Boundaries

[nurselpn88]

I've had a patient of mine Inboxing me private messages on Facebook. I have declined their friend request. I feel like I've built a good therapeutic relationship and this person is obviously reaching out to me because they Trust me and we are around th same age. Very little has been said, just general conversation and bland responses from myself. Nothing nursing or illness related. However, there is something about it that I find unsettling and I feel like it is wrong and that I could get in trouble. I have found no policy's against it so I am unsure how to handle the situation. I don't mind conversing with this person but if it is forbidden I need to know. Could I lose my job over this? i don't want to bring trouble into my life over this. Any input would be appreciated.

[NotReady4PrimeTime, RN]

The various Colleges take a really dim view of nurses entering into relationships with patients via social media. Every month it seems, someone is in hot water with one or another of them over some social media blunder. It's considered one of those boundaries we must not cross. So you're on the right track in not engaging with this person, but might be better off simply laying it all out there. Be polite but firm. Tell this person you wish them well but just cannot entertain even a casual connection because of the potential ramifications to your career. If it continues, block them. Best wishes!

[madricka, BSN, RN]

I used to have patients/family members/friends trying to add me on Facebook and ended up covering my last name on my badge with a sticker (one of the family members was repeatedly asking me out in person/online despite my adamant protests and it was scaring me). If anyone needs my last name, I will gladly provide it but I don't like it out there. I've also made my social media accounts super secure & removed my last name from them as well.

I think you should go with your gut feeling on this one. Worry less about hurting your patient's feelings and more about what is best overall for the therapeutic relationship (see RNAO's Best Practice Guideline on "Therapeutic Relationships"). Communicating on Facebook implies the relationship is being taken outside the hospital, not shared with the rest of the care team, and, even though you did not accept the friend request, could be perceived as a "friendship". You are not friends. You are their nurse & that means a certain level of professional distance. Sounds harsh but it's very important to keep your interactions inside the hospital and within the realm of providing direct patient care.

As for "getting in trouble", you very well could end up in trouble. You might not lose your job but the CNO takes it very seriously when a professional relationship becomes friendly/casual. Draw the line, you'll feel better about it later.