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

[SilverBells]

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?

[Wuzzie]

9 hours ago, SilverBells said:

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'm sorry but this statement leads me to believe that you have crossed not only professional, moral and ethical lines but the situation is bordering on becoming pathologic if not already there. I get the sense that she is filling a need in your life that should not ever be filled by a patient.

[kbrn2002, ADN, RN]

The fact that are even asking if this is appropriate makes me think you are probably aware it is not.

The first red flag is that you regularly spent two hours with this one resident helping her get ready for bed. Of course nobody else does this, I can't think of a single nurse or nursing assistant ever that has two hours to commit to one person's care in a facility setting. Not to nitpick on this too much but if your job title during this time is manager I also can't think of a single manager ever that is helping one resident with HS cares. Maybe helping on the floor to cover a shortage, but not making it a point to take care personally of one person.

Obviously for whatever reason this resident means more to you than others but it isn't fair to your other residents or to yourself to get so involved. I have to say it appears you have gone beyond blurring professional boundaries in this case. Frankly I am a little surprised your supervisor has allowed this situation to progress to this point without at least talking to you about it.

[KatieMI, BSN, MSN, RN]

Silly question:

- if that client eats and drinks "only" with the TS, does it mean that TS works 7 days a week to complete her 6 daily visits? If so, aren't her management aware about huge amount of overtime which might continue for unknown period of time, or how it works?

Or, the TS "visits" 6 times only at her workdays (possibly letting some of her other responsibilities go) and that client is doing just fine all the other time?

[SilverBells, BSN]

16 hours ago, Florence NightinFAIL said:

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

It does sound ridiculous, but I felt bad that other nurses weren't willing to give her foot soaks. I also made sure other residents had their medications, etc before going into her room. Other staff felt I was doing them a favor because they didn't want to spend that time with her

[SilverBells, BSN]

11 hours ago, kbrn2002 said:

The fact that are even asking if this is appropriate makes me think you are probably aware it is not.

The first red flag is that you regularly spent two hours with this one resident helping her get ready for bed. Of course nobody else does this, I can't think of a single nurse or nursing assistant ever that has two hours to commit to one person's care in a facility setting. Not to nitpick on this too much but if your job title during this time is manager I also can't think of a single manager ever that is helping one resident with HS cares. Maybe helping on the floor to cover a shortage, but not making it a point to take care personally of one person.

Obviously for whatever reason this resident means more to you than others but it isn't fair to your other residents or to yourself to get so involved. I have to say it appears you have gone beyond blurring professional boundaries in this case. Frankly I am a little surprised your supervisor has allowed this situation to progress to this point without at least talking to you about it.

Yeah, I had a feeling it would probably seem excessive to others. I visited her five times today, and it seemed as if staff members on the other unit were wondering what I was up to. Also, half of the time I went to her room today someone else was already in the room or somebody came to her room shortly after I entered.

Edit: I was not nurse manager at the time I was spending so much time in her room

[SilverBells, BSN]

I also will say that I am not ignoring other patient's needs, but I will admit to going out of my way more for this person. I have a fierce dedication to her care. I will admit that choosing to assist this resident with repositioning when a care conference for someone else was going on probably was not the best decision.

[Closed Account 12345]

I would recommend reviewing the NCSBN materials on professional boundaries, reviewing the ethical principle of justice, and perhaps ANA's Code of Ethics. This is no longer a patient-centered professional relationship, even if you tell yourself it's for the patient. If she is receiving inadequate care, you need to speak up to management. If she is receiving appropriate care, just not to *your* personalized preference, you need to distance yourself. If I were her nurse, I'd be asking why you were in my patient's room repeatedly throughout the day, and I'd have no problem letting you know it was inappropriate and needed to stop. Your frequent presence could be a hindrance in other staff forming the therapeutic relationship needed for her to trust them with her care. If you have extra time to visit with someone, use that extra time to go above and beyond for those in *your* care.

[Kooky Korky, BSN, RN]

13 hours ago, Wuzzie said:

I'm sorry but this statement leads me to believe that you have crossed not only professional, moral and ethical lines but the situation is bordering on becoming pathologic if not already there. I get the sense that she is filling a need in your life that should not ever be filled by a patient.

That is what we are taught. I have sometimes wondered why.

Is it so totally verboten, so awful to "fall for" a patient? especially one who is all alone?

A great many soldiers died alone in Vietnam and certainly other wars, too. The nurses could not be everywhere at once. To save lives that could be saved, they had to let die alone some soldiers who were determined to not be able to be saved. This is according to Lynda VanDevanter, RN.

So if soldiers on foreign soil, far away from their kin can die alone, so can we. Yes, it is very sad but lots of folks are dying alone now due to the damned virus.

Now: The pt might not even be allowed to move to your floor because of your work's policy re: the virus.

You are, of course, wrong to think she won't eat or drink for anyone else and to spend so much time with her, especially if she is not your patient. What about the approximately 12 hours per day that you are not there?

You sound very unhappy in your job. I hope it can get better.

[Wuzzie]

2 hours ago, SilverBells said:

I visited her five times today, and it seemed as if staff members on the other unit were wondering what I was up to. Also, half of the time I went to her room today someone else was already in the room or somebody came to her room shortly after I entered.

I’m mystified why you appear to be so obtuse as to what is going on. It’s clear your relationship with this patient has become suspect. I wouldn’t be surprised at all if they have started a a paper trail on you. Your job and likely your license is in jeopardy. You need to reestablish your professional boundaries immediately. I would also suggest that it might be prudent for you to explore the reasons behind this obsession with a professional. You are in the red zone and about to get burned.

[NRKB, MSN, RN]

It sounds like a lot of visits, but it is obvious that you care about her end of life experience and don't want her to die alone or uncomfortable, and as a human being and a nurse, I don't see anything wrong with that. However, you have to give the same love, dedication, respect to your other patients. They deserve it too, and they may need a lot too, just different needs at this time, and they and their families are depending on you to give them great care that they also deserve.

Have you ever worked hospice?

Sounds like you would be great.

[SilverBells, BSN]

Unfortunately, I'm wondering if based on some responses, it might be best for zero visits a day, maybe once or twice a week at the most. If I'm having to compete with other staff members (at least, that's how it feels), clearly she is being cared for. I've worked with her for 4 years, so I'm disappointed I don't get to work with her as she is declining as we got along very well when she was relatively healthy. But maybe the other manager is better to manage her care since she doesn't have an emotional attachment to this patient

[NRKB, MSN, RN]

On 6/12/2020 at 10:46 PM, SilverBells said:

Unfortunately, I'm wondering if based on some responses, it might be best for zero visits a day, maybe once or twice a week at the most. If I'm having to compete with other staff members (at least, that's how it feels), clearly she is being cared for. I've worked with her for 4 years, so I'm disappointed I don't get to work with her as she is declining as we got along very well when she was relatively healthy. But maybe the other manager is better to manage her care since she doesn't have an emotional attachment to this patient

Yeah... maybe weekly visits would be good for you both and more appropriate. That way you're not over doing it or over stepping her care by other team members. Also it gives her time to adjust to other staff and get use to the pace and environment where she is. Poking your head in once or twice a week will be nice for her and give her something to look forward to.