Dating former patient

psu_213, BSN, RN · Oct 19, 2013

What is very concerning the the number of posters who are stating that hospitalization for a depressive episode is a huge red flag and that the guy has "relationship issues".

I was reading the various posts and was thinking the same thing. I do agree with the vast majority of the posters that the OP is best to stay away from pursuing this relationship; however, I have a problem with people whose only argument is that he was on a psych unit. The fact that he was on your psych issue is a problem (as someone said, what if he is readmitted to your unit just after you finished your relationship?). However, would you totally exclude having a relationship with someone who at some point previously had to be admitted to a psych unit? At what point does that red flag become a yellow flag? Is it possible for the flag to go away completely?

I would have qualms if they were discharged yesterday from a psych unit for a major psychological illness. However it is unfair for that to follow him around forever, and it is unfair for someone to say "run away" because he had a psych admission in the past. If he had been on one's oncology unit, would you stay away from him because, even though he is in remission, his CA could reappear at any time, and who wants to be entangled in that??

As for the OP, politely decline. You can always fall back on "I'm sorry, I can't date individuals who were treated on my unit." The fact it is a psych unit is inconsequential to the situation.

Retired APRN, MSN, RN, APRN · Oct 19, 2013

(I thought I'd posted this, but I guess I didn't. I'm new here, so please excuse me if I've messed up.)

In terms of professional ethics in psychiatry, there is no question: if someone has ever been your patient, you must not enter into a relationship with them. It's as black and white as that. This is not a judgement on the patient; it is ethical professional behavior related, among other factors, to the power dynamic.

Even if he was never your patient, if he was on your unit, same thing goes.

applesxoranges, BSN, RN · Oct 20, 2013

I wouldn't go there simply because there's a chance it'll cost you your job. What if one of your coworkers recognizes him and reports you? What if you break up with him and he wants to get even by making you lose your job? What if he decides to get admitted and harass you or cause issues with your coworkers who will have to care for him?

I've dated someone who went off the deep end when I broke up with him (he wrote anonymous letters to my job (with bad information such as saying the company was involved in the community a long time when they were open six months and using my last name when I do not have a name tag with my last name) to try and get me fired. He also harassed me by showing up to fire department calls and posting stuff online. So on a personal level, I would avoid a situation that may be viewed unethical by the state board and your employers to begin with. There's a good chance nothing would happen, but sometimes you cannot tell when someone may try to ruin your life after a breakup.

LaRN · Oct 25, 2013

What is very concerning the the number of posters who are stating that hospitalization for a depressive episode is a huge red flag and that the guy has "relationship issues".
a large number of people suffer depression - for a variety of reasons- and many are hospitalized or medicated. It does not mean that people are necissarily permanently afflicted, creepy or "psychiatric".
The judgemental attitudes from so-called caring professionals are very disturbing.

if being hospitalized over a relationship breakup isn't a relationship red flag, what is ?

just because it isn't politically correct for nurses to say this, it doesn't make it any less true.

Other than being a poor choice, I doubt that the nurse's license would be in jeopardy for dating a former patient with that much time lapse. That would be overly restrictive.

Retired APRN, MSN, RN, APRN · Oct 26, 2013

I am very surprised and confused at the number of people who offer job consequences as the reason for not doing this, as opposed to the ethical issues. Is it because people are not seeing an ethical issue here or because the possible consequence of getting fired is more important (a greater deterrent?) than an ethical "misstep"? I'm very curious about this.

psu_213, BSN, RN · Oct 26, 2013

I am very surprised and confused at the number of people who offer job consequences as the reason for not doing this, as opposed to the ethical issues. Is it because people are not seeing an ethical issue here or because the possible consequence of getting fired is more important (a greater deterrent?) than an ethical "misstep"? I'm very curious about this.

I think if you just raised it as an ethical issue (take psych out of it), most people would say it is unethical. A lot of people are going to put it in term of losing one's job. Why would you lose your job? Because of a breach of ethics. Now there are some who would be opposed to such a relationship only because they would lose their job (not because they themselves find it unethical). However, most people who say "you would lost your job" also find it, in and of itself, unethical. Or so I hope...

LaRN · Oct 28, 2013

I don't think its a good choice at ALL, however I don't think its entirely unethical...a bit cheesy, yes. The whole nurse/patient experience is sometimes a bit over valued and tremendously exaggerated when in fact, it just isn't that significant of a deal for most patients (ESPECIALLY when some time has passed), and its unlikely that dating a previous patient is going to cause extensive psychological damage to said patient. We are important, but not that important.

Retired APRN, MSN, RN, APRN · Oct 28, 2013

With respect, LaRN, in psychiatry--particularly on inpatient units--there is an enormous power differential between nurse and patient. Once established, that kind of dynamic is pretty much permanent. It is unethical to enter into a relationship when there is such a power differential. I would suggest that the nurse examine his or her motives very carefully and look for the secondary gain.

LaRN · Oct 29, 2013

enormous power differential. - i understand the theory behind this statement, but can you tell me what does this REALLY mean to you in reality/practice? what type of impact does this power differential have on patients, and how does this permanence occur.........is there any magic involved?

most of the psych patients i've encountered pretty much treated the nurses as someone who was there to meet their needs. some treated them as servants. this is in acute, long term and outpatient.

however, I do think this is the case with the adolescent patients, especially when the nurse is therapeutic and kind to them.

Retired APRN, MSN, RN, APRN · Oct 29, 2013

No magic, just social dynamics. :)

The nurse has the keys, the single most potent symbol of authority on a psych unit. The nurse is the one who represents and describes the patient to the doctor, giving him or her (in the patient's eyes) a huge influence on provision or withholding of privileges (depending on the setting: telephone, grounds, day/overnight passes, outings, etc.) The nurse is the first point of contact for getting needs met. In a very real and practical sense it is very similar to a parental role.

Yes, patients on psychiatry and other units often treat nurses as servants. I believe that a large part of that is a conscious or unconscious defense mechanism against the powerless/helpless feelings of being a patient. Being demanding or imperious is a way of counteracting the sense of lost identity, lost "uniqueness" that accompanies most hospital admissions. I've experienced this myself as a patient on orthopedic and surgical services, but most particularly as a cancer patient. The patient's behavior, whether stemming from psychological defenses or not, does not change the fact of the power differential. In fact, it puts it into relief.

The "permanence" comes about simply as a social and cultural fact. If you run into a high school teacher ten years after graduation, you still relate to that person as your teacher. We tend to establish relationship patterns when we first meet someone and these generally do not change very much.

Is that any clearer? :)

elkpark · Oct 29, 2013

No magic, just social dynamics. :)
The nurse has the keys, the single most potent symbol of authority on a psych unit. The nurse is the one who represents and describes the patient to the doctor, giving him or her (in the patient's eyes) a huge influence on provision or withholding of privileges (depending on the setting: telephone, grounds, day/overnight passes, outings, etc.) The nurse is the first point of contact for getting needs met. In a very real and practical sense it is very similar to a parental role.
Yes, patients on psychiatry and other units often treat nurses as servants. I believe that a large part of that is a conscious or unconscious defense mechanism against the powerless/helpless feelings of being a patient. Being demanding or imperious is a way of counteracting the sense of lost identity, lost "uniqueness" that accompanies most hospital admissions. I've experienced this myself as a patient on orthopedic and surgical services, but most particularly as a cancer patient. The patient's behavior, whether stemming from psychological defenses or not, does not change the fact of the power differential. In fact, it puts it into relief.
The "permanence" comes about simply as a social and cultural fact. If you run into a high school teacher ten years after graduation, you still relate to that person as your teacher. We tend to establish relationship patterns when we first meet someone and these generally do not change very much.
Is that any clearer? :)

Terrific reply, and I would also add another factor -- the relationship starts with the nurse knowing everything, or nearly everything, about the client and her/his personal life and history (much more than people typically know about their friends' lives, at least early in the relationship), and the client knows nothing (hopefully :)) about the nurse's life. The relationship is initiated in a professional/helping context, which is v. different from a standard social context, in which the two individuals disclose information on a more equitable basis.

Retired APRN, MSN, RN, APRN · Oct 29, 2013

Great additions, elkpark. Thank you.