Feeling Guilty- Desperately Need Opinions

Werblessed · Sep 5, 2009

I feel your pain, Sue and I've been there with patients myself with whom I've relaxed boundaries and allowed personal feelings to intermingle with professional practice. My recommendation is for you to talk with your manager about having this patient reassigned to another nurse. Your patient may be upset by this decision initially but she will receive the care and attention she deserves from a nurse who is not exhausted by this case (and you can give the newly assigned RN the skinny on the importance of strict boundary-setting with this patient). If your manager is unable to reassign this case based on your circumstance, then I would encourage you to involve the MSW on your team to intervene in getting things back on track. It's a lesson we all learn the hard way and one you will not soon forget. (I was cooking italian meals for one of my patients 2-3 times a week at one point!! Yeppa...lesson learned!)

rngolfer53 · Sep 5, 2009

I have a hospice pt with cholangiocarcinoma. She was my palliative pt for 1 1/2 months. She is a nurse and is very controlling and demanding. I am just so exhausted with caring for her all this time. She finally decided to go on hospice and because she is declining so quickly I have her on daily visits. I'm off this weekend and believe me, I need it, besides being so mentally exhausted I have a lot of errands to run and I'm taking care of a friend of mine who has ovarian cancer. I told her today that someone else would be seeing her over the weekend and she got very angry with me because she only trusts me. The nurse who will be seeing her has seen her before. She begged me to see her over the weekend and I'm so badly in need of a break and she doesn't live close to me. Also, I'm on call Labor day night and have a horrible caseload on Tuesday. I asked everyone not to let her know that I'm the one call that night because she'll call me all night long. Am I horrible for feeling this way? I just can't work all night and all day anymore. What does everyone think?

You most certainly aren't horrible for feeling that way. I work doing after hours calls, so I don't have a specific case load. We get a few people who are insisting on their regular nurse at 0200, and I explain to them that no person can work any job, and especially this one, 24/7. I let them know that in order to be able to care for her Pts the nurse needs time to recharge. Perhaps because I'm a different person from the one they're used to seeing, they seem to accept this explanation.

Like everyone else , you require rest, physical, mental and emotional. Rest isn't optional. The nurse who will be seeing her over the weekend has the responsibility of doing so, even if it's difficult. She just needs to go and get 'er done, so to speak.

Take care of yourself, please.

rngolfer53 · Sep 5, 2009

(I was cooking italian meals for one of my patients 2-3 times a week at one point!! Yeppa...lesson learned!)

Can I be your Pt? :chuckle

Werblessed · Sep 6, 2009

:typing LOL!!! Yeah...when I started making brochiole (flat steak rolled up with pine nuts, raisins, garlic and cooked in homemade sauce) and aboop (octopus cooked in tomato sauce...yummy actually!) for him, I knew I'd crossed WAY over that professional/personal boundary....Live and Learn! Although now that I work as crisis RN after-hours, I have been known to swing by some NY-specialty restaurants for some terrific matza-ball chicken soup or black & white cookie when I know I have an East-coast pt visit and they live alone! It's the Italian in me, really!

Ginapixi, BSN, RN · Sep 7, 2009

:yeah:some where some how there is always one pt/one family, that is for what ever reason closer to your heart.

However, we are all human and have limits, physical as well as emotional ones; you can only give so much until you too need a break and recharge! Please do not feel guilty! you are not abandoning this patient! You give both - you and the pt- a "new day" a "fresh start" a needed break; you are not the pt's savior, you are the nurse! as much as we want to make every thing right, in the end it is up to the pt and the higher powers in charge; we are just there along the way; and if it is another nurse this pt needs to learn to trust then so be it. Do not let this one suck your life out of you!!! I wish you all the best and do not feel guilty! you have done your job and beyond.

Sue Damonas, BSN · Sep 11, 2009

Well, I did take the weekend off(except for caring for my friend) and certainly needed a break from this patient. She has required so much physical care and support, also her family. I've had some tough patients over the years but she was the toughest!! She finally passed yesterday and I feel a huge weight lifted off my shoulders. Thanks everyone for your advice and support!!

greenfiremajick · Sep 14, 2009

I have a hospice pt with cholangiocarcinoma. She was my palliative pt for 1 1/2 months. She is a nurse and is very controlling and demanding. I am just so exhausted with caring for her all this time. She finally decided to go on hospice and because she is declining so quickly I have her on daily visits. I'm off this weekend and believe me, I need it, besides being so mentally exhausted I have a lot of errands to run and I'm taking care of a friend of mine who has ovarian cancer. I told her today that someone else would be seeing her over the weekend and she got very angry with me because she only trusts me. The nurse who will be seeing her has seen her before. She begged me to see her over the weekend and I'm so badly in need of a break and she doesn't live close to me. Also, I'm on call Labor day night and have a horrible caseload on Tuesday. I asked everyone not to let her know that I'm the one call that night because she'll call me all night long. Am I horrible for feeling this way? I just can't work all night and all day anymore. What does everyone think?

1st and most important--take care of yourself. Otherwise you can't take care of anyone else. So no, I don't think you should feel guilty, at all. Easy for me to say, right?

tewdles, RN · Sep 17, 2009

Any nurse who case manages patients in hospice understands your feelings. I hate it when patients or families pick up my work cell number from their caller ID. That enables them to call me directly on my work phone 24/7. While most patients and families have access to that number and never use it, there are some who abuse it immediately. The moment that happens I begin to send those calls directly to voice mail...I do not even answer them even when I KNOW they are having symptom issues. I NEED my patients and families to follow the communication chain the way it is set up...I cannot be interrupted by Mrs Smith's phone calls while I am visiting Mr. Jones. I CAN glance at a text message from the office advising that I need to call Mrs Smith when I am done. If the patient is insistent on calling me directly they MAY find that their response from me is SLOWER than when they follow the proper chain of communication. I make sure that my voice mail indicates clearly that I may not check my voice mail for several hours, so if they need something urgently they should call the office. I don't practice this way because I do not care about my patients, in fact, I care very much. I don't, however, have some illusion that I alone am the angel of hospice that will single handedly make their hospice experience what they need. I understand that I work with a team and that we have systems and protocols in place that allow us to provide excellent care...as a team. I quickly educate, and re-educate families and patients about hospice contact procedures and how following the procedure will insure that they receive the BEST care available to them in the fastest possible manner. It is so important to have good, firm boundaries when it comes to our patients. Maintaining the boundaries makes us healthier, more effective hospice nurses and happier, better balanced humans.

Werblessed · Sep 17, 2009

Tewdels, very well said.:yelclap:

SuesquatchRN, BSN, RN · Sep 17, 2009

:typing LOL!!! Yeah...when I started making brochiole (flat steak rolled up with pine nuts, raisins, garlic and cooked in homemade sauce) and aboop (octopus cooked in tomato sauce...yummy actually!) for him, I knew I'd crossed WAY over that professional/personal boundary....Live and Learn! Although now that I work as crisis RN after-hours, I have been known to swing by some NY-specialty restaurants for some terrific matza-ball chicken soup or black & white cookie when I know I have an East-coast pt visit and they live alone! It's the Italian in me, really!

I'm a relocated Staten Islander and whenever I visit I load up on things I can't get here. Just brought back Medaglia D'Oro espresso and black and white cookies. And real bagels.

Salumerias and pastosas and good bakeries with cannoli - drool.

I think I would burn out quickly in hospice.

island40 · Sep 17, 2009

Get a backbone and stop being a martyr. This client could benefit from some serious boundaries. I work with boarderline personality disorder client and believe me... boundaries!!!