Dating a former patient

[sarahg88]

Hello,

I am an LPN in Canada working at a mental health facility. I met a patient nearly a year ago whom I had a totally unexpected connection with. It isn't something I was seeking out and never in a million years did it occur to me that something like that would happen. I explained at the time that it was inappropriate and crossing an ethical boundary. The patient understood. Now, that former patient is doing very well and doesn't have a long standing illness and are well into their recovery. It was a short admission and I would have only been in the circle of care. We have been talking and spending time together (initiated by him) and it is obvious that after all this time we would like to be with each other and are meant to be, regardless of the circumstances of how we initially came into contact, so we are now officially in a relationship. He is in university with a bright future and such a wonderful and kind person who just had a little episode. He comes from a wonderful family. I'm afraid my co-workers will judge me if they find out I'm dating an ex "mental patient" and that I will be the topic of gossip in the work place. How do I deal with this situation in a professional manner? As far as I can tell, I am doing nothing wrong. A significant amount of time has passed and their is no element of vulnerability.

[bluescrubs, ADN, ASN, RN]

I personally would not date a patient or ex-patient. Never even let the chance for that to happen. There are so many people in the world, why would you need THAT ONE. If things end badly between you two he can report you and say you took advantage of him. I would end it in a polite way.

[Castiela]

Dear OP,

I'm not sure which province you are from, and I recognize these are RN regulations, but I am sure it would be similar to LPN regulations. This is from the CARNA (Alberta's RN legislative body, http://www.nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Guidelines/RN_ProfessionalBoundaries_May2011.pdf )

Romantic or Sexually Intimate Relationships

Romantic or sexually intimate relationships between registered nurses and clients arenever appropriate during the course of a therapeutic professional relationship. Theconsequences of sexual relationships with professionals can be long term for vulnerableclients. Registered nurses must prevent the formation of inappropriate relationships.Some key things to remember include:

•  There is no arbitrary time limit that makes it safe for a professional to have aromantic or sexual relationship with a former client. The rule of thumb is that whereany doubt exists, the registered nurse should seek impartial advice beforeproceeding.
  
  
• In some instances, registered nurses may have a social relationship with a formerclient if it is anticipated that there is no further requirement for their nursing care.
  

Personal relationships with former clients, or continued relationships that existed prior togiving nursing care, must be justified in terms of the public's need for trust in nursing asa profession. The registered nurse should consider the client's overall health statusincluding competence, mental and emotional well-being, the potential for confusionbetween a therapeutic and a personal relationship, and any harm to the client orsignificant others which confusion could cause. However, if a former nurse-clientrelationship was a psychotherapeutic one, the registered nurse must not engage inromantic or sexual relationships at any future point unless an impartial professionaljudges that the relationship would not have a negative impact on the client's well-being.

Furthermore, the CNO states (https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf)

1. ensuring that after the nurse-client relationshiphas been terminated and the nature of therelationship has been psychotherapeutic or forthe provision of intense psychosocial counselling,the nurse:
   
   
   • must not engage in a personal friendship,romantic relationship or sexual relationshipwith the client or the client's significant otherfor one year following the termination of thetherapeutic relationship, and
     

may, after one year, engage in a personalfriendship, romantic relationship or sexualrelationship with a client (or the client'ssignificant other) only after deciding thatsuch a relationship would not have a negativeimpact on the well-being of the client or otherclients receiving care, and considering theclient's likelihood of requiring ongoing care orreadmission (if the client returns for further careat the facility, the nurse must declare to her/his manager the nature of the relationship anddecline the assignment of the client)

being cautious about entering into a personalrelationship, such as a friendship or romanticor sexual relationship, with a former client

or a former client's significant other after thetermination of a therapeutic relationship if:

â– it is determined that such a relationship wouldnot have a negative impact on the future care ofthe client,

â– the relationship is not based on the trust andprofessional intimacy that was developed duringthe nurse-client relationship, and

â– the client is clear that the relationship is nolonger therapeutic;

Most other provinces had similar guidelines, but I'm sure you get the idea. Notice in Alberta, the distinction about psychotherapeutic relationships was made? My red flag is hat you are hiding the relationship. My opinion is that you're best bet is to discuss with your manager and a college/ patient safety rep this relationship and ensure it doesn't harm you, your patient or your career.

[Workitinurfava, BSN, RN]

Be prepared to be his 24 hour nurse if and when he has a relapse, let the word "patient" sit on your mind for a longer amount of time. I work in a mental health facility like you but I would never date a patient former or whatever. Many of these patients end up coming back. Can you imagine him asking for his "girlfriend" to provide his care when you are working.

[adventure_rn, MSN, NP]

Many of these patients end up coming back. Can you imagine him asking for his "girlfriend" to provide his care when you are working.

Or if you broke up and he were to be readmitted! Bad news for all parties, especially the patient! (Now I'm just speaking in hypotheticals, no wishing any ill will on the OP).

[Ben_Dover]

OP... So let's say a great friend of yours or a co-worker or one of your family members is in this same exact type of situation, what advice or recommendations will you give them?

It'd be interesting to know your response!

[Apple-Core, ASN, BSN, RN]

OP... So let's say a great friend of yours or a co-worker or one of your family members is in this same exact time of situation, what advice or recommendations will you give them?

It'd be interesting to know your response!

That is EXACTLY what I was going to ask.

My thoughts....big no-no. Not worth the potential ramifications, which could be many!

[DnCali]

Keeping it simple...NO!

[poopylala, BSN, RN]

What the actual ****.. No! This is a patient, former or otherwise, and that is a very unique position to be in. They trust in you to care for them and you are supposed to be the one responsible for them. They are in a vulnerable position and should always remain on the other side of the boundary. This is a huge red flag to me that you don't see the difference between dating someone who had their arm broken and dating someone who was inpatient psych. Not because he was psych but because it was only a year ago that you were in the care provider role for him!! I wouldn't come near anything romantic with any former patient with a 10 foot pole. Not even a patient's sibling. It's too much of a risk. Yes, psych is not life-defining but it kind of is when it comes to nurses dating former psych patients. You came here for advice or support and we're giving you our thoughts. If you don't want to hear people not validating your thoughts, then don't post asking something that it seems deep down you know might be crossing the line.

[BostonFNP, APRN]

It has been interesting to read the feedback, especially from those with their own history on mental illness. It has made me consider my own thoughts on the matter.

I keep going back to the example the OP provided of a patient visiting the ED for a fracture. An admission for a decompensated psychiatric event is wholly different in my opinion, by the sheer nature of requiring inpatient level of care, so I started comparing a mental health admission to a CHF admission.

Does the nature of it being a psychiatric admission change the ethical consideration in this case? While I would argue that in either case there are ethical concerns, do the both sit at the same place in the spectrum?

I do feel that if we take the generic definition of decompendated metal illness that we all learned in school (a disturbance in thought, mood, or behavior) and we combine that with the fact a patient made their first connection with someone providing their care at that time, does that place the patient at higher risk than if a patient with decompensated heart failure does the same?

[DeeAngel]

You are flirting with the possiblity of losing your license by doing this.

[Agatha12]

Since reading your first post and then next replies I was wondering if you had a mental issue yourself.your replies were very immature and emotional especially when you realised that we dont support your view. I think in this case, you need a bit of councelling before deciding if you want to carry on with that person.

[traumaRUs, MSN, APRN]

This thread has provided the poster with a lot of info for her to make her decisions....closed now...