How do you let go of the patients?

madwife2002, BSN, RN · Dec 11, 2009

What a lovely thing you did for your patients. During your career you will meet many people from all walks of life but there will always be some who touch your heart more than others.

This week we dialysed an old blind lady who loved suckers but never had any we bought some into the hospital and treated her to one each dialysis. It made her hospital stay.

shiccy · Dec 11, 2009

Honest answer? Sometimes you never do. The thing that has helped me in my line of work is to know that they do have families most of the time, and if they weren't in a LTC facility then they'd have *no* contact.

Also, if it's a place that gets a lot of student nurses, she will have another nurse to help her, talk to her, etc.

IMHO and I don't know if it would be allowed, but as long as you go through the correct channels (getting permission to visit, etc) you should be able to set up times to go visit. I actually don't think there is nothing stopping you from being able to visit. The only caveat is that you're obviously not allowed to perform nursing care. If you think about it, there's a lot of schools (high schools, church organizations, etc) that go to ECF's or SNF's to give out cards, play games, etc with the elderly. You visiting would be the same thing. I would, however, make your visitation as public as possible. Some Alzheimer's or demented patients can claim that people are sexually abusing or physically abusing them when really that's not happening. I wouldn't be changing briefs and what-not ... it'd have to be PURE VISITATION.

kfarinato · Dec 11, 2009

When I did my maternity clinical's a family I had asked me if I would be back the next day, when I told them no, they asked if I could come visit them anyway. I was touched, but I didn't think I could so I told them I had class (I did). When I told my instructor she said if I wanted to visit I could, but that I would be a visitor only and to make that clear.

It is very hard to let go of some patient's, I would talk to your instructor again if you feel that strongly about it.

chicookie, BSN, RN · Dec 11, 2009

There is nothing wrong with going again. Its really up to you were you draw the line. I have had patients that I loved and they have invited me to dinner with their families and such. I personally have refused because while I did love them I feel really uncomfortable about the whole thing. On the other hand I have seen nurses that do go visit their patients outside of a nursing-care relationship. It really depends on you and how safe and comfortable you feel.

FroEJ25 · Dec 11, 2009

Well, you have two options: lose your humanity and become a jaded robot, or continue to care and be willing to suffer the slings and arrows of outrageous fortune... You'll be a better nurse if you pick option #2 (in my opinion), but #1 is easier. My first job- and only so far- has been hospice (7 months); this is pretty much set up to be difficult environment possible. You start your nurse / client relationship knowing that the person is likely to die within 6 months (and usually much sooner), build a close relationship, be involved in their care at home, get to know their whole life story and family...

Then they die.

No really good options for how to deal with that situation. One of the reasons I want to get out of this job is compassion fatigue- I am afraid of the dehumanizing potential of going through this repetitive loss cycle. Sure, right now I am willing to stay late just to visit with lonely patients (salaried, so no $ benefit), but I doubt I would be able to sustain this for long.

On the plus side, in my case you generally know the person is at the end of life, and usually have lived a fairly long one. I suspect ICU / ER / OR where someone in their prime has an accident and dies could be challenging in a different way.

So, you live, learn and deal with it, or you go into administration. Good luck :)

studentNURSEwyo · Dec 11, 2009

You should begin planning termination with a patient at the beginning of the relationship. This does not mean that you can't do special things for them, or give them the best care possible, but if you treat everyone like this you might get emotionally burned out. Focus on the positive - you really made a difference in this woman's life, and you will probably help many more people throughout your career. :yeah: :yeah:

tewdles, RN · Dec 11, 2009

As nurses we sometimes fall in love with some of our patients. We enjoy our visits with them. We are touched by them and they add wonderful things to our experiences as a nurse and a human. Sometimes these people break our hearts, not intentionally of course, but just by the nature of what we do.

You will learn how to create boundaries for yourself. You will figure out how to care deeply for people "in the moment" which will allow you to move forward without them the next day or week or month. When our patients experience victory we celebrate. When our patients die we grieve.

Nursing is a wonderful career that is filled with pitfalls and potholes. If you can keep your wits about you as you work and build your skill sets you will have a successful career. It is okay to consider what you did for your patients yesterday "enough", it is also okay to want to do more...the important thing is to maintain an appropriate balance for YOU so that you can nurse tomorrow and the next day and the next. I hope that someday you will look back on your nursing career and feel as I do..."what a ride!" I hope that you have many wonderful experiences. Good luck.

netglow, ASN, RN · Dec 11, 2009

"You will learn how to create boundaries for yourself. You will figure out how to care deeply for people "in the moment" which will allow you to move forward without them the next day or week or month. When our patients experience victory we celebrate. When our patients die we grieve." tewdles

I love how you said this. I think OP, you will begin to find as I am, that these "rules" are for your emotional status as well. This letting go deal is hard, and you have to always be monitoring yourself. I've had several weeks in ICU, and there are some really tough issues going on there along with the stress of the place. If I don't keep doing little internal "couch sessions" I can see me bursting into tears, and there is no time for that.

Keep your heart, just not on your sleeve.

AmericanChai · Dec 11, 2009

Thank you SO much for your heartfelt answers! They really helped me. I will just have to prepare for the termination of the relationship as I first see them, that is a good idea.

With patient #1 who was going home probably before Christmas, we shook hands and he said good luck and we both said goodbye and that one went well. I would have liked to have had him under my care a little while longer because like I said, I was just starting to get to know his needs and develop a working care plan. But I know that regardless he would probably be fine. He had good therapists, a family that visited daily and he had optimism that he would go home soon.

With patient #2 (the one with the oranges) she just had no good family ties, and was facing end of life day after day of the same thing. Those oranges really made her day (probably her week or month!). With her, since she was so close to the end, I may ask if I can visit her one last time, or maybe even just leave some more oranges and a card for her at the front desk at Christmas but no more. I don't want her hanging on to the hope that I will come back many times-- and I know she would ask that I did. I do need to keep my professional boundaries, but at the same time have a heart and not treat them like objects instead of the human beings they are.

Most of the many other patients I helped, because we were kept very busy in the facility (sometimes our assigned patients took long naps, etc) I did not feel that strong pull of the heart. I mean, we made a connection on a human level, and I enjoyed talking to them and caring for them, but I did not feel there was unfinished business at the end of the time with them.