Continuing to work with patient if change job?

[Ms Blue Sky]

Hello all nursing angels

My question is, I work as a community mental health nurse and have formed a therapeutic relationship with a client who didn't engage for many years, it has taken weeks, now helping him make massive changes in his life and he is a pleasure to work with, he will only engage with me.

I travel miles however for my job and was offered a similar job in the same trust but different borough near my house to start in a week which would be wonderful for me but I feel I cannot abandon this case.

Can I continue working with this chap though the borough will be different?  I don't want to abandon him and still have appointments to attend etc. He has no NOK etc and only me right now. 

The new job have said at the start they will be flexible with days so I can spend some time then.

I am working as a nurse combined with carer duties at the moment so may be able to work some days as his carer via social services, right now I provide support in all areas as he does not trust anybody else. 

This is a very unusual case with a complex chap...he has now settled for the first time in years. 

Advice appreciated thanks ?

[klone, MSN, RN]

The only ones who can answer that are your employers. We would have no way of knowing this. Good luck!

[Ms Blue Sky]

Thank you klone and for the good luck ? yes I'm impatient to know 

[Davey Do]

I worked per diem HH for two different agencies and stopped working with one. I had a patient who wanted to continue services and belonged to the agency I stopped working for, so the patient's family merely discontinued services with one and started services with the other.

No big deal, except the agency that lost the case squawked a bit but had to acquiesce.

[Hoosier_RN, MSN]

I understand your good intention, but also think of this: being "the only person that he will engage with" isn't therapeutic as well. What if you have a long term illness, etc? The patient will need to learn to receive care from others. Part of your therapeutic journey with this patient should include this

[Davey Do]

1 hour ago, Hoosier_RN said:

I understand your good intention, but also think of this: being "the only person that he will engage with" isn't therapeutic as well. What if you have a long term illness, etc? The patient will need to learn to receive care from others. Part of your therapeutic journey with this patient should include this

I truly appreciate your take on this situation, Hoosier, but sometimes, well, sometimes it's best not to fix what's not broken.

Take my situation, for example. I became really good friends with the patient's husband, and it was a relatively close relationship which lasted for years.

My patient was discharged from HH services after a few months, but I would stop and visit them every so often on bike rides to town. Sometime later, my ex-patient fell, broke her hip, had surgery, and rehabbed in LTC. She recovered nicely and the couple went on to reside in assisted living where I continued visiting them now and again.

They both died within a few months of each other, living to be well into their 90's.

I don't know... maybe I crossed a line, but it seemed everyone benefitted from the relationship. I know that I did, am grateful for the continued relationship, and I hold a special place in my heart for them to this day.

[Hoosier_RN, MSN]

2 hours ago, Davey Do said:

I truly appreciate your take on this situation, Hoosier, but sometimes, well, sometimes it's best not to fix what's not broken.

Take my situation, for example. I became really good friends with the patient's husband, and it was a relatively close relationship which lasted for years.

My patient was discharged from HH services after a few months, but I would stop and visit them every so often on bike rides to town. Sometime later, my ex-patient fell, broke her hip, had surgery, and rehabbed in LTC. She recovered nicely and the couple went on to reside in assisted living where I continued visiting them now and again.

They both died within a few months of each other, living to be well into their 90's.

I don't know... maybe I crossed a line, but it seemed everyone benefitted from the relationship. I know that I did, am grateful for the continued relationship, and I hold a special place in my heart for them to this day.

Visiting is one thing, assuming care and making yourself "the only one" who is able to engage is quite another. This doesn't allow the patient to be able to move into therapeutic relationships with other providers. You weren't going as the nurse to provide care, but as a friend dropping by here and there

[Ms Blue Sky]

I haven't "made myself" the only one who can engage, another person visits as well and I'd be really happy for him to mix more

Gut instinct informs me, back off as this could turn into an unhealthy dependency which would not benefit him 

Hence my dilemma really 

All I want is what is best for my patient 

[Ms Blue Sky]

Thank you for the post though, it expressed what I think I'm worried about perfectly, it has been a fear in the back of my mind 

[Ms Blue Sky]

Davey Do that is lovely such a sweet story but yeah it is quite a different situation to mine I guess, but like you I do care about this patient

In my case, it's got to the stage where this chap will only take meds if I give them at the moment as it's hard for him to trust

But yes I feel a part of me may be blowing myself up a bit, this has helped me land back down to earth

Nobody should be dependent on one person, it could lead to some unhealthy attachment issues which I should not encourage 

It's a hard situation, he doesn't trust many people, it has taken so long to build up this therapeutic relationship and now he is engaging with services more such as GP

People tried to engage before me and couldn't, I persevered as his situation when I met him was dire 

I just wouldn't want him to go backwards if the relationship ended and feel I would feel guilty for going 

He is on the verge of getting things which I am advocating for him 

However this job is physically exhausting me being miles from home 

 

[Davey Do]

Okay, I see this in a different light, thank you Hoosier and Ms. Blue Sky.

I admire your introspective search and insight, Ms. Blue Sky. We all need to do that sometimes, ask ourselves and get others' opinions on what's best for all concerned.

36 minutes ago, Ms Blue Sky said:

Gut instinct informs me, back off as this could turn into an unhealthy dependency which would not benefit him 

Hence my dilemma really 

All I want is what is best for my patient 

This says it all. The best to you, Ms. Blue Sky.

[Hoosier_RN, MSN]

21 hours ago, Ms Blue Sky said:

I haven't "made myself" the only one who can engage

No, but it's unhealthy for the patient to remain in a therapeutic relationship where they only allow one caregiver to provide care. I'm encouraged from your other posts in this thread that you see this