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How do you quit a case, and do you feel guilty for it?

Specializes in Pediatrics.

When I quit or request to be taken off a case, I'm not shedding any tears over my agency being inconvenienced, but I do feel a tremendous amount of guilt for (some) patients. Sure, there are the wacky new assignments you never accept again (Mom running around the house naked talking to ghosts, one family decides to turn off the AC in July, maybe a case feels like a big fat lawsuit waiting to happen, etc), but what about the ones you've had for awhile?

If I'm leaving a case because it's gotten stale or because I feel like I'm being involuntarily sucked into the family dynamics, I usually never tell the family. The agency is informed well beforehand, but I feel like the family would take it as betrayal if they knew I was voluntarily leaving, and possibly retaliate in some way. So, I smile big, wave, and never come back.

I'm torn because I'm having elective surgery (weight loss surgery) and will be out for six weeks. I'm agonizing over how to break the news to my patient's family, and whether I should say anything at all (or simply lie about it being some other surgery). I've been the only nurse staffing their case for almost two years, and given their rural location and complexity of the patient, I know they will have a hard time replacing me. I *have* to do this for myself, my health, and my future, but that doesn't help the crushing sense of guilt I feel for abandoning” my patient (whom I adore like my own niece). The family has received a series of devastating blows in terms of the patient's health over these past few weeks, and I figured I'd drag my butt to the AN forums to commiserate.

What is your MO for quitting a case? Do you tell the family, or do you high-tail it out of there without a word? Do you ever feel guilty for moving on? Anyone have any stories?

I left one case simply because I felt I could not provide adequate care for the child whose illness was getting worse. I was honest with my agency, and they were very understanding. I didn't tell the parents, but it wasn't on purpose. The next months schedule was not out yet and I didn't realize it would be my last day with the patient. I did not feel guilty because I felt it was right for both the child and myself. A few years later I left the agency altogether for a different field of nursing. When that happened, I did tell the families. I wanted to tell them myself instead of hearing it from my supervisor. It was hard, since I had been with those patients for a few years, but the families understood that I had to do what was best for myself and my career. I would say be honest, but only reveal any details that you are comfortable sharing. Best of luck with your surgery!

I do not have any discussions with the family regarding the fact that I won't be coming back, if that is the case, and there is some "less than desirable" reason. After all, on more than one occasion, when the decision was made on their end, I never got told at all by the family. One time I was told at the end of my shift. Even though there was a good reason for that one, I felt that it was the responsibility of the agency to inform me of the change in circumstances. I didn't fault the family for holding back the bad news. More than once, it was the agency's responsibility, and they dropped the ball. Why, I don't know. I have even had families discuss with me the fact that if we don't keep each other informed, neither of us will be getting any info from the agency. Poor, but valid, observation made by the families.

As far as feeling guilty: It did not take long for me to figure out that the lack of income was never matched by a phone call from my employer(s) asking me how I was doing for rent or food, or to make the immediate offer of new work. At some point in time you have to look out for your own interests and refrain from getting sucked into relationships that indicate the crossing of professional boundaries.

SDALPN

Specializes in Peds(PICU, NICU float), PDN, ICU.

I never tell the family. I work for the agency, not the family. And if you tell the family why, they may retaliate.

Just recently a nurse left a case I'm on. She told me it just wasn't a good fit. The agency told the parents that the nurse wanted more hours. Of course that wasn't a good lie and the parents saw through it. Its best if the agency leaves it as confidential if the parent asks. Then nobody has to lie and it won't hurt the family as much.

I never tell the family. I work for the agency, not the family. And if you tell the family why, they may retaliate.

Just recently a nurse left a case I'm on. She told me it just wasn't a good fit. The agency told the parents that the nurse wanted more hours. Of course that wasn't a good lie and the parents saw through it. Its best if the agency leaves it as confidential if the parent asks. Then nobody has to lie and it won't hurt the family as much.

This. I've often found it very uncomfortable when the agency does not keep the lies straight and then I end up looking like a jerk.

I just got a new hospital job. I am leaving a family I have been with for years. I am feeling so very, very guilty. The guilt is making me question my decision. í ½í¸¥

I just got a new hospital job. I am leaving a family I have been with for years. I am feeling so very, very guilty. The guilt is making me question my decision. ������

This situation indicates that you became too involved and near the threshold (if not over) for crossing professional boundaries.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics.

This situation indicates that you became too involved and near the threshold (if not over) for crossing professional boundaries.

Exactly. You most definitely need to move on for your own professional progression and mental healtg

Ok. I can see why you would say that. I also think it's natural to become attached to a patient you've cared for for years. I will take this as another reason why it's good that I'm moving on.

The agency is also adding to the guilt. They are buttering me up and begging me to stay.

I can relate. I haven't been in PDN longbut u hate it .. the agency is screwed and uses me...I get LPN pay for being an RN and most of my cases are more suitable for a CNA. However, there is one family I will feel so bad for when I leave. Apparently they haven't had a day nurse in a longtime and are so thankful for me. They're well aware of how horrible this agency is and told me they don't blame me if I move on to another job. I haven't told them I have some interviews lined up and this family certainly isn't changing my decision to leave because I have to watch out for myself. But I do pray things work out for them when I leave.

Also ... I wish my agency would allow me to be taken off a case!! Realistically I should request to be taken off ALL of my cases because they're fit for a cna not an RN and /or aren't paying me RN pay. But no ... I ask to be taken off of ONE and they practically made it where I couldnt say no!

I have done private duty for 26 years but now I work in the office with scheduling . More often that not, the family doesn't care for the nurse and I have the awful job of explaining that she/can't return to the case. I agree though..no lies !! I think it depends on the case whether you want to tell the family yourself or you would prefer the agency to handle it. Personally, I prefer to tell the family myself.

Kitiger, RN

Specializes in Private Duty Pediatrics.

This may sound unfeeling, and I don't want to sound like I don't care, but I am not indispensable. If I were to leave, they would probably miss me for a while, but - a year from now - they won't even think about me except maybe once in a while. My shift will belong to another, and they won't miss me. Life moves on.

Your life also moves on. What was right for you, what was a good fit then, might not be a good fit now. That's OK.

I'm always honest, but that doesn't mean that I have to explain that which is really my own business.

I want to quit a case that my agency sgain, is begging me to stay on because I'm a high caliber nurse, and the bottom line is NO ONE ELSE WANTS TO DEAL WITH THE CHILD'S PARENTS. I texted my on call tonight and told them I've just experienced the straw tgat broke the camels back and I want off this case immediately.

The parents are bullies and disrespectful to me, especially in front of other nurses or adults. Go ahead, find someone to work your crazy hours snd fulfill your REDICULOUS requests. See if I care. Only one I do care about is the chikd. Hopefully if someone else picks up my shifts they are competent enough. The child is pretty ill.....

OrganizedChaos, LVN

Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I want to quit a case that my agency sgain, is begging me to stay on because I'm a high caliber nurse, and the bottom line is NO ONE ELSE WANTS TO DEAL WITH THE CHILD'S PARENTS. I texted my on call tonight and told them I've just experienced the straw tgat broke the camels back and I want off this case immediately.

The parents are bullies and disrespectful to me, especially in front of other nurses or adults. Go ahead, find someone to work your crazy hours snd fulfill your REDICULOUS requests. See if I care. Only one I do care about is the chikd. Hopefully if someone else picks up my shifts they are competent enough. The child is pretty ill.....

I quit a case not that long ago & I never looked back. Once you start getting emotionally involved is when you should pull back. I know it's tough because we work 1:1 but we are nurses, we are there to do a job. If the family is making your job that difficult,

the office/supervisor has been notified then I would drop the case.

When I quit or request to be taken off a case, I'm not shedding any tears over my agency being inconvenienced, but I do feel a tremendous amount of guilt for (some) patients. Sure, there are the wacky new assignments you never accept again (Mom running around the house naked talking to ghosts, one family decides to turn off the AC in July, maybe a case feels like a big fat lawsuit waiting to happen, etc), but what about the ones you've had for awhile?

If I'm leaving a case because it's gotten stale or because I feel like I'm being involuntarily sucked into the family dynamics, I usually never tell the family. The agency is informed well beforehand, but I feel like the family would take it as betrayal if they knew I was voluntarily leaving, and possibly retaliate in some way. So, I smile big, wave, and never come back.

I'm torn because I'm having elective surgery (weight loss surgery) and will be out for six weeks. I'm agonizing over how to break the news to my patient's family, and whether I should say anything at all (or simply lie about it being some other surgery). I've been the only nurse staffing their case for almost two years, and given their rural location and complexity of the patient, I know they will have a hard time replacing me. I *have* to do this for myself, my health, and my future, but that doesn't help the crushing sense of guilt I feel for abandoning” my patient (whom I adore like my own niece). The family has received a series of devastating blows in terms of the patient's health over these past few weeks, and I figured I'd drag my butt to the AN forums to commiserate.

What is your MO for quitting a case? Do you tell the family, or do you high-tail it out of there without a word? Do you ever feel guilty for moving on? Anyone have any stories?

Thanks for posting this, Nekozuki. I just left a case I was on for a year and 10 months. I had an injury that required me to be off work for 2 weeks following an almost 2 week vacation. When I asked to go back to work, my shifts had already been covered for the whole next month. At that point I had to request a new assignment, which fortunately looks like a "go." This agency pays no vacation or any other paid time off until after FIVE YEARS ! of service.

Anyway, yes. I don't feel guilty, but I miss my client very much and worry that she will feel abandoned and confused about my unexplained and abrupt departure. I asked the agency to explain why I accepted another assignment, but I was discouraged by my supervisor from making contact myself.

I have a master's in counseling psychology and one of the things always stressed in that program was the importance of preparing the client for termination. It was also considered important to recognize that after a long period of working together, both parties will have feelings about ending the relationship. The work at the end was to allow both parties to process and come to terms with issues and feelings that arise and the acceptance that it cannot continue as a friendship because of the professional boundaries. That is the reality.

I believe it is okay to feel sad at the loss of that person. I believe it is okay to miss them. I think it is okay to tell them that you will miss them, and they may miss you, but they and you will move on and get over the missing in a fairly short time. I believe it is important to explain your leaving face to face, if possible, and if the reason would be hurtful, to not explain fully. It is always possible to find a grain of truth and to hold back anything that harms rather than helps.

I don't feel guilty, because it is the agency's responsibility to get the shifts covered and find a good fit for the family.

In my case, I think I'm going to send a brief note to my patient and another to the patient's family to briefly state that I enjoyed working with them, have made a change that will work out better for me, and hope they are well and remain so.

I am interested in what you decide to do. Keep us posted. I relate to some of the issues others raised about agency differences in this area.

My agency says to me that we now need to give 2 weeks notice before coming off a case.

I do not think that is fair,because things could happen during those 2 weeks.

What if the family tries to retaliate?

I could see many things going wrong there,plus if the family does not want the nurse there,the nurse does not get a 2 week notice.

he or she is taken off the case immediately.

Can someone explain becoming too "emotionally involved"?

I feel there is one such case where the parents get mad if you do not eat their food and attend the child's birthday parties(I have been on the case for 6 years).

Problem is I am looked at as the "unfriendly,non-caring nurse" because i will not attend parties,eat the food,and refuse to receive pics of the client on my personal cell phone.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics.

In my case, I think I'm going to send a brief note to my patient and another to the patient's family to briefly state that I enjoyed working with them, have made a change that will work out better for me, and hope they are well and remain so.

.

Why would you do this if you don't feel guilty? The family & client has likely moved on at this point and now your note may reopen old feelings. Especially since your agency told you not to, in my agency this could be grounds for termination.

Two weeks notice may not be for the family SmartNurse it can be for the agency to cover shifts. I did two weeks notice for leaving. I was explicitly told to not discuss it with the family as the mom rarely took rejection well.

As far as food. Being a vegetarian with a food allergy (I rarely reveal my specific allergy) those offers stop quickly without insult. I work nights so not much of an issue. Unlike others that there are photos of nurses drinking wine as they work a child's party...i don't do parties. I may do a thoughtful card. I manage to have shifts or other obligations during the parties.

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