Ethics of Nurse/Patient Relationships

Atheos · Oct 10, 2008

Here is my take.

I have had 2 separate BONs say that it was acceptable to accept gifts from 'former' patients that were no longer patients or family members of patients that were deceased as they were no longer under your care.

Basically, what they are saying is that it becomes acceptable after the nurse or aide/patient relationship ends.

I believe you can apply this to the current situation.

After the nurse/patient relationship is over there is nothing unethical about having a personal relationship. The only question seemed to concern when that relationship was officially over.

I think when he was pushing her out after discharge the relationship was NOT over. I agreed with the idea of waiting some time and bumping in to them because that would obviously be in a time after the end of the nurse/patient relationship ended.

No nurse/patient relationship, no ethical problem.

Liddle Noodnik · Oct 10, 2008

PS: For those who think I might have an ulterior motive, I am happily married with my wife reading over my shoulder. She has let me know, in no uncertain terms, that violating that relationship will lead to a significant change from me being a nurse - to being the patient!:no:

ha ha ha ha ha! I just love the way you worded that --

No opinion really on this issue - altho I read the other thread with interest. I guess "trolling for dates" would be frowned upon - but if, after the nurse/pt relationship ended, one or the other party wanted to pursue dating, it would be ok. (How to bring it up though! Awkward!)

That's not how I was brought up, however.

We were taught that it is NEVER ok.

But, I have seen a few fruitful relationships develop this way.

patwil73 · Oct 10, 2008

We were taught that it is NEVER ok.
But, I have seen a few fruitful relationships develop this way.

I too remember being "taught" that it was not ok to do. However, the why was frequently skimped over. Or my instructors mentioned something about inequality of power and vulnerability but didn't elaborate or provide for discussion on if that was really true.

Everyone just seemed to accept that it was wrong and leave it at that. However, I have discovered as I grow older that one of the few passions left to me is questioning why things are the way they are (I will rarely play basketball anymore, I left martial arts way behind, work and lack of exercise combine to limit what I am willing to exert myself to do - and questioning is high on that list).

So do you remember when you were taught why it was wrong?

Thanks

Pat

patwil73 · Oct 10, 2008

No nurse/patient relationship, no ethical problem.

Thanks for the response. Here is a twist - what if you are a nurse but not the patient's nurse. Would an ethical problem exist beginning a relationship even if that patient had not yet been discharged?

Or perhaps even grayer - what if that patient is discharged to a rehab facility. Can you begin a relationship with that patient there when you are not a nurse there? Would an ethical conflict exists simply because you were a nurse and s/he was a nurse?

Thanks

Pat

heron, ASN, RN · Oct 10, 2008

The issue is one of power. As caregivers we show all the signs of a positive emotional bond ... we care how the pt feels, is doing, go to bat to get them what they need, make their welfare our priority. (More of a parent than a partner or girl/boyfriend, really.) We do that because it is our professional responsibility to do so. Because of our position as a professional caregiver, the pt is dependent on us to meet many of their needs.

If we succeed in helping the pt to feel better, physically and emotionally, we have done a good job. However, this engenders normal responses in the pt. ... liking, gratitude, all kinds of warm fuzzies. And that response does not disappear upon discharge.

It is this positive emotional response that we CANNOT capitalize on to meet our own needs.

The "waiting time" is suggested because it gives the former pt a chance to return to his/her own level of independence and emotional balance. This way, the former pt. can possibly meet the former caregiver as an equal.

'Tis a hot-button issue for many of us, as evidenced by many of the replies in the previously mentioned thread.

To answer the original question: I believe it is unethical to pursue a personal relationship with a former pt until enough time has passed to allow the pt to put his/her responses to the nurse into some perspective.

The universe does not owe us "relationships" ... if the positive feelings do not survive the waiting period, so be it.

Liddle Noodnik · Oct 10, 2008

I too remember being "taught" that it was not ok to do. However, the why was frequently skimped over. Or my instructors mentioned something about inequality of power and vulnerability but didn't elaborate or provide for discussion on if that was really true.
Everyone just seemed to accept that it was wrong and leave it at that. However, I have discovered as I grow older that one of the few passions left to me is questioning why things are the way they are (I will rarely play basketball anymore, I left martial arts way behind, work and lack of exercise combine to limit what I am willing to exert myself to do - and questioning is high on that list).
So do you remember when you were taught why it was wrong?
Thanks
Pat

I do recall it being about the power/control thing. I recall too that the attitude was, "that's not what you're there for."

There was a great emphasis on the fact that the relationship was all about what the patient needed - that we shouldn't be talking about ourselves, but rather that we should keep it professional based on what the patient needed.

Now if either party expressed interest while the pt was inpatient, you could get sexual harassment issues in there. The nurse could become uncomfortable caring for him/her so she/he might avoid the patient more. Or, if she/he was interested, might spend MORE time and thus deprive his/her other patients. The patient might feel he/she has to behave a certain way in order to get good care from the nurse who is interested in him/her.

If the focus was on the two of them, there would be less attention paid to whether the pt was having symptoms. Would his/her hospital stay be prolonged? Would Dr. Smith Make Life Hard for Ms. Jones? And what about the baby?

ha ha ha

Anyway - point being - keep it professional! And I can't see a smooth transition when the pt gets taken out to the car at the end of their stay! But there are others who have more finesse than I

racing-mom4, BSN, RN · Oct 10, 2008

I think alot has to do with the scenerio that made the pt a pt----Say Nurse Suzy is taking care of Patient A who just had an appy. Pt A tells nurse Suzy he was supposed to go to the blues concert tonight but now cant, Nurse Suzy says Oh I love that blues band etc etc etc and a conversation begins, a few weeks later nurse Suzy and Patient A are now at the same bar watching the same show and Pt A buys nurse Suzy a drink and a relationship begins....perfectly fine if you ask me.

Or Nurse Suzy is taking care of Pt B in the Behav Health unit, had read pts Bs chart about his past relationship troubles-job trouble etc etc etc and Nurse Suzybeing a bit crazy her self (lol) and thinks Pt B is "hot" so she calls him after he is dismissed at home to "just talk" and see how he is doing etc etc etc and a relationship begins, well this is bad if you ask me.

I dont think this is a black and white question. Lots of grey areas!!! But good topic though!!

MB37 · Oct 10, 2008

There are definitely grey areas here. As the nurse, I feel it would be inappropriate/unethical to pursue or agree to a relationaship with any pt while they're still a pt in your system. It's the dependency/vulnerability thing, and I think it's unprofessional to either hit on your pts or to flirt back with them if they start it. If they leave your facility entirely, but still remain a pt over in the rehab center, or are still a pt of one of the docs on your floor...maybe you aren't doing anything wrong. However, I would still avoid calling them to "check up" when you really have an ulterior motive. As racing-mom 4 said, I think that if you run into a pt post-d/c, they're fair game. Unless you expect to continue to have to care for them - i.e. they're frequent fliers, or you're a clinic nurse and they come in on a regular basis - the imbalance of power in gone once they're out of the hospital.

I too am happily married, so this is the first time I've sat down and thought any of this through. It wasn't covered at all at my school, and I did have to take a nursing ethics class.

Iam46yearsold · Oct 10, 2008

I have never dated or been involved with a patient, or even a former patient, not that I am aware of.

I Do not date doctors or coworkers either. That just will not happen with me.

sicushells, RN · Oct 10, 2008

I think part of the 'never ever ever date a patient' rule from nursing school has to do with the stigma of nurses as 'professional' women (wink wink nudge nudge). If she's not at home, she must not have any honor... all that jazz. I think the world's changed enough that that mentality is pretty much gone, but it seems like nursing school is often the last institution to notice social changes. I will say I've had a few older male patients (not confused, either, just a little pervy) try to get a little "extra" with their baths *shudder*.

heron, ASN, RN · Oct 10, 2008

I think part of the 'never ever ever date a patient' rule from nursing school has to do with the stigma of nurses as 'professional' women (wink wink nudge nudge). If she's not at home, she must not have any honor... all that jazz. I think the world's changed enough that that mentality is pretty much gone, but it seems like nursing school is often the last institution to notice social changes. I will say I've had a few older male patients (not confused, either, just a little pervy) try to get a little "extra" with their baths *shudder*.

Nope, it's far more serious than that. It has to do with the problem of using a professional relationship to meet one's own needs. The emotional bond established during the caregiving relationship is, almost by definition, an artificial one resulting from our professional duty to care and the patient's natural reaction to being cared for. It is unethical to exploit that bond to meet the professional's personal needs ... whether for friendship, money or intimate attachment. The question is, how long does one wait after the end of the professional connection to approach the former patient?