Boundaries

[jharper]

My hospice has asked a group of us to put together a procedure/ set of rules on boundaries with patients. They want to establish a uniform way of allowing patient contact. In the room, the group is all over the board, some of us give out cell phone numbers to certain patients, others refuse in any case.

What started this is that over the last few months we have had a couple incidents. A nurse that recently retired went to visit a former Patient, and gave that patient medical advice contrary to the plan of care; another case was when our one male nurse took his brother to the patient's house on a visit. Our clinical director has flipped out!! I would too!!

But this goes back to boundary issues. How can the retired nurse (23 years) not know the damage she can cause? I am so upset by this, that I recommended that we all sign a "No contact" agreement that kicks in if we resign/retire, but others in my group think that they need to be able to maintain contact. Anybody have any thoughts? I will you let me know what we sort out.

J

[caliotter3]

System double post.

[caliotter3]

I have been in home health for almost 20 years and have seen professional boundaries breached left and right. The cozier that nurses become with the families, the more difficult it is for a new nurse that comes to the case to establish and maintain boundaries. My clients just seem to think that they have a heaven given right to have my personal phone number so they can call me whenever they please. Only one has ever abused this. I've given out my number once I establish that the people won't be calling me to discuss the price of rice in China or to make unreasonable demands. It is courtesy to call back and forth to inform one another when shifts must be cancelled. We can't always rely on the agency to pass messages. I always call my agency also, but I will call my client first. And they do the same. I also inform my clients that I change my number on a regular basis and I would expect them to respect the privacy of my phone number.

I've been on a case, where the RN who had been there approaching 19 years stayed in the spare bedroom on her days off rather than travel home to her family and home that was a long commute away. She was not paying rent for that room. She also drove the family's cars and I was told by the Director of Clinical Services that she had wrecked one of the cars when she was using it for personal business. The entire group of nurses who were on this case had various breaches of boundaries. They were constantly keeping secrets from the agency and clearly were enmeshed with the family. The primary RN copied the nurses' documentation and provided it to the family before she personally turned in the documents to the agency. The family had sued in the past, and wanted these notes without going through the proper channels (and paying for them) like they were supposed to.

I've been on similar cases where the nurse(s) are clearly acting beyond the scope of their jobs in catering to the client or family. I make it clear to families that my first responsibility is to protect the best interest of the client and that I take good care of my employer by keeping them in the loop. If they don't like me protecting the sources of my paycheck, they can always find a way to complain about me and we can mutually remove me from the case. I refuse to join the games that I see so many nurses get themselves into.

I think that for starts: 1) absolutely make it a policy that personal phone numbers and addresses are not given out. Enforce this policy equally across the board. 2) a no contact stipulation should be signed by each employee. If hired private duty by the client, standard protocol is for six months to pass unless both the employee and client want to pay a fee to the agency. This keeps the employee who prefers to stay with their agency from being harangued by the client to work privately. 3) employees have no business visiting the home during non-duty hours unless for a work related reason, and the agency is aware of it. Some go to visit the client, the family, other employees. This detracts from patient care. It also creates a situation where the client and/or the family are hearing too much about the business of the agency. They don't need to hear long discourses about how much Employee A hates the supervisor, etc. 4) when a nurse asks to leave a case because of some type of client/family misconduct or a bad situation, warn the other employees so that they are reminded about boundaries. When one nurse is the victim of sexual battery in a home, then the other nurses need to know this. Don't dismiss her and hide everything under the rug because the agency wants the almighty dollar that goes with the case. This is one of the most abused of boundary issues. All nurses have the right to have their persons respected while they are in the home. Don't fire the nurse because she is a victim.

I'm sure there are other boundary issues that I haven't covered.

[freesia98]

These stories are all to familiar to anyone in home care/hospice. Some "professionals" really don't understand why boundaries protect them.

Our organization has instituted a zero tolerance policy for contact with patients/families outside of work hours, period, no exceptions. These patients are not my patients, they are our (the agency) patients.

Employees do not realize the lawsuits they open themselves and their agencies up to. Many employees believe "their" families love them too much to harm them, let alone sue them.

All it takes is one perceived slight. Maybe even just that the patient went and died!

The other problem this creates is that the family only trusts that one employee for better or worse! No one else can ever gain the trust of the patient/family. It is so sad when they put their co-workers in a no win situation like that. Cuz even these no boundary employees have to take a vacation sometime. Boy do they enjoy the first day back when everyone is talking about the problems with their patient that they say they "have never had any trouble with" (usually the first clue there is a problem!).