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 ?

[Kitiger, RN]

4 hours ago, Davey Do said:

When I stopped working for the agency and they tried to transfer the case to another nurse, the client refused further services from that agency.

The client's husband said, "We don't care about the agency, we only care about the nurse".

Where I live, the client is now required to sign an agreement that prevents them from switching agencies. To do so can result in a lawsuit worth thousands of dollars.

If the agency cannot provide a nurse, the client may ADD an agency, but they may not drop an agency.

[Hoosier_RN, MSN]

9 hours ago, Kitiger said:

Where I live, the client is now required to sign an agreement that prevents them from switching agencies. To do so can result in a lawsuit worth thousands of dollars.

If the agency cannot provide a nurse, the client may ADD an agency, but they may not drop an agency.

It's getting that way in my neck of the woods too. Too many agency hopping, as nurses job hop

[Davey Do]

13 hours ago, Kitiger said:

Where I live, the client is now required to sign an agreement that prevents them from switching agencies. To do so can result in a lawsuit worth thousands of dollars.

As I noted before, the agency "acquiesced" to letting the client go, probably because the client was an easy once a week Medicare visit. The case did not have long for services, so it would have been more trouble than it was worth to pursue litigation.

On the same note, the agency that I was working for sent me to a community mental health clinic to cover for an RN who was going to be out due to a chole. Ironically, this RN and I had worked together when I was an LPN back in the '80's.

The clinic really liked me and offered me a position in a new ACT program. I informed the administrator that I could not leave the agency due to breach of contract, or the clinic would have to buy out my contract.

The clinic bought out my contract for $1,000 and I worked at that clinic from 1996 to 2002.

 

[Ms Blue Sky]

Update: I have made the wrench! I had to quit the job with notice as the commute was killing me...I had another wonderful opportunity and couldn't turn it down. I almost didn't take it because of this chap as he has no family etc.

It actually all went pear shaped too. He suddenly told me to leave him alone, felt smothered I guess by just engaging with me / just when things are going good his pattern is to disengage with services

That was my cue really to bow out I guess, this guy does not want that feeling of dependency, the last thing I want is for the dynamic to become codependent and damaging 

I need to watch out for too much of ye olde white knight syndrome ?

Am starting a wonderful new job in one week, a friend said you have to accept, it's unlikely you could have changed him or stopped him self neglecting, I have done what I could and hope he will move into the assisted accomodation I took him to view ??

[Ms Blue Sky]

If I can I will say bye and explain I got another job 

It will be hard but I was starting to feel like I would never get free and had to forever be his carer as he is so vulnerable

I may possibly continue with a brief voluntary call to deliver his meds once a week ( a routine now ) but that has to be it 

 

[Davey Do]

3 minutes ago, Ms Blue Sky said:

It actually all went pear shaped too. He suddenly told me to leave him alone, felt smothered I guess by just engaging with me 

 

Ironically, I'm rereading Ray Bradbury's classic novel "Dandelion Wine", I first read when I was about the same age of 12 as the main character, Douglas, is in the book. In a portion of the novel, Douglas' best friend, Charlie, has to move far from the town in which the story is set, Green Town Illinois.

I was exposed to a concept that I've found to be a truism in human behavior: It's easier to be angry with someone than to have to deal with the pain of loss, as Douglas gets angry with Charlie and tells him he won't miss him when he goes.

A concept to consider in this relationship.

[Ms Blue Sky]

Awww yes for sure, it's a really tough one, just before this pushing away he said a previous nurse had helped him and then left him  ?

And with his BPD he probably dreads abandonment

I love Ray Bradbury, his stories are so touching, I love Kaleidoscope

 

[Ms Blue Sky]

So maybe it's better I leave it so he feels he pushed me away and can be angry...than me leaving? Less painful?

[Davey Do]

1 hour ago, Ms Blue Sky said:

So maybe it's better I leave it so he feels he pushed me away and can be angry...than me leaving? Less painful?

Well said. If he feels like he has control- power- he will feel better about the situation. We all like to feel that we are in control and have power.

One's consciousness is heightened by working through the true cause of our pain, but that's a decision we all have to make for ourselves. We cannot always be in the business of overseeing another's growth and development unless we commit to that individual entirely, unless they read and agree to the disclaimers written in fine print.

 

[Ms Blue Sky]

Thank you Davey Do, in a nutshell that's how it is

He is angry because he feels he has no control over his own destiny and I don't blame him. The problem is he is more vulnerable than he knows or will admit. He is living in squalor with diabetes and a heart condition, not engaging with any professionals. Says he wants to move or have a house clean then will not let anybody through the door or answer the bell

I have poured my life, my time, into trying to help him tolerating a lot of him berating me etc. Waiting till he came out, looking for him in cafes, all to try to help him. It was controlling. 

I actually can't do it anymore I don't think, the efforts and the worry made me quite sick and I feel I was being manipulative and controlling in my attempts to get him to engage - so he would not get seriously ill and could move somewhere he wouldn't be living in squalor and filth. 

He just will not take the help offered, I don't think there's more I can do without sacrificing myself and my own mental well-being 

Have been washing his clothes, buying food, bought a special dosset box all unpaid and doing things out of my remit, bent over backwards and now he is telling me I'm crazy and need help myself and is angrily saying I hid his medications and why haven't I cleaned his flat for him ( offered previously he wouldn't let me touch anything )

I'm exhausted mentally and emotionally with trying, my friend said well is he likely to change after 78 years old? She suggested I work on myself and not him

I have ended up feeling unable to be objective and worrying about his wellbeing all the time. In addition to the above he says he is severely depressed yet when you try to help he gets angry with you and you end up feeling so anxious yet powerless to do anything to help

Thankfully in the end I did take the wonderful job offered, I almost turned it down to continue in my quest to help to help this chap 

His social worker is visiting tomorrow so sharing the responsibilities

Thanks for reading ! And thank you for all the replies ?

 

 

 

 

[Ms Blue Sky]

It kind of feels like Sisyphus, like pushing this gigantic heavy boulder up hill, getting to the top. Then the boulder just rolling down and you're back at square one again

To compensate for his lack of control and power imbalance I guess because he is unfortunately, old and getting dementia, he is picky and controlling around me and I feel I'm walking on eggshells, following orders and he wants the upper hand

Usually gets it as I'd feel bad if I ordered him around or patronised him or went on about how he needs help 

I don't talk down to him but in the process I feel often that I'm being obliterated

The dynamic feels unhealthy 

If I don't pick up his meds weekly though I don't know how he will get them, he will not let anybody in to deliver them and has said he cannot walk to the pharmacy

I will back off and hand over everything for my wellbeing, yesterday he shouted out of the window to leave him alone when I rang the doorbell ?

 

 

[SmilingBluEyes]

On 5/22/2022 at 9:12 AM, Hoosier_RN said:

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

My thoughts exactly. Boundaries people.