Help me get some peds perspective about attachment?

[mskate]

So, this is about a friend of mine who is a relatively new, new grad. She worked as a nanny before nursing school and couldn't find a hospital job, so she started doing pediatric home care as a new grad RN, no orientation with another nurse, etc.. - just here is your assignment - GO. This has had mixed results, I get lots of text messages "I have a kid who is on a versed medicine at home. What is it? How much should I give?" types of questions throughout the day which, for me - is a scary thing and I don't think she is particularly safe or adequately trained/prepared to be a home care nurse.

Anyways, she gets very attached to her patients. One patient, she started taking pictures of him, uploading them to her facebook, talking to people in the community about him, etc... and I called her out about how its inappropriate, HIPAA, etc... and she eventually said she "got permission" to do it. Whatever.

Ultimately, the child's disease got worse over the course of the 3 weeks she was watching him and he died. She stayed in his house, without pay, for 28 hours while he died. Leaving her parents to watch her own child, neglecting her own well being, not sleeping.... I should add that she did have a relief nurse come in to take over care, but she felt it was "too much to leave to 1 nurse, that it would take 2:1 nursing care." It is not as if the patient would have been left alone... and coming from an adult ICU background - it takes A LOT to need 2:1 nursing care... let alone for an at-home death with controlled symptoms and family care.

I question the appropriateness of the situation. I know in the adult world, that really isn't something that you do, and it is important to, although always be invested and caring - to maintain professional boundaries.

She insists that it is different with kids and that's the way peds works.

Not trying to start a he said/she said battle, not looking for an "i'm right/you're wrong" discussion, but I am genuinely curious if that would be considered normal and acceptable to the pediatric nursing world.

[llg, PhD, RN]

No. That's not appropriate in peds, either. Unfortunately, it takes a while for some people to realize how wrong it is and people get hurt in the process.

[BrewerRN]

I have worked in peds for the majority of my 19 years in nursing and I can honestly say it is hard NOT to get attached to some of those little ones. One the other hand, what your friend is doing is inappropriate. She needs to learn how to control her feelings and be professional. You can care for your patients without emersing yourself into their life. She will burn out fast if she does not get hold of her emotions; especially if she is working in a hospice situation. Good luck to you explaining it to her and good luck to her working through this.

[umcRN, BSN, RN]

To be immersed that deep seems inappropriate though I agree sometimes its hard not to get attached, however there are differences in how attached one can get. I had two primaries the last two years who I got very attached too. One passed, I did attend her funeral, and her mom emails me every so often to let me know shes doing ok, in this situation its more likely that her mom is more attached to me, as someone who knew her baby almost as well as she did (she never had any family/friends visit in the hospital), so I allow it but I do not see her, get lunch with her, or get involved in her life in any way. My other kiddo I was attached too is now home, and thriving after doctors suggested to his family that they make him a DNR. He has surpassed any and all expectations made for him and his mom sends me the occasional photo and update on him every other month or so. I did go to his birthday party but that is the only time I have involved myself in his life outside of work. It's hard, but once discharged they must move on and use their own family and friends for support.

In the situation you describe your friend may burn out too quickly if she cannot detach her self from the patient and is working overtime like that. I am sure that is not allowed, it could be comparable to the nurse staying late in the ICU with a dying patient even though the nurse taking over is perfectly capable of handling it. It happens, but it's not healthy and not encouraged.

[NotReady4PrimeTime, RN]

This situation is a serious violation of professional boundaries and could become an issue with the BON. She could actually lose her license over this. As for her statement that it's different with kids and this is how peds is", that's bunk. In my 28 years as the parent of a medically complex child and my 17 years as a peds nurse, I've seen it a few times... in very dysfunctional people. The only scenario that I've witnessed where a nurse stayed in a person's home for more than 24 hours as death arrived that was appropriate was a pediatric in-home hospice program that operated through oncology in a small city. It was this nurse's job to be there, and it was kept completely professional. I'm afraid your friend is riding for a fall.

[Nurse Netty]

There is a clear difference, in peds home care, between, loving your kiddos, letting them steal your heart, etc. and crossing the line into being unprofessional such as taking pics, posting to your facebook, talking about the child to anyone other than the parent, etc. I've had several patients for more than 5 years now, and I've allowed myself to love everyone of them, to give them my all and my best while I'm there to care for them, every kid deserves that. But, when my shift is up, my shift is up, it's hard to balance~yes, but THAT is peds home care nursing. It should be every nursing, give your patient your all and your best while you are their nurse, because your patient is somebody's child, mother, father, brother, sister, spouse, etc. And you'd want your family cared for in the same manner, but don't cross the line and try to take the place of their family.