Is this crossing boundaries?

[SNurse15]

I'm a student nurse and i've been caring for a patient with a terminal diagnosis, she only has a few weeks left. I've become very fond of her and she has been so thankful for everything i have done for her and always wants to know what time I'm her nurse till. I promised I would say goodbye before I left, a lot of stuff happened on the afternoon shift with other patients, i then tried to see her but she was with someone else so 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. Would it be really bad if I went to the other facility to say goodbye? I don't wan't people to think that i'm being over involved.

[jadelpn, LPN, EMT-B]

And as an aside going forward, make sure that if you are completed with your duties with any patient, you have a closure.

Knowing that nursing is not always a "I will come back before you go" job.

And remember, never assume that someone is "all alone and scared".

You can't possibly know that for certain. So don't guilt yourself into more of a situation than what was presented.

And to turn that into a nursing thought process, the patient is going to a facility that will continue her care which is more than likely a hospice? Who are 99.9% of the time AMAZING, and invested in peace and pain free. So an alternate level of care is appropriate.

Additionally, if patients are "scared" then you can advocate for social work, a volunteer sitter, someone from their faith, --something to alleviate that distress that you SEE/ASSESS and not ASSUME.

Use this experience to refine your practice. And as I suggested earlier, do have conversation with your local hospice to understand their process, and how to effectively manage your own emotions when patients present that are end of life.

[SNurse15]

Thank you for all of your comments. I just wanted to clear a few things up. I didn't assume she was scared and alone, she did actually tell me she was both of these things several times. On the topic of who's benefit is it for, I have already had a good think about this and I definitely wouldn't be doing it for my benefit (as thats a big no). I feel guilty about not keeping my promise as she asked me to stay with her all shift, so I would only want to go and say goodbye if it was for her benefit. Yes i feel really bad about breaking my promise, and it wasn't a case of not wanting to stay late (as i would of done this if possible) and was nothing to do with time management as I was called away by the charge nurse in an emergency which I had no say over. After this I was called away by the colleague who was taking me home, and this is how it slipped my mind that I was meant to go back.

I am grateful for the responses, I really am, but I kind of feel like this situation is making me out to be an awful nurse

[vanilla bean]

I am grateful for the responses, I really am, but I kind of feel like this situation is making me out to be an awful nurse

Here's the good news: you're not a nurse yet, so you can't be an awful nurse. Here's the bad news: wait, there isn't any... you're a student and learning how to work through ethical dilemmas (as you will continue to do throughout your career). You made the correct, professional decision to not visit a former patient and have been given good advice about not making promises that you may not be able to keep. I say you have a win/win scenario here based on the information you've shared.

[LobotRN, BSN, RN]

I remember a ways back in nursing school that a good nursing plan starts with the end! Advice that was given to me by some wonderful instructors and a great preceptor is to let the patient know the conclusion right from the get to. When I meet my patients at bedside shift report, and we are wrapping that bit up, I usually end by saying, "again, my name is LobotRN, my name is on the board, and I'll be your day nurse until we change shift again at 7 oclock tonight. Now, is there anything else I need to know so I can take care of you for the next 12 hours?"

This has become a habit phrase and sets an appropriate boundary right from the start.

I also never promise that I will be assigned to them the next day even when I am scheduled. If that comes up, I respond with "yes I am scheduled tomorrow, but I can't guarantee where my assignment will be. The nurses on this floor are great, is there some information we should plan on passing on to your next nurse?"

[TheNGTKingRN]

If the OP cannot realize that saying goodbye is benefiting her, as opposed to benefiting the patient I don't know what to say.

OP, you feel GUILT which would be alleviated by saying goodbye.

Even if you say it's not to benefit you, it is. No and/if/but.

[Meriwhen, ASN, BSN, MSN, RN]

Keep in mind that as a nurse, you're not always going to have the opportunities for closure that you'd like to have. Patients are going to discharge/transfer/die whenever fate decrees, and you can't control when that is, or always be there for/before that moment. It's not always fair, but that's what it is.

I agree with what everyone said about maintaining professional boundaries. And don't run afoul of your uni policy, because not graduating nursing school is going to tank your nursing career before it even starts. As much as it may pain you to do so, keep your distance.

Sorry if this isn't the answer you were hoping to hear.

[RNNPICU, BSN, RN]

OP.. your responses and scenario do not make you out to be a bad student nurse. You are asking great questions and thinking about how to address issues that are occurring while you are a student. This is the best time to learn, question, explore these ethical issues you will be facing again as a nurse. This patient may have shared with you that she is alone and scared, but you would need to really see the bigger issue. It could be that family has been involved but they are also trying to move on, it could be she is scared knowing what fate awaits her. All of your future patients may have these same feelings. Get the right people involved in their care and see what can be done to help alleviate these feelings. As for her wanting you to stay with her the whole shift, that could be a warning sign that you are crossing boundaries.

Only you have the ability to set the tone. I agree with others that it is going to be benefitting you, because you still want that closure for not saying good-bye. I know it stinks that you were not able to have that send-off you wanted, but that is what happens in health care. This isn't meant to be cold or heartless, but this will happen again and again. You will have patients even get closer to you in the future. Learn how not to take them home, as your home should be your home, work is your work. This doesn't mean that you can't be close with your patients, hold their hands when they are most vulnerable, it is just practicing setting boundaries so you don't have the hurt build up and up.

Keep up the great work.

[SeniorNurseMan]

Nursing is a tough role with many amazing rewards. Building relationships is an amazing part of the profession but the tradition of wanting to be correct is a strong one too. The rules of your school sound typical and popular with the readers. It is easy to follow the herd and do "what is right". Why do we need thousands of lawyers and judges to figure out such things? I do not know.

A mentor I value greatly loved to lecture on "boundaries." In Hospice there are risks of slipping to too close of a relationship and many nurses differ on their interpretation. After a service failure where my mentor took over managing a case I heard her giving out her direct phone line to the family of a challenging patient. If she caught a nurse doing that she would have had a fit.

Our biggest gift is our personhood and connecting with our patients is a big part of our task. Find your way and do it well. It will be a gift you can never replace with a pill or procedure.

[Oceanpacific]

You know, I have to disagree. My Dad is 80 and fell overboard into icy waters last year and he had a prolonged period of time in the water before he was rescued. During his rewarming at the ED in his rural community, he arrested and was successfully resuscitated then transferred to the trauma service of a larger hospital. His nurse there was phenomenal! About 5 am she was giving him some meds and my Dad asked if he was going to see her again before she went home. She said "Yes, you will see me again, I say goodbye to all of my patients before I leave and, for you, there's going to be a hug."

True to her word she came in at 7 am and told him it had been a pleasure to be his nurse and she gave him a hug. Poor boundaries? Maybe, but if I am ever sick, I would be thrilled to have such a talented nurse. My Dad still talks about her and cherishes the Get Well card that she and the whole night crew mailed to him.

[weirdscience]

You know, I have to disagree. My Dad is 80 and fell overboard into icy waters last year and he had a prolonged period of time in the water before he was rescued. During his rewarming at the ED in his rural community, he arrested and was successfully resuscitated then transferred to the trauma service of a larger hospital. His nurse there was phenomenal! About 5 am she was giving him some meds and my Dad asked if he was going to see her again before she went home. She said "Yes, you will see me again, I say goodbye to all of my patients before I leave and, for you, there's going to be a hug."

True to her word she came in at 7 am and told him it had been a pleasure to be his nurse and she gave him a hug. Poor boundaries? Maybe, but if I am ever sick, I would be thrilled to have such a talented nurse. My Dad still talks about her and cherishes the Get Well card that she and the whole night crew mailed to him.

I think that's different, if he was still in her facility.

[Conqueror+, BSN, RN]

If you just won't be able to let it go send an anonymous card and flowers. No I am not kidding as I have done it.

[Ruas61, BSN, RN]

Think a good thought for her and release it to the universe or say a prayer or do a kindness in her honor- what ever works for you.

We often don't get the closure we would like.

It's not always easy, but it is the reality.