I just finished reading the thread about dating a former patient. 11+ pages of strong opinion regarding the ethics of starting a relationship with someone you are caring for. I am not trying to restart whether or not people believe that particular poster was wrong or right in his decision, but instead in discussing the reasoning people use in deciding if it was ethical or not.
So for anyone interested in joining this discussion - do you believe that it is ethical to start a relationship with someone you cared for as a nurse?
Why?
From reading the prior thread many posters brought up vulnerabilty - that the power balance led to inequality between patient and nurse and hence it was morally wrong to exploit that inequality. If you do believe this, do you feel that all relationships that begin with one partner in a vulnerable state should not be pursued? Or any relationship that is unequal can not work?
Are all nurse patient relationship inherently unequal? Why? Does the patient not have the right to accept or refuse any treatment, to determine for themselves how their care will proceed, to even "fire" their nurse and demand another one? If the patient is A&O and at least semi-independent in ADL's where exactly is the inequality?
Many posters seemed to indicate that the ethics changed with time (many mentions of 6 months to 1 year). What exactly has changed in 6 months that didn't in 1 week? (and honestly, how many relationships survive 1 year of no contact?)
So have at it! Can the nurse patient relationship survive? Should it? Or are there perhaps other reasons we should strive to sever that possibility?
Thanks
Pat
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:
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
Thank you very much for your response. Please understand that all disagreement/argument is merely an attempt to understand or delve into why we believe that something is wrong or right.
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.
Does the ethics of the situation depend on what needs are being met, or how many? Would you argue that it is a black/white where if you meet even one need for the patient it is unethical to pursue a relationship while such need is being met?
If so, how would you argue that all relationships are not on the surface unethical since (I would argue) all start with the meeting of one need or another, ie friendship, security, closeness, emotional support, heck even the old dinner and movie meets the need of food.
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.
Isn't all human reaction built on capitalizing on positive emotional responses. I take a girl out on a date. I buy dinner, listen to her carefully through the meal, agree with her a lot (which makes her feel better). If things move quickly there could even be a physical/emotional component that gets filled. She has the normal response of liking, gratitude, warm fuzzies - are you arguing that I should not pursue the relationship because it proceeded along the lines intended?
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
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.
Thanks for the reply. I think you might be right here. Although I don't believe expression of interest (a simple I like you would you be willing to go out on a date) does not rise to the level of sexual harassment, although in our litigous society it certainly might.
However, the feelings engendered could become an ethical issue. As nurses we believe that we are responsibly equally for all our patients and anything that distracts from that could be ethically wrong. That was one angle I did not consider, so thank you.
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
It depends on a few things:
1) The patient must be of sound health and mind. A relationship should not be started while the patient is still acutely ill, or if the patient is mentally ill.
2) The nurse/patient relationship must be over.
3) The nurse/patient relationship should not be used to initiate the relationship--i.e. no looking up a phone number in the medical records.
If those are met, I have no issue with it.
I am wondering if even on this board we could come to an agreement on when exactly the nurse/patient relationship is over?
Hey Pat, you take a girl out on a date yes there are positive emotional attachments which can form. But at least you do not have the priviledge of inside information knowing she can never have children due to hysterectomy, or that her hiv test is neg,, unless of course you asked her and she gave you the answers.
Will people agree as to when it would be safe to date a former patient once they are discharge. I do not believe there is a hard and fast rule.
On psych we had a rule, former patients could not visit patients on our unit for 30 days after discharge. Again it was to protect them both due to understanding that unhealthy attachments can be made during times of vulnerablity.
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
Hey Pat, you take a girl out on a date yes there are positive emotional attachments which can form. But at least you do not have the priviledge of inside of information of knowing she can never have children due to hysterectomy, or that her hiv test is neg,, unless of course you asked her and she gave you the answers.
Thank you for the response. I hope that you understand that I am not actually advocating a nurse patient relationship, but merely exploring why we consider one unethical. Sometimes when people disagree online it can be very difficult to determine what they are really saying, and we miss all the little signs that make disagreement more palatable.
That said, I am afraid I disagree here. Are you arguing that "inside knowledge" of someone by itself makes a relationship unethical? I can think of a few ways someone might get access to such knowledge.
Knowing someone likes daisies vs roses and you show up with them is seen as cute. Knowing their favorite food is Italian and you take her to such a restaurant makes you considerate. Knowing she had a hysterectomy and your conversation indicates sympathy for such a condition makes you what?
We utilize our knowledge of others in every relationship, at every stage. Sometimes we get that knowledge from the person in question, other times from mutual friends, others from overheard conversations, other times from running into someone at the clinic, etc.
Bringing it back to OP, can we argue that having inside knowledge of the patient in and of itself makes all such relationships unethical, or that only specific knowledge makes it so?
I would make the case of having specific information about someone due to my having the privilege to information they did not personally tell me. Medical records are not public.
Unlike say doing a web search about a potential date and you discover in your search they had a prior DUI ( driving under the influence )which is public information, different than my knowing his MBA was 4.0 as I saw his emergency report and my god why wasn't he dead he must really be practiced drinker with a problem.
Unlike someone tells me hey that guy you are dating is a real so so because they did such and such. In which case I might bring up my concern with the person/date and hear their side of it. Then make my own opinion from that. As no matter what I hear it would be hear say not fact as yet.
Patient medical records which we are privileged to see if we are caring for a patient are factual , considered legal documents, trusted that we will maintain confidentiality and protect our patients.
OK, say I date a former patient of mine, say we actually get married. Then marriage starts to sour, in a horrible , horrible fight, I low ball him saying " yah and you think you are so perfect what about the time you had VD" To which he says how did you know that? I never told you. No one knew.. gulp..... ever been in nasty divorce,, lets see would that potentially put me in a vulnerable spot as I just in anger divulged privilege information I read long ago and once upon a time in their chart? So now I lose my house, give up any chance of getting his pension as oh my God I am now trying to protect my income my license....lol,,, ok taken to the ninth degree
Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.
OK, say I date a former patient of mine, say we actually get married. Then marriage starts to sour, in a horrible , horrible fight, I low ball him saying " yah and you think you are so perfect what about the time you had VD" To which he says how did you know that? I never told you. No one knew.. gulp..... ever been in nasty divorce,, lets see would that potentially put me in a vulnerable spot as I just in anger divulged privilege information I read long ago and once upon a time in their chart? So now I lose my house, give up any chance of getting his pension as oh my God I am now trying to protect my income my license....lol,,, ok taken to the ninth degree
Thanks again for the reply. I must say I am enjoying this discussion.
I might be misunderstanding you, but it seems you are arguing that since bad things can happen when you have private information about a person then you should not pursue a personal relationship. All relationships are built on personal information and when the relationship goes sour there is always the chance that you will say or do something which you wish you could take back. However, just because the potential for ruin is there, it does not necessarily follow that one should not pursue a course of action.
Wherever you get the information does not change the fact that it can be used well or poorly. Just having the information should not in of itself immediately make a relationship unethical, it is how you use that information - at least in my opinion.
I believe in relationships. I believe in love and all that goes with it. I also believe if I take care of a patient I do not cross the professional boundary.
Anything beyond that is hypothetical , as I have never dated a patient nor been interested in a patient.
That could change however if some billionaire with one foot in the grave happens to be single and dumb enough to marry me at that point. Of course I only know he is going to die in 3 months as I read his records. how fast could I say " I do" and man that Will had better change.. just call me ANNA NICOLE. you realize of course these are uncertain economic times..course now how do I convince the family. I really married him for love and not his money. Oh I know, I can lie,,,,,,
Some interesting points have been made, here, and I find the issue is less clear to me than it was before reading this thread. I'm still inclined to view dating a former patient as a boundary violation, but I wonder if I might feel differently if I were younger and actively interested in a romantic relationship. Certainly, it seems like there must be some qualitative difference from meeting a potential life-partner versus dating a different former patient every week.
I've actually used the ethical objection to gently fend off unwanted overtures, and I didn't feel dishonest doing so. Now that I think about it, it has been an extraordinarily rare event for a woman to "hit" on me away from work, but not entirely uncommon at work. I suppose it's conceiveable that I just look that good in my uniform, but it seems rather more likely that patients are more vulnerable, more dependent.
Or maybe just more lonely. I'm a middle-aged bachelor with cats, but a lot of single women--single people--in my age bracket are not single voluntarily.
I've argued rather vehemently, on some other threads, against the notion that all men are natural predators, but it occurs to me just now that the idea of a female nurse dating a male patient doesn't seem quite as creepy to me. And I don't seem to have a clue as to how I feel about situations where both parties are of the same sex. I think I may just have a bias that men aren't quite so vulnerable--even though I know better than that.
Just lately, I've had occassion to provide some nursing care, at home, to my father. Glad as I am that I was in a postion to do so, I found it extremely difficult to function objectively. Maybe that's reason enough to maintain a boundary between a professional and a personal relationship, although that reason would seem less compelling in terms of an ex patient.
I like your response"Certainly, it seems like there must be some qualitative difference from meeting a potential life-partner versus dating a different former patient every week."
I have rarely met someone who did not hope of meeting a potential life partner. Meanwhile the healthy ones lived their lives bought their own homes/condos made a life for themselves. Did not put their life on hold for when their prince or princess would come. Did fun things with their friends instead of going out with their friends with one eye scanning the room for a potential partner. How insulting to the friends with them.Yes, I had a friend who routinely did that. I finally said you want to go someplace and spend the time with me catching up fine, you want to use me so you are not out alone hunting not okay.
The dependent personalty types saw potential partner where ever they went. Off on a first, started planning the wedding in their head ,,,sheeeeeeeeeesh
I agree with you it is simply a boundary I do not cross while at work. I think it might be more of an issue for the nurses who might be unattached. Live in small towns where everyone knows your name.
Not something I have ever done, but dating a patient's family member I do not see as a problem. But again if it were me I would most likely wait to accept that first date after the patient was discharge so that I would not accidentally say something that would violate patient confidentiality. I might also make a point that if they brought up their loved one I would not discuss anything medical about their family member for professional reasons outside of a casual, how are they doing.
:no:
patwil73
261 Posts
Thank you very much for your response. Please understand that all disagreement/argument is merely an attempt to understand or delve into why we believe that something is wrong or right.
Does the ethics of the situation depend on what needs are being met, or how many? Would you argue that it is a black/white where if you meet even one need for the patient it is unethical to pursue a relationship while such need is being met?
If so, how would you argue that all relationships are not on the surface unethical since (I would argue) all start with the meeting of one need or another, ie friendship, security, closeness, emotional support, heck even the old dinner and movie meets the need of food.
Isn't all human reaction built on capitalizing on positive emotional responses. I take a girl out on a date. I buy dinner, listen to her carefully through the meal, agree with her a lot (which makes her feel better). If things move quickly there could even be a physical/emotional component that gets filled. She has the normal response of liking, gratitude, warm fuzzies - are you arguing that I should not pursue the relationship because it proceeded along the lines intended?
Thanks again,
Pat