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Boundaries question

Psychiatric   (3,652 Views 14 Comments)
by cargalrn cargalrn (Member) Member

2,960 Profile Views; 51 Posts

Is it illegal to speak to a former patient on the phone if they call in, or if you see them, say at the mall? I try to be aware of boundaries, but if I really bonded with that patient, how would it harm to ask how they are doing or to give ongoing encouragement if I don't comment on their treatment at our facility or their current treatment. I do realize it may just be bad judgement, but I was told by a co-worker that it was illegal.

What do you say?

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2,139 Posts; 16,513 Profile Views

OK, thanks. Is it even unethical?

What's "ethics?" LOL jk. Probably yeah. Questions of laws and ethics depends on reasonableness and totality of the circumstances. It'd weird to give them the cold shoulder, but you should probably give more than the cursory head nod and "wut up?"

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

15 Followers; 1 Article; 6,341 Posts; 78,560 Profile Views

I follow a rule that was presented to me early in my career: IF a former Patient acknowledges you first, it is no breach of confidentiality. Otherwise, If I'm out in public, and I make eye contact with a former Client, I will give them the same kind of "nod and smile" I would give to a total stranger. I leave it up to the former Client if they want to initiate something.

I've even had a conversation with a former Client out in Public and had a Companion ask, "How do you two know each other?" I've responded by saying, "We've worked together." I've often told Patients, as they've been discharged, "It's been good working with you" so my response is not far from the truth.

Dave

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flpsych has 7 years experience and specializes in Psychiatric.

23 Posts; 1,166 Profile Views

The above is good advice. If the former patient approaches you then it is fine. I would say if the person is alone it is probably okay too. It is when they are with a friend/family member that things would cross the line (eg. they would have to explain where they know you from,etc).

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Whispera is a MSN, RN and specializes in psych, addictions, hospice, education.

3,458 Posts; 28,151 Profile Views

I go by whatever the former patient does. If he or she speaks, I respond. I keep any conversation on neutral topics unless he or she talks about the time when we knew each other. I never initiate conversation, since the former patient might not want to talk to me, even if no one else is around.

As for the patient calling to the hospital, surely, if I have time, I'll talk to him or her, and again, keep the conversation neutral unless he or she doesn't. I'll also keep the conversation as short as is logical, since I am at work and have things that need to be done. However, if a patient is in crisis, I'm not going to just say goodbye. I'm going to do my best to get the patient to find appropriate help.

It's not illegal to talk to a former patient outside work. It is against most facilities' rules to initiate contact, such as calls to them, or visits, at least for a specified time-frame, such as 6 months. This also depends on where you work. Hospice nurses often keep in touch with their former patients' families. It has to be considered case-by-case.

Edited by Whispera

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Jules A is a MSN and specializes in Family Nurse Practitioner.

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Good question about boundaries and you got great answers. In psych we tend to get very familiar with our patients so it is important to remember that we need to remain professional and follow their lead should we run into them elsewhere.

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51 Posts; 2,960 Profile Views

Thanks for all the responses. I remain unsure why this nurse said this to me. She is pursuing a doctorate and I question if she knows something about this topic that I don't. (I'm sure she knows much more, lol).

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the long and short of it is that once the patient is discharged you are no longer in a caregiver role. as such it is inappropriate to continue to act as though you are. if you bump into a former patient on the street and they want to talk shop you need to politely inform them that you are in the "wrong setting" to discuss such matters, but are glad to hear that they are recovered, or are willing to assist in their care should they seek such again. "my isn't the weather nice lately" is fair game.

if any other person is in earshot you may not disclose or make reference to the nature of your past relationship in any manner or detail. this would be a huge hippa violation.

it is considered inappropriate to be "friends" with or "date" or otherwise socialise with any former patient for a significant period of time, depending on your particular role as a caregiver (different for psych nurse than for psych social worker or psychiatrist). this generally extends to any patient of which you may be privy to the details of their condition and care. this would be a "dual relationship" in which there is a disparity of power, whether perceived or actual.

some psych caregivers wisely choose to refrain from relationships with former patients indefinitely. even if you follow the guidelines for your specific profession, a dual relationship can bite you in the ass right hard.

in small towns this can get confusing. 10 years ago an lcswc lived with me while in her clinical program. she moved out when her demons multiplied (3 immediate family members manifested already), but i have been aware of where she is and what she is doing thru common acquaintances. the other day i saw her in the grocery for the first time in 10 years, but it wasn't her, just a woman who looked damned like her.

when i spoke to her she told me she was not the person in question, but that she did know her. foolishly i asked how they were acquainted. as you guessed, it was in a patient/client relationship. i refrained from asking who was treating who.

best shag i ever had, but nuttier than a snickers bar.

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