Encouraging peds parents to call/text the nurse during off-hours? Common occurrence?

[klone, MSN, RN]

In my job, I work closely with the NICU. It's not uncommon for there to be patients who are there for months at a time, and so there will often be a nurse who is a "primary" - she will take care of a particular baby every time she works. As a result, she gets to know the parents well. Apparently, some of these nurses develop, what I would consider, perhaps unhealthy blurring of nurse/patient boundaries. The nurse will encourage these parents to text or call her when she's not working if they have questions about the baby's care or wellbeing (rather than directing their questions to the nurse or physician who IS working). It seems that these nurses are encouraging the fostering of an unhealthy codependent relationship with the parents, wherein they're getting the parents to rely on her to the exclusion of the other care providers. It just seems inappropriate to me.

What are your thoughts on this practice?

[MattNurse, MSN, RN]

It's wrong, I agree with you. And it undermines the other nursing staff if the nurse taking care of that patient on that shift also has the parents checking with another nurse not at bedside.

[caliotter3]

It is obviously inappropriate.

[xoemmylouox, ASN, RN]

Not a good idea. I can understand building a very strong relationship, and even becoming very attached to a family, HOWEVER you have to have limits. This exceeds all of them.

[llg, PhD, RN]

Totally inappropriate. Where I work, that sort of thing can get you in trouble -- and if it continues after the employee gets some counseling, the nurse could even lose her job.

[BlueDevil,DNP, DNP, RN]

Agree with all of the above. It is potentially very divisive and fraught with conflict. Leadership should formally discourage this practice.

[Jolie, BSN]

Not only professionally inappropriate, but potentially dangerous. These relationships can sometimes go south when a baby suffers a setback or fails to progress as hoped. Parents can become irrational and take their frustrations out on the nurse(s) who were once their "best friends."

[Gold_SJ]

Agree with everyone else, inappropriate also risky. If a parent is ringing to check on her baby and the nurse isn't even with the neonate, what if she gives false reassurace? The babe could of crashed in the next shift and the nurse mightn't be aware.

Blurring these sort of boundaries can also foster distrust between the babe's family and other nursing staff, which is counterproductive. It'd be frustrating for the team if a mother only wants X nurse to care for her child, or only shares info with X nurse etc. Not good for the unit's morale.

[jadelpn, LPN, EMT-B]

Yes, they are blurring boundries and fostering co-dependent relationships. Questions and concerns should be directed to the nurse taking care of the patient at the time, not the "primary" nurse who is not working. Here's my question--what happens when parents calls/texts the "primary" with a complaint or question regarding care--does the primary nurse then call the care nurse to question? Unfortunetely, this practice will probably stop when a primary nurse puts in for OT due to too many texts. This does seem to be something to bring up to your NM for clarification. Either these "primary" nurses are glorifying themselves as the only nurse capable of taking care of the baby, which in itself fosters a huge mistrust in the care of another nurse, or there is some sort of policy in place that the primary nurse needs to be "on call" for this......but I think that is what the doctor is for.....

[tnbutterfly - Mary, BSN]

Moved to Pediatric Nursing to get input from more of our pediatric nurses and to see how common this practice is.

[KelRN215, BSN, RN]

This is inappropriate. Not super common but I have seen it happen before. Actually, I guess I shouldn't say it's not super common- it varies by the floor. Floors where patients are inpatient for longer tend to have more of this. I know it was something that happened with relative frequency on the Stem Cell transplant unit of my old hospital.

The ONLY time I would ever call the hospital to check on a patient would be if something happened on my shift (i.e. a rushed a baby to the OR at change of shift) or I was a primary nurse for an end of life patient and I wanted a general idea of what had been happening before I had to come in and take care of him. And in this situations, I would always call the nurse caring for the patient or the charge nurse to inquire about the patient. Would NEVER give a parent my cell phone number and have them text me with questions when they have a nurse caring for their child 24/7, that's who they should be asking.

It also undermines the nurse caring for the patient when nurses do this... if you're trying to take care of little Sarah in a crisis but Kelly is her primary and has given mom her cell phone number, how would you feel if in the midst of assessing Sarah and trying to get her to wherever she needs to go (CT, the OR, ICU, etc), the mom says "I think we should call Kelly." Um, no. And, what kind of nurse wants people calling them about work on their day off? No, thank you.

[NotReady4PrimeTime, RN]

So wrong on so many levels. The BON would have a field day with this scenario. It's unprofessional, it's unethical and it's quite possibly illegal.

There is a (former NICU) nurse on our unit who has done things like this. She gets herself very enmeshed in relationships and truly believes no one can give the family what she can. She has gone so far as insist that she be called, day or night, if one of "her" babies (she has a weight restriction so all she ever is assigned are the babies) is nearing the end of life. I've seen her come in late in the evening to "support the family", pushing out the nurse assigned to the patient and even escorting the body to the morgue under the guise of being asked to be there by the parents. She then, of course, puts in for (unauthorised) OT. She calls it "family-centred care" while I call it abuse of influence.

I suspect that individuals like this may be displaying features of an Axis II disorder along the line of a narcissistic personality. Very difficult to observe and more difficult to do anything about.