouth.

[rubie]

I am so sorry for your loss and that you have to deal with this along with your own grief. I am starting my hospice job on Monday so have no practical advise as to policies re boundaries.

The situation you have described does sound unethical and the nurse involved appears to exhibit poor judgement. It also sounds as though she is furthering her own agenda - be it some personal need she would like met, or worse.

Good luck in dealing with this unfortunate situation.

Rubie

[mc3, ASN, RN]

I'm sorry, too, for your situation and the additional stress this person has caused your family. We don't have an "official" policy. Honestly not sure what would happen if this came up. Even if the hospice did fire the RN for unprofessional behavior, that still wouldn't make her go away, would it?

I'm interested in what others have to say also.

mc3 Hospice:nurse:

[scribblerpnp]

I'm having a friend (who works at the facility) get me the policy. If there isn't one (and there should be), I'm going to write a letter addressing the lack of policy and asking a policy be written as well as a yearly inservice and inservice for all new employees.

So if any of you DO have a policy where you work, I would be greatly indebted if you could post it here or IM me with it. I would like to find HH with actual policies to include in the formal complaint as examples.

I would be suprised if there isn't SOMETHING somewhere that addresses this (either in a policy or employee handbook), as I am sure it is not uncommon for Hospice families to have trouble detaching themselves from the nurse relationship due to the extreme closeness that can develop. And this is where the professional nurse is responsible for making that transition occur in an appropriate manner.

And no, it might not make her go away (especially if her motives are questionable), but it MIGHT keep it from happening to someone else. All I can think about is that I know this type of thing is not appropriate because I am a nurse, but what about the families who don't realize that this is not a good relationship to continue? I would think that teaching the nursing staff about the letting go process that families must go through with their Hospice relationships after the pt has passes would be something that is taught and reinforced.

ANd at the two major hospitals where I have worked (pediatric and a psych) there WAS a policy and it was definitely reviewed during orientation as well as in the employee handbook. There hsould be some kind of structure in place to protect those grieving from possibly being taken advantage of or developing inapproriate attachments.

I DO know that this Hospice does have a policy that family members of the dying pt may not volunteer at Hospice until one year has passed from the date of death.

[finn11707]

I understand the concern. Our agency has a nurse who once married a former patient. It was before I was employed there but, I wondered too. The nurse was good friends with the nurse manager of our hospice and no reprimand occurred.

Our affiliated Home Health agency also has a well respected nurse working. still with in the agency, who married a former patient's wife about a year after the patient died.

Where I worked before, there was a strictly voices rule that we could not see a patient or patient's family member for a year after we had worked as their nurse.

In the same hospital, I work with a nurse who met and married the son of her patient. They began dating soon after the mother was in the hospital and married a year or two later. No repercussions there.

I don't know of particular policies regarding timeframe guidelines about dating, etc. Our annual compliance training definite addresses financial gain---gifts, business interactions and the sort. Though we have a current investigation reported to the compliance line about a nurse who purchased a home from a patient who was selling the mom's home---he said he gave a good price to her. And another patient who gave an expensive necklace to a nurse.

[scribblerpnp]

My main concern is the time frame. I wouldn't think so much about it if it were 3-4 months from now, but two weeks after the death seems a little skeevy to me.

You have to wonder about a woman who is willing to go ona date with a man two weeks after his wife's death. It does bring up the idea that her intentions may not be honorable.

[rph3664]

I understand the concern. Our agency has a nurse who once married a former patient. It was before I was employed there but, I wondered too. The nurse was good friends with the nurse manager of our hospice and no reprimand occurred.

Our affiliated Home Health agency also has a well respected nurse working. still with in the agency, who married a former patient's wife about a year after the patient died.

Where I worked before, there was a strictly voices rule that we could not see a patient or patient's family member for a year after we had worked as their nurse.

In the same hospital, I work with a nurse who met and married the son of her patient. They began dating soon after the mother was in the hospital and married a year or two later. No repercussions there.

I don't know of particular policies regarding timeframe guidelines about dating, etc. Our annual compliance training definite addresses financial gain---gifts, business interactions and the sort. Though we have a current investigation reported to the compliance line about a nurse who purchased a home from a patient who was selling the mom's home---he said he gave a good price to her. And another patient who gave an expensive necklace to a nurse.

It's also very possible that they escaped punishment because they also knew each other from somewhere outside the health care world.

[finn11707]

It's also very possible that they escaped punishment because they also knew each other from somewhere outside the health care world.

Nope, not these instances...

[rph3664]

Nope, not these instances...

Okay.

[tencat]

Very unethical and inappropriate of the nurse. You are right to be concerned.

[marymary16]

So sorry for your loss. Also for the conflict you are experiencing. This behavior is totally inappropriate. I work for hospice and our policy is that there is no contact on a personal level with a patient's family for 1 year after our services have been given.

[AtlantaRN, RN]

I worked with a nurse on a neuro unit. Had a patient that had been a frequent patient, who had a husband who was a big wig at a large telecom company. Said patient died, nurse went to funeral. Next thing you know, she was dating the widower, engaged, then married, all in about a 6 month time frame....Alot of talk between co-workers, but no formal reprimand was ever issued.

linda