boundaries becoming blurred

MattNurse, MSN, RN · Mar 16, 2012

I would stay out of it.

Double-Helix, BSN, RN · Mar 16, 2012

I do not think you should report it. The relationship between the primary nurse and the family is the business of the primary nurse and the family, provided that the child is not in any danger. If something were to happen to the child while at the nurse's house or in the nurse's car, then the agency would find out and the nurse would be disciplined accordingly. Since you don't know the nurse or family very well, they quite possibly could have made arrangements with the family and company to transport the child in their own car.

Since you're new to home health, you will find that it is incredibly difficult, nearly impossible really, to maintain the company's version of professional boundaries. You are working in the family's home, very closely with them and the child. That's an intimate relationship that requires trust and friendship from the get go.

In regards to the phone number policy- say the family is visiting friends at night and running late. Your shift is supposed to start at 8 pm. The family doesn't have your number. So they call the company, but the company is closed. No one is checking non-emergent messages this late, so no one contacts you to tell you to arrive later. So you end up sitting outside the family's home for two hours because the family couldn't contact you. Or say that the family want's to take the child out for a hike during your shift. They call the company and ask them to inform you to bring comfortable clothes and shoes, but by the time the message is passed on, you've already left your house. So as a result you have on tight jeans and heels because the family couldn't just call you. See how silly this is?

Are the nurse's actions crossing a boundary line? Yes, they probably are. Are they harming the patient, the family, or putting anyone at risk? No, they aren't. Could this relationship be beneficial to both the child and the family? Yes, it could be and very likely it.

"I don't want to get this very nice and capable nurse in trouble and risk her license because she does provide excellent care for this patient and the family benefits from her care by keeping this child healthy through her good care and out of the hospital."

^^ Exactly.

caliotter3 · Mar 16, 2012

Everyone involved will find out soon enough that this was a bad choice when something untoward happens. The only thing that would happen if you report it, most likely, is that you would be put into the "troublemaker" category. Keep mum. If queried down the line, "Oh, since this was not discussed with me, I knew that the agency must have given their blessing to the practice, so I minded my own business", should be a sufficient comeback.

allnurses Guide · Mar 18, 2012

I agree with everyone else. I would not report that.

cayenne06, MSN, CNM · Mar 22, 2012

You know, they might be blurring boundaries but as a home health nurse and the mother of a SN child, let me tell you that it can sometimes be difficult to find opportunities for your child to socialize with other kids. It sounds like this is happening when the nurse is off duty, right? I think the family and the nurse have developed a natural friendship and while it may be "crossing the line," it sounds okay to me. If it is happening when the nurse is on duty, I agree she probably shouldn't be transporting the child herself, but I would not report it.

CloudySue · Mar 22, 2012

I concur with the importance of having each other's phone numbers. The agency does not want you to do it because if anything undesirable happens because of it, they can wash their hands of the issue, citing their own policy. I work for an alert and oriented teen girl who, despite her use of a wheelchair, has a very active and social lifestyle. There have been many times where she'll text me with something like "I hope you didn't leave yet! We're still at dinner and I lost track of time!" If we would have relied on the agency to convey that, I would probably have been sitting at her empty house for 45 minutes before getting a call. And yes, it's so easy to cross that professional line. We adore each other and she's been known to text me to chat as a friend, she's even sent me pics from her vacations. I allow that "friend" line to be crossed because she respects my opinions and recommendations regarding her health, and will listen to what I say and believe in me at times when she won't accept help from anyone else. I can say the same thing her mom would say; she'll scoff at her mom yet take me seriously. In Home Health care, if you stay with a family long enough, you start to morph from a plain old nurse into a guardian angel.

I always say that when a nurse works in a facility, the pressure is on to keep to policies 100% with no shortcuts. In home health, the pressure is the exact opposite: parents want rules bent, for a number of reasons: for convenience, to save money, to save time, to feel normal, you name it. When you resist parents too much, they'll just call and ask to not have you come back. So a nurse just has to make a judgement call. Will the ct. be safe? Is it insignificant? Is there even any chance anyone is ever going to know? With that criteria, I would NEVER transport a client in my own car. One accident could injure or kill the client, and bring about lawsuits, revocation of license, etc. My client wants me to spin around when I pick her up to transfer her. I'd love to do it, since she is a thrill-seeker, but NOOOOO!!!