Crossing the Line?

Nurses General Nursing

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My first post on this board, and I have a feeling it is sure to attract some heated debate. Here goes...

I've been a nurse for almost 8 yrs and was working most recently at a Level I trauma center in the SICU. Had been working there about 6 months when I started taking care of a 33yo male patient who was injured in a motorcycle accident. He had suffered a T6 complete spinal cord injury and had to be stabilized before he could have extensive surgery to fuse his spine. He was on our unit for approximately 3 weeks, most of the time on the vent w/ heavy paralytics and sedation on board. I was working like mad back then (12 hr noc shifts, tons of overtime) and took care of him most nights I worked. He was barely conscious the majority of the time I cared for him, but the last few days before he was transferred to a stepdown unit (where they almost killed him I might add) he was awake (no head injury, thank God), extubated and being weaned off the sedation. I recognized early on that while the other nurses and the doctors that cared for him gave him the technical care he needed, none of them were supporting him emotionally through such a devastating injury (paralyzed at age 33!). His only family was his dad and he had some friends that inquired about him, though they did not visit in those early stages after his accident. After being transferred to a stepdown unit I began to visit him regularly before and after my shifts and we talked at great length about his accident, injury, recovery etc. I had become a trusted friend and advocate to him and, since he was no longer a patient on the unit where I worked, I was comfortable with that. His recovery was complicated and there were numerous instances when the care he received was less than optimal (bordering malpractice I believe). I tried to bring these issues to the attention of the staff on the other units he was on but was met with a great deal of resistance. Most of the nurses were extremely defensive (especially when they found out I was an evil SICU nurse!). My manager came to me and said she had gotten some complaints from the nurses on the other units he was on, saying that I was "overstepping my bounds." I tried to explain to my manager about the horrible care he was receiving and she brushed me off. Long story short (too late now, huh) I stuck to my guns and advocated for this person (I was told more than once that I'm not a family member, don't get involved, blah, blah, blah). Both the patient and I got into it w/ the other nurses, managers, administrators (I was suspended for 2 days pending an "investigation"...more like an inquisition). He received HORRIBLE care and gross mismanagement almost killed him. To this day he will tell people that if I hadn't intervened on several occasions he would be dead...the senior surgical resident even told me that himself. I've read all the article about "inappropriate therapeutic relationships" with patients but this was nothing like this. A friendship had developed after the time I took care of him on my unit, there was nothing romantic or sexual in nature, and most of all he trusted me to be his advocate during this awful time. I was so disgusted with the management at that institution. I was disgusted with nursing in general at that point. I ended up getting fired some 5 months after that situation, allegedly for calling in sick too many times, though I suspect that had less to do with it than the fact that I had become a squeaky wheel around that place, pointing out the gross malpractice going on. As I told management during my 2 day "inquisition", I would do it all over again and, if needed, I would hire an attorney. Many of those close to me, who knew all the details, suggested I hire an attorney, but to be honest, my main concern was making sure this patient got the kind of care he deserved. Despite being fired form that institution (trust me, they don't "listen better" as their craft advertising slogan goes), I WOULD do it all over again. And if inquiring minds want to know...my friendhip with this patient did develop into a relationship...AFTER he was discharged. I've seen him progress through rehab and getting aclimated to his new world of paraplegia, and having him become a part of my life means more to me than any run-of-the-mill nursing job in the world. Any comments?

Originally posted by TeleNurse_02

I applaud you for your bravery! If you believe that you made the right choices, then you did.

Read my signature line!

Thanks!

No flame here...I am just curious why you chose to tell us your story and why in your first post to the board?

It's really been bothering me still, I guess. I really appreciate all the feedback. Suppose if it ever happened again I want to make sure I do it better!

It's always easy for others to have 20/20 hindsight in these situations or alternative solutions, but I imagine you were facing very difficult challenges at the time you had to make your decisions. One word of caution for others that may be involved in patient situations; The hospital could file a complaint with the SBON for "boundary violations" if the SBON has a regulation that addresses it and nurses have been brought before the board. Some states such as Minnesota do address it and are specific (they address psychiatric patients, etc.) Some states do not recognize the fact that the therapeutic nurse-patient relationship has terminated and engaging in personal contact, (albeit consensual) may still be considered a violation. This is just something to consider. Perhaps another means to advocate for a patient in the acute care setting is to call for an ethics consult. There are no easy answers to situations such as this :confused:

Specializes in CV-ICU.
Originally posted by mmb-rnjd

One word of caution for others that may be involved in patient situations; The hospital could file a complaint with the SBON for "boundary violations" if the SBON has a regulation that addresses it and nurses have been brought before the board. Some states such as Minnesota do address it and are specific (they address psychiatric patients, etc.) Some states do not recognize the fact that the therapeutic nurse-patient relationship has terminated and engaging in personal contact, (albeit consensual) may still be considered a violation. This is just something to consider. Perhaps another means to advocate for a patient in the acute care setting is to call for an ethics consult. There are no easy answers to situations such as this :confused:

I was also going to comment about the legalities of overstepping boundaries in nursing. I do not know what your State Board of Nursing says about professional boundaries, but my state (Mn) is very explicit about this. Your license MAY be in jeopardy if your previous hospital would report you to the BON.

Please do talk with an attorney who is experienced in cases like this. Here in Mn. a person can speak with a lawyer for an hour without charge to see if they have a case; and you may need a lawyer to represent you in front of the BON plus you may also be entitled to back pay for being fired.

I commend you for your advocating for your patient. I am also very concerned about where this will eventually lead to in the end.

Did you cross the line?......yes probably

Can you live with your decision?.......appears so

Would you do it again?.......I hope so

I do believe you did the right thing. I feel that governing bodies have been working so hard at improving the "PROFESSIONAL" image of our career that they have lost site of the caring aspect a little.

Somewhere along the line they need to find a balance so we have care in a professional manner and not just another professional carrer.

:rolleyes: Jaded...if you were a good nurse and have worked with spinal cord & head injuries...you did what you had to do...you expected somebody to listen to you?

Yes, you were a SICU nurse.....try being on that Step down unit and having a patient that you know shouldn't be there. We also have the problem with battling the "powers" to try to get the patient back. We don't have the patient staff-ratio to take care of even the type of patient we are supposed to do.

Sorry for what you had to indure....Glad you put this on this site...never responded to anyone before...but your story got to me.

My husband also read it and encouraged me to reply...he read your story and seeing it from another nurse...think he has got it!

Face it (if we really ever can) You only get recognition if you punch in on time...don't work extra hours unless they try to kill you with Guilt about taking them) You may get a piece of candy or something if some little old lady writes something nice on their evaluation of the Hospital's Services...but try and prevent a Law Suit or "Death" before it happens ....and you will find yourself out of the door of the Hospital.

Hey...you don't have to be a patient's family to become an advocate for him........you did right!

There has never been a shortage of Nurses...just when things get bad out there...nurses go into hiding.

I've gotten in more trouble for trying to do the right thing than in doing some paperwork. Hospitals should realize that ..yes we work for them...yes we work for the patient....but why don't they understand if they would listen that we could prevent harm to the patient before it happens and a lawsuit before it happens!

Good for you Nurse...!!

Forget the lawyer...fighting your way back into a hospital...they never forget and you would be monitored (they would admit to it as it is illegal) but it would have only a matter of time before they made you so stressed that you would quit...or they would find some reason to make you.

We all hope that somewhere out in Nursing is a place that we can Nurse and have back-up of Management...think there qualifications are to know it is easier to fire one Nurse than admit that everything isn't just "Peachey" with their Nursing Staff.

Have you noticed how some of the Nurses who don't do a good job...seem to major in "Brown Nose 101" with the Management...they don't take as good of care as you did...but they get the credit. Myself...would rather you take care of me or my family....than a nurse who just wants her job and closes her eyes to what is in front of her.

Thank You Jaded!!!! Can match your stories...but this story is about you....and you will survive...you have...wish I could work with a bunch of nurses like you.

Wow, what a wonderful story. You are truly a great, wonderful nurse. I hope all is well for you right now.

Jadednurse, I want to commend you on your spunk and caring. This just goes to show you that a hospital will only back you when you show your caring side if it is what they want you to do. It is very important to make sure that we advocate for patient rights. Not everyone has a family member that can be there all of the time or at all. I think what you did was brave to say the least and I am proud that you are able to call yourself a nurse.

I think what you did was WONDERFUL, I am sure, you don't need to be related to be an advocate.

Quote

"They know they are letting people down every day, and here's a news flash for you- they don't care. That's why caring devoted nurses like yourself are so precious,and so important to keep in the profession. Otherwise the patient becomes a "market share" and the nurse is no different from a piece of equipment."

I go with Canoehead and as long as they don't care people like you will always be needed.

I admire your bravery,surely this person is special that his unfortunate circumstance have drawn you to him,I`ve heard stories couples breaking up because of one`s illness but you as a patient advocate stand up for him to the point of loosing your job.I just hope that everything is going fine now.Goodluck on your battle.

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