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

Nurses General Nursing

Updated:   Published

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?

Specializes in Rehab/Nurse Manager.

Because of COVID restrictions, the other manager has taken over for three long term patients I've worked with for a long time. Finding it hard to let them go. Somehow, you don't develop the same connections with the short term rehab patients

Specializes in ICU, LTACH, Internal Medicine.
On 6/12/2020 at 8:49 PM, Kooky Korky said:

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

It is never verboten to care for a patient while remaining what you are: a professional doing what you are there for professionally.

We can and, IMH(umble)O, must preserve a human touch and emotions in the world of totally "professionalized" medicine. This is one of the things which, at every level, defines nursing as a separate profession, not a part of "biomedical science". But getting involved in care for someone for whom you are not supposed to care can be brought up as HIPAA violation. Providing bedside care for someone you are supposed to function in different role can be named "violation of scope of practice". Both are strictly verboten.

I just cannot imagine how a nurse with 20+ residents to care for can spend 1/6 of her work shift for a foot soak for just one of them. Really... just, technically, how to do it without tuning up personal time squeezer or without simply letting everything else just go by as it might?

Specializes in Rehab/Nurse Manager.

Another thought is possibly that these frequent visits could be construed as harassment. Not sure, since the patient hasn't made any complaints about me seeing her. But if her call light isn't on, it could mean she is already being helped or doesn't need or want anything at the moment.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

It's probably a good idea to meet with your manager and tell her you realize you've crossed boundaries. This move might be necessary to save your job and your license.

Then ask yourself the really hard question: was this really just about the resident's needs? What need has this relationship met for you and what do you need to do to meet it more appropriately?

Specializes in Rehab/Nurse Manager.
2 minutes ago, TriciaJ said:

It's probably a good idea to meet with your manager and tell her you realize you've crossed boundaries. This move might be necessary to save your job and your license.

Then ask yourself the really hard question: was this really just about the resident's needs? What need has this relationship met for you and what do you need to do to meet it more appropriately?

At this point, my thought is that if I can pull myself away from this resident on my own, it may not require a conversation with my superior as these excessive visits really were only the last couple of days and I have plenty of documentation supporting that I have seen and met other residents' needs as well. With that said, it does mean I should act on these thoughts quickly so that my preference for this patient doesn't become blatently obvious to others or result in me ignoring another resident who actually may need me more.

In regards to your question, I'm not sure what my answer is other than this resident has always been appreciative and has called me an angel

Specializes in Rehab/Nurse Manager.
15 minutes ago, SilverBells said:

Another thought is possibly that these frequent visits could be construed as harassment. Not sure, since the patient hasn't made any complaints about me seeing her. But if her call light isn't on, it could mean she is already being helped or doesn't need or want anything at the moment.

Also, if she is on hospice, she may prefer to rest rather than have frequent interaction. Sometimes hospice patients would rather be left alone than be constantly checked on, at least from my experience

Well, you shouldn't be surprised when you are accused of abandonment for neglecting your assigned patients and of a gross HIPAA violation for inserting yourself into the care of a patient to whom you are not assigned. What you are doing is both abnormal and unprofessional and I hope you will seek help to work though your obsession with this patient before you lose your nursing license and your job.

Specializes in Rehab/Nurse Manager.
4 hours ago, FacultyRN said:

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.

All good resources, thank you

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
3 hours ago, sevensonnets said:

Well, you shouldn't be surprised when you are accused of abandonment for neglecting your assigned patients and of a gross HIPAA violation for inserting yourself into the care of a patient to whom you are not assigned. What you are doing is both abnormal and unprofessional and I hope you will seek help to work though your obsession with this patient before you lose your nursing license and your job.

Yes, this. This is why I advocate for speaking with your manager. Just in case someone has already reported your behaviour, it would be a good idea to get ahead of it.

If someone being appreciative and calling you an angel is all it takes to throw away all professional boundaries, something is missing in your life. You work at your job to pay the rent and buy groceries. Your emotional needs should be met outside of work. It may take a bit of soul-searching to figure out what to do about the missing pieces in your life.

6 hours ago, TriciaJ said:

Then ask yourself the really hard question: was this really just about the resident's needs? What need has this relationship met for you and what do you need to do to meet it more appropriately?

This.

This post and another post (by a different poster) on the first page right now that makes me think of the same.

There are personal psychological aspects (as opposed to just altruism and concern for others) involved in the belief that others just don't care as much, others don't try as hard, others don't connect as well...and as a result the patient needs me. Will only eat for me. Is only getting proper care because of me. Would have nothing if it weren't for me. Et cetera.

There are some good things about choosing to go out of one's way sometimes as long as basic boundaries are maintained. When reasonable boundaries aren't maintained there is (? by definition) some degree of pathological underlay.

Specializes in ER.

One thing staff would do with Edna (she was a favorite of many), was to spend their lunch break with her. It was a 60 bed nursing home in a small, rural area where Edna had lived her whole life. She was an O2 dependent lady in her 80s with Parkinson's. She could barely walk with a walker. But her personality and mind were totally vibrant and engaged.

She knew a lot of interesting things about people around town, plus she like to keep up on the nursing home gossip. It was just really fun to hang out with her because she was so likable and enjoyed people.

After my husband died I took time off and my little girls and I would go visit her. It was back before the internet and we had a fax machine. They would draw pictures and my older daughter would narrate short letter. We would fax it to her and she would get them at the nursing home. I also got to know her daughter who had moved back to the area after a divorce and taught in the local schools.

She died during my time away from the nursing home, we went to the funeral, and I kept in touch with her daughter and younger sister because it was a small-town and I would run into them at church and at the gas station her younger sister and family owned.

The thing is though, nobody had extra time to spend with Edna in the middle of the busy shift. We might linger a little bit while giving her care, but I don't remember anything crossing the boundaries that you are describing.

I definitely think you need to dial it back. Like someone said, pop your head in now and then. I don't see anything wrong with spending some of your lunch time visiting with this gal. I do think that the foot soak thing is over the top.

Specializes in Rehab/Nurse Manager.
10 hours ago, sevensonnets said:

Well, you shouldn't be surprised when you are accused of abandonment for neglecting your assigned patients and of a gross HIPAA violation for inserting yourself into the care of a patient to whom you are not assigned. What you are doing is both abnormal and unprofessional and I hope you will seek help to work though your obsession with this patient before you lose your nursing license and your job.

Shoot, and that is the last thing that I am wanting. Thanks for your thoughts.

6 hours ago, TriciaJ said:

Yes, this. This is why I advocate for speaking with your manager. Just in case someone has already reported your behaviour, it would be a good idea to get ahead of it.

If someone being appreciative and calling you an angel is all it takes to throw away all professional boundaries, something is missing in your life. You work at your job to pay the rent and buy groceries. Your emotional needs should be met outside of work. It may take a bit of soul-searching to figure out what to do about the missing pieces in your life.

Hmm, okay. It probably would be best if it came from me rather than someone else and/or before it becomes out of control. Not to mention the fact that other residents are capable of showing appreciation as well, not just this one.

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