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

[nekozuki, LPN]

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?

[shenanigans_RN]

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!

[caliotter3]

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]

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.

[caliotter3]

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.

[Sostuckrn]

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¸¥

[caliotter3]

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, LPN]

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

[Sostuckrn]

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.

[Sostuckrn]

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

[tinybbynurse]

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.

[tinybbynurse]

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!