How to terminate/separate from a pediatric case successfully

[paulinejoyRN]

Hello, fellow home health nurses!

I have been a shift-home health nurse for 4 years now (work 8 hr shifts), and have been working with my current case for 2+ years. I started with a few shifts here, but have since been working 32-40 hours/week here. My client is a 5 year old who is completely cognitively developed, but suffers from physical disabilities and is nonverbal (but "speaks" in his own way). I have realized it is time for me to switch cases, for multiple reasons. My main question is how to do this while minimizing the trauma/stress/sadness my pediatric client will experience.

I am his main nurse and have a very strong bond with him. My main reason for leaving is in search of a more challenging case or more challenging job. I just want to do so while minimizing the trauma my client will experience. Any advice is welcome, as I really do care about the impact my decision will have on my client. Thank you, in advance, for any help you can give me!

[ACrawford]

I really wish I had some good advise for you because I am going through the exact same thing, but I'm with a 4 year old. After taking care of him daily for 2 years I am so concerned of how he and his family will feel when I tell them that I am leaving in a couple of weeks! I also have decided that it is time for something that will facilitate growth of my career and knowledge as a nurse that is more of a challenge so to speak. Doing the same type of patient care everyday for 2 years has become mundane and I think it will really limit my long term career if I continue to stay here. I wish you the best of luck and if you figure out a successful way please let me know.

[paulinejoyRN]

I real.... wish you the best of luck and if you figure out a successful way please let me know.

Sounds like we are going through the same thing. My research so far has been based on how to tell children of a divorce to minimize separation anxiety. So far what I've read says not to tell children more than 1 week-10 days before separation so they do not dwell on the negative meanings that separation might mean.

For me, that means that when I give my 2 weeks notice to the parents, I will also tell my client before (want him to hear it first from me). It will be hard, but a mentor of mine pointed out that it will only get harder the longer I wait. She's right. It already feels difficult now, I can only imagine how difficult it will be months from now.

I am also leaving because work feels stagnant and I'm still a young nurse so I want to improve my skills as much as possible. I really hope some more experienced home health clinicians will reply and shed some light on this.

[paulinejoyRN]

I also ended up searching how nannys say good bye to a child with minimal trauma to the child. Here's the link to the site I found relevant: Eight Ways a Nanny Can Help Her Charges Say Good-Bye | Nanny Jobs

Good luck on your own search, please share if you find anything useful!

[brkndoll18]

I recently left a family that I had worked with for almost 2 years, since the baby came out of the nicu. It was hard. I told the family before my company and gave them 3 weeks notice. I was lucky. the family was truly happy for me and supportive. I miss the cutie, but I know with my new job I will be able to help so many other little cuties.

[paulinejoyRN]

I know it might be too late for your last patient, but for the future (because us homecare nurses do have the biggest, softest hearts), I think I did find a success way to say goodbye. My sister is a school nurse, and she suggested reading "The invisible string" to my patient a few times before I left. It's a book typically used to help children deal with unexpected separations (death, divorce, etc), and it really helped me.

Now, when I visit my patient as his case manager, we refer to our invisible string and I know he feels better knowing I will always care for him. Let me know if you get to check it out.