Is 6 times a day too many to visit a favorite patient who isn’t on your caseload?

[SilverBells, BSN]

About 4 years ago, I started as a part time nurse in a LTC/Rehab facility. Since then, I’ve moved on to full time nurse, interim nurse manager and now, full time manager. Over the past 4 years, I’ve had the pleasure of working with one lady that I’ve always had a connection with. I used to spend 2 hours getting her to bed, including giving her a nightly foot soak. On Sundays, we used to pray together with Eucharistic Minister that would visit our facility.

Because of the COVID pandemic, they have rearranged patients. Thus, she is no longer assigned to my case load as she is now on another unit. The other staff members and manager do not give her the same amount of attention. She will only eat and drink for me, and is now on hospice. She has no family in her life. Now that she’s dying, I want to spend as much time with her as possible regardless of whose patient she is. I try and always plan my day to start and end with a visit to her, along with four other visits. Because of my dedication to her care, I find myself getting irritated when patients on my unit take up time I’d rather be with her. These patients have family, are not dying and are overall annoying. I even got involved with repositioning the resident and taking her vital signs when a care conference for a different patient was occurring. However, if I do not make regular visits to this lady, she won’t get the attention she needs.

I am just wondering if 6 visits a day is too many? Also, anyone else experience increased dedication when they find out a favorite one is dying?

[SilverBells, BSN]

Also what are your thoughts on trading this patient for another? I could offer to take over this resident’s care for the other manager in exchange for her taking one of my others? There are a few I would gladly handover in order to get this lady back on my workload so I can be with her during her final days

[HandsOffMySteth]

I believe those patients assigned to you are your primary responsibility. That being said, nursing is about relieving suffering and no one should die alone. Also this patient is without family. I would talk to my supervisor and see if there is an arrangement that will work out for the sake of that patient.

It can be hard to keep a professional distance from the patients you really like but you need to be mindful that there are reasons for it.

Good luck to both of you.

[JKL33]

Yes. Of course it is clearly too much. I state that with such certainty because it is negatively affecting your duty to other patients under your care and/or management. All the other patients deserve for you to properly attend to your duties.

It sounds like you believe your facility does not provide proper care to residents. Your on-the-clock time would be well-spent addressing that problem--which affects every resident, not just the one resident who happens to be well-liked by a particular nurse.

No one wants a patient to die all alone. Also, I do understand some of your actions represent grieving an anticipated loss and that this is a sad time for you. You have my sympathies for that. You could request time off or an LOA if you feel you must dedicate yourself in this way.

[dream'n, BSN, RN]

My opinion is that you have crossed the boundary line long ago. To get irritated at your own patient's needs "because they have family" is ridiculous. And that you used to spend 2 hours getting her in bed at night, when you had other patients to attend to, was not appropriate. (What nurse has two extra hours to spend on non-essential care with one patient?)

I can believe that the patient won't eat or drink for the other nurses (or take meds, or shower, or etc), which is what happens when nurses blur boundary lines sometimes.

It's very nice that you care so deeply for this lady, but it was at the expense of professionalism and your other patients care.

Honestly, maybe you should resign and work elsewhere. Then spend your free time with her. At least your private and professional lives won't be conflicting.

[Emergent, RN]

I get it. I loved Edna, years ago. But you can't let it affect your duties.

Edna became a surrogate grandma for my little girls, 2 and 4, whose father had died. We would visit her, on our own time.

Don't allow this to affect your professional obligations.

[sevensonnets]

You complain that this patient is not getting proper care when you can't be with her and that the patients you are assigned to are annoying and take up time that you'd rather spend with a patient you are not assigned to. Frankly, I think you're jeopardizing your job.

[Here.I.Stand, BSN, RN]

So many boundaries, so many crossings...

Yes 6 visits a day is too many.

The residents on your current caseload deserve all of your attention.

No you shouldn’t try to swap cases... if you’re dedicating their time to this one resident NOW, what’s to say you won’t favor this one when she IS your responsibility?

The feeling that only you can provide adequate care is a HUGE red flag for crossed boundaries... the only reason that occurred is you dedicated such a disproportionate amount of your time to her. The rest of the staff aren’t doing that BECAUSE THEY SHOULDN’T.

Your assigned residents and their families are ENTITLED TO your attention. You don’t have the right to be irritated with them for needing you. Those families made the difficult decision to place their loved one in a SNF because they need more nursing care than they can provide in the home.... you can’t expect them to do your job simply because they are present in their loved one’s life.

I’m not nearly as heartless as I might sound... it’s natural to feel differently about some people than others. The issue is that as a professional you can’t give favorable treatment to those ones who give you the feels. Every resident is entitled to the best care you can provide, within your time constraints and physical abilities.

If you want to visit her, do it on your break or after you clock out... and don’t insert yourself into her nursing care.

[caliotter3]

Ask your mgmt to allow you to spend time with her while you are off the clock and then visit away, on your time and dime. During your paid 8 hours do your job without going to another unit and neglecting your paid duties. Once your friend passes, if I were your mgr, I would make certain to counsel you concerning professional boundaries and how they impact you retaining your present employment. In other words, don’t allow this to happen again.

[Florence NightinFAIL, BSN, RN]

You lost me at nightly foot soak and 2 hours to get to bed.

[Jedrnurse, BSN, RN]

The fact that you're asking the question makes me think that you know the answer...

[CharleeFoxtrot, BSN, RN]

6 hours ago, sevensonnets said:

You complain that this patient is not getting proper care when you can't be with her and that the patients you are assigned to are annoying and take up time that you'd rather spend with a patient you are not assigned to. Frankly, I think you're jeopardizing your job.

Not to mention busting through multiple ethical barriers.