Is this crossing boundaries?

TheCommuter, BSN, RN · Aug 28, 2015

As a human, I would visit the other facility to bid farewell.

As a professional nurse, I would not make the trip to the other facility because it would cross a boundary line and travel down a slippery slope. The nurse/patient relationship between you and the patient ended when your last shift with her concluded.

Inserting yourself into the private lives of your patients is a recipe for burnout, disaster, and overstepped boundaries. You must learn to compartmentalize and keep your professional life separated from your personal sentiments.

Good luck to you!

SNurse15 · Aug 28, 2015

Thank you. Yes according to the code of conduct and what I've been told at uni its a definite no. However, like you said as a human, I feel like I should. Especially when you doesn't have much support and is really scared. She is my first patient that I know is going die soon. I'm scared to admit this to my lecturers and preceptors because it may show over involvement, but I feel close to her and it is really upsetting knowing she is dying. I am really torn.

Pangea Reunited, ASN, RN · Aug 28, 2015

You came into this individual's life at the 11th hour. Although you may have gotten along well with her, your goodbye visit is probably not as significant to her as you may think it is.

There's even a small chance that the contact would be entirely unwelcome.

Trust that your good care of this patient was enough and maintain appropriate boundaries.

jadelpn, LPN, EMT-B · Aug 28, 2015

Thank you. Yes according to the code of conduct and what I've been told at uni its a definite no. However, like you said as a human, I feel like I should. Especially when you doesn't have much support and is really scared. She is my first patient that I know is going die soon. I'm scared to admit this to my lecturers and preceptors because it may show over involvement, but I feel close to her and it is really upsetting knowing she is dying. I am really torn.

Yes, I am sure that you feel as if you did not do as you said you would. However, you can take comfort in the care you gave this patient, and allow her to go and to be cared for in the final stages of her life by another nurse who more than likely is as invested in good patient care.

This really SHOULD be something to discuss with your lecturers. They may be able to provide insight on how to maintain boundaries. They may also have other ideas on how you can put these experiences away and feel good about the care you provided without the emotional attachment.

Your local hospice/palliative care offices would also be a place where you can get information, references and books on this very subject. It would also be a place where you can speak to someone about your feelings, and put things in perspective going forward.

Best wishes

RNNPICU, BSN, RN · Aug 28, 2015

I agree with others that going to the other facility as a student nurse would be crossing boundaries. As a concern for another's well-being it is a kind gesture.

One thing you should ask yourself, is it more for you to have the closure or for the patient. Think about who would benefit more. I think as health care providers that sometimes is the hard, wanting to support our patients, but then walking that fine line of when is it a benefit to the patient or to us.

In your future as a nurse you will have connect with many patients. If you take home everything, want to see patients outside of the nurse-patient relationship, always ask yourself, who is benefiting more, me or the patient.

From your post it appears as though you may need the closure more, unfortunately you did not get to say your good-byes and have the closure for yourself. We all get busy, have other patients that have just as many needs. You will not always get the chance to have your good-bye with the patient, and take comfort in knowing you provided the best care within the time you had. Talk with your instructors and maybe have a discussion on how do we as health care providers get the closure we sometimes need, especially when caring for patients at end of life. Also think about the benefit to the patient. just because the patient may have had a good couple of shifts with you, they also have nurses on other shifts who provide equal care to the patient as well. If you can, talk with the nurses on the unit and ask how the cope with patients leaving who won't return, or how they deal with closure

Do something nice for yourself, many health care providers struggle with balancing the fine line of over-involvement and being a caring nurse

elkpark · Aug 28, 2015

" i meant to go back later but with everything that was happening it slipped my mind. Now I feel really awful especially as she is being transferred to another facility tomorrow."

The "slipping your mind" part is the problem. It would have been appropriate to even stay a little late in order to check back with her and say goodbye at the current facility, but going to the other facility is inappropriate and definitely a violation of professional boundaries. Your relationship with her is as a professional, not as a "human," so the professional standard is the one to which you're obligated. Accept this as a lesson learned and move on --

A) Don't make promises to clients that you can't keep, and

B) Make sure you keep the promises you do make.

RNNPICU, BSN, RN · Aug 28, 2015

" i meant to go back later but with everything that was happening it slipped my mind. Now I feel really awful especially as she is being transferred to another facility tomorrow."
The "slipping your mind" part is the problem. It would have been appropriate to even stay a little late in order to check back with her and say goodbye at the current facility, but going to the other facility is inappropriate and definitely a violation of professional boundaries. Your relationship with her is as a professional, not as a "human," so the professional standard is the one to which you're obligated. Accept this as a lesson learned and move on --
A) Don't make promises to clients that you can't keep, and
B) Make sure you keep the promises you do make.

Exactly. These are the hard lessons we learn everyday in nursing. You will get caught up with other patients, have more pressing things to do. You will just have to accept that sometimes we will not always have the closure we need.

It sounds like you had well intentions, but learn from this and remind yourself next time to go back because you might not get the chance again

Here.I.Stand, BSN, RN · Aug 28, 2015

Thank you. Yes according to the code of conduct and what I've been told at uni its a definite no. However, like you said as a human, I feel like I should. Especially when you doesn't have much support and is really scared. She is my first patient that I know is going die soon. I'm scared to admit this to my lecturers and preceptors because it may show over involvement, but I feel close to her and it is really upsetting knowing she is dying. I am really torn.

My bolding. Here's your answer. I understand feeling bad, but violating school policy is often grounds for expulsion. Not worth it. At all.

OrganizedChaos, LVN · Aug 28, 2015

This will not be the first time you feel this way. But you need to learn how to create professional boundaries now. While at work you are that patient's nurse after work you have nothing more to do with them. Even if you said you would do something for them, after your shift you must not do it or see them. You could lose your job and/or get in trouble with the board.

la_chica_suerte85, BSN, RN · Aug 29, 2015

Being overly-involved or not, most facilities don't like people of the student variety showing up when a) it's not their clinical site and b) they are unaccompanied by their instructor.

I had that happen a few times, too. I would say I would be back to do something and then totally forgot and felt badly about it. Take this as a lesson in time management. Sometimes there are things that you can't fix but, like others have said, this is the patient's journey. Your part is what you learned from your interactions. That's it -- there's nothing to feel badly about anymore because it's not about you. They tell us that the moment you have feelings like this it is due to you making it about yourself and not about the patient. Don't worry. I'm sure she is still happy with the care you provided. :)

allnurses Guide · Aug 29, 2015

I agree with the majority on the advice about visiting her current facility. I would also point out that your quality of remembering what you tell your patients you will do is way up there on my list. So I have stayed a few minutes late if I haven't had time to do what I said I would.

I've worked with a lot of people who forget about following up with something they say they will do, and if it's not important medically, they just forget.

I'm kind of OCD anyway, but when I kept my word on the little things the way the patients light up is surprising! You're on the right track!

Is this crossing boundaries?

Should I go and see her?