Crossing the Line?

Nurses General Nursing

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My first post on this board, and I have a feeling it is sure to attract some heated debate. Here goes...

I've been a nurse for almost 8 yrs and was working most recently at a Level I trauma center in the SICU. Had been working there about 6 months when I started taking care of a 33yo male patient who was injured in a motorcycle accident. He had suffered a T6 complete spinal cord injury and had to be stabilized before he could have extensive surgery to fuse his spine. He was on our unit for approximately 3 weeks, most of the time on the vent w/ heavy paralytics and sedation on board. I was working like mad back then (12 hr noc shifts, tons of overtime) and took care of him most nights I worked. He was barely conscious the majority of the time I cared for him, but the last few days before he was transferred to a stepdown unit (where they almost killed him I might add) he was awake (no head injury, thank God), extubated and being weaned off the sedation. I recognized early on that while the other nurses and the doctors that cared for him gave him the technical care he needed, none of them were supporting him emotionally through such a devastating injury (paralyzed at age 33!). His only family was his dad and he had some friends that inquired about him, though they did not visit in those early stages after his accident. After being transferred to a stepdown unit I began to visit him regularly before and after my shifts and we talked at great length about his accident, injury, recovery etc. I had become a trusted friend and advocate to him and, since he was no longer a patient on the unit where I worked, I was comfortable with that. His recovery was complicated and there were numerous instances when the care he received was less than optimal (bordering malpractice I believe). I tried to bring these issues to the attention of the staff on the other units he was on but was met with a great deal of resistance. Most of the nurses were extremely defensive (especially when they found out I was an evil SICU nurse!). My manager came to me and said she had gotten some complaints from the nurses on the other units he was on, saying that I was "overstepping my bounds." I tried to explain to my manager about the horrible care he was receiving and she brushed me off. Long story short (too late now, huh) I stuck to my guns and advocated for this person (I was told more than once that I'm not a family member, don't get involved, blah, blah, blah). Both the patient and I got into it w/ the other nurses, managers, administrators (I was suspended for 2 days pending an "investigation"...more like an inquisition). He received HORRIBLE care and gross mismanagement almost killed him. To this day he will tell people that if I hadn't intervened on several occasions he would be dead...the senior surgical resident even told me that himself. I've read all the article about "inappropriate therapeutic relationships" with patients but this was nothing like this. A friendship had developed after the time I took care of him on my unit, there was nothing romantic or sexual in nature, and most of all he trusted me to be his advocate during this awful time. I was so disgusted with the management at that institution. I was disgusted with nursing in general at that point. I ended up getting fired some 5 months after that situation, allegedly for calling in sick too many times, though I suspect that had less to do with it than the fact that I had become a squeaky wheel around that place, pointing out the gross malpractice going on. As I told management during my 2 day "inquisition", I would do it all over again and, if needed, I would hire an attorney. Many of those close to me, who knew all the details, suggested I hire an attorney, but to be honest, my main concern was making sure this patient got the kind of care he deserved. Despite being fired form that institution (trust me, they don't "listen better" as their craft advertising slogan goes), I WOULD do it all over again. And if inquiring minds want to know...my friendhip with this patient did develop into a relationship...AFTER he was discharged. I've seen him progress through rehab and getting aclimated to his new world of paraplegia, and having him become a part of my life means more to me than any run-of-the-mill nursing job in the world. Any comments?

Would love to have you in my corner if needed. Good for you! :)

:kiss Hi, i agree use proper procedures with patients, and direct them ,in getting help in not being cared for right, or even call avocate for them, if hospital is looking other way.

Specializes in Corrections, Psych, Med-Surg.

"Any comments?"

You chose your battle, chose the tools to use to fight it, chose not to engage an attorney on your behalf at the first sign of personal opposition, and you paid the price for those choices. Fair enough.

A good warrior (i.e. one who survives to successfully fight again another day) carries BOTH a spear AND a shield. If you don't protect yourself in battle, you can expect to be wounded, regardless of the wounds you are able to inflict on the enemy.

No flames. I think you said it all your self. You did what needed to be done.

You are what "being a nurse" is all about! :)

I have to agree wth the others, Your courage and determination to protect this patient should be commended. I also wish you happiness in your new found personal relationship. :)

JadedNurse,

Please make yourself immediately available should I or anyone I love be hospitalized, okay? =0)

Seriously, you advocated for your pt, plain and simple. Employers love to hear noise from nurses about their pts coming first, but when you actually base your nursing interventions and behaviors on those ideals, mgmt does not like that one bit. Lip service to pt advocasy is as far as they go.

The fact that you developed a relationship after the pt was D/C seems fine to me. He was D/C.

Hope you've found a better job.

Specializes in Critical Care Baby!!!!!.

You did exactly what needed to be done! Often times, it is the nurse who spots problems in the care with a patient and points the docs to the right path.

I think sometimes people get so caught up in the technical part of nursing that they forget that it is a PERSON in that bed and not the pt. in bed 8.

Emotional support is just as important and sometimes even more important than the technical care. It is my FAVORITE part of the job!

Way to go! You truly portray what it means to be a nurse!

It is important to support excellent care and support our patients and I have no problem doing that. How do we draw the line when our 'concern' for patient care disrupts another unit? IMO the best way to problem solve poor care issues is through appropriate chain of command, not direct personal involvement.

It's important for nurses to recognize when we may be crossing professional boundaries with patients and coworkers....and take a moment to step back and analyze actions and feelings.

Looks like I will be the lone dissenter here, because I feel the OP MAY have crossed that line, and from her post, she may recognize this too. It seems to be a risk she was willing to take.

One of my wise ol' instructors waaay back told me "If you ask yourself if you are 'crossing the line', you probably already have. "

We can't possibly know the whole story, and I always try hard not to judge another nurse harshly until I've walked in his/her shoes. This goes for the OP AND the staff she reported.

Sounds like you were the only person with his best interests at heart...how would you have felt if you had done nothing? I applaud your bravery and caring..you can be my nurse any day :)

Specializes in ER.

You did a great job. I hope you don't find that the backlash against your advocacy makes it hard to stay in nursing. I think any problems originated in the system, not in your care or concern for this man.

I admire you for what you did!

Enough said....

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