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

[klone]

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?

[elizanne]

We practice primary nursing on our unit (surgical NICU in a children's hospital). The primary nurse is in charge of discharge planning, such as making sure the chart is updated as to what types of teaching parents need to take the baby home, etc., and are assigned to the baby whenever they are working. They definitely aren't supposed to encourage parents to call them instead of the nurse on duty, although some might. I have seen some nurses get a little territorial, but that type of thinking isn't encouraged. NICU babies, and kids in general, can get sick fast. How on earth would a nurse at home be able to update parents with current information? There's no way to know if the kid got septic, coded, or what have you. Last week I started my night with a baby who was supposed to go home the next day, had no lines, no O2 requirements, really seemed totally straightforward. By 0600, he had an IV, was on O2, had an NG tube, was on a radiant warmer, and was undergoing a septic work-up. All happened within about 6 hours. There's no way his primary nurse would've had any idea about any of this.

[nursel56]

No, not appropriate for reasons stated by others. It's not therapeutic for the families, and feeds into the type of personality that likes the ego stroke of feeling indispensable.

[heirn13]

I agree that this is totally inappropriate for so many reasons. I work in a NICU unit that encourages primary nurses, but our management team discourages this type of behavior. I know of a few nurses that over-step this boundary at times, but not to this extent. Is your managment team aware of this practice? If not, I would make sure that they are made aware. This type of practice could cause problems for other people and ruin the career of these nurses.

[canned_bread]

It definitely seems inappropriate especially as there is already facilities set up, such as home health care, baby community centres, hotlines to call... Sounds like some education needs to be done on the ward.

[NicuGal, MSN, RN]

No, no and no. Where I work, this can get you fired if they find out the parents are texting you, esp if you aren't at work. I don't know why people think this is okay, you have to draw a line between your professional life and your personal life. And once the kid goes home, and mom texts you and says, hey ABC is happening what do I do, and you give advice and something happens to Johnny, and they show the text to someone and it says your name and advice, you are going to be hung out to dry. You are held to a higher standard as a nurse, esp if you had a relationship with this family.

[Lynstat1]

I agree 100% with all these comments , and just wanted to add that even in home health care nursing (Paeds) we would never give out our personal phone number and would be counseled and disciplined if we did. This type of emotional over-involvement has no place in delivering professional, competent and compassionate nursing care to children and their families.