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

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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?

2 hours ago, SilverBells said:

Not to mention the fact that other residents are capable of showing appreciation as well, not just this one.

I was beginning to think you had gained some insight until this.

SilverBells. Your focus should be on what’s good for your patients not what you get out of it emotionally. Being appreciated is nice of course but that should not be what drives you as a nurse. I really, really think you should explore this with a professional before you find yourself in some serious hot water.

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Specializes in Rehab/Nurse Manager.
37 minutes ago, Wuzzie said:

I was beginning to think you had gained some insight until this.

SilverBells. Your focus should be on what’s good for your patients not what you get out of it emotionally. Being appreciated is nice of course but that should not be what drives you as a nurse. I really, really think you should explore this with a professional before you find yourself in some serious hot water.

Shoot, that message may have came out wrong. A previous poster had questioned what my true motive may have been regarding devoting a large amount of time to this patient, and I thought it was possible that it may be because this patient had always shown appreciation. All I meant by this was that if I spent the time other patients needed, I may find that some of them would appreciate my help as well. I definitely agree that as a nurse, and especially as a nurse manager, my goal should be meeting the needs of each individual regardless of their reactions to my assistance. I am being paid to manage the care of many patients, not to be one particular patient's private duty nurse. If I truly feel the need to focus on only one patient, then perhaps a career change would be needed; at this point, I do not believe this is necessary. Also, as a manager, I am in a leadership position, so I should hold myself to higher standards. Showing favoritism to anyone, whether it be residents or other staff members, does not bode well for someone in my role. Hopefully that makes further sense...

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That’s really good to hear. I was truly becoming concerned for you. And thank you for not flying off the handle at my posts. I think most of us have had a favorite patient or two so we understand how it happens. Oddly enough mine was a 65 year old drug dealer from a very different part of town. When he came to the ED I usually had him assigned to me. But I did that for two very specific reasons. He treated my colleagues like crap but for some reason he liked me and he was prone to flash pulmonary edema and I knew him well enough to recognize it at the beginning so could head it off at the pass. He never got any special treatment from me except for kindness that he often did not deserve. ?

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Specializes in NICU, PICU, Transport, L&D, Hospice.

I'm so glad that I read through this entire thread.

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18 hours ago, SilverBells said:

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.

Then why are you asking for advice if your not willing to listen to what people are saying or seem to already have the answer? If your okay with your very odd, wrongful and unprofessional behavior then don’t ask for people’s feedback. I don’t think your handling this right and within professional boundaries, and not to be mean but honestly it seems like you need a psych eval.

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Specializes in Rehab/Nurse Manager.
7 minutes ago, MInurse2b said:

Then why are you asking for advice if your not willing to listen to what people are saying? If your okay with your very odd, wrongful and unprofessional behavior then don’t ask for people’s feedback. I don’t think your handling this right and within professional boundaries, and not to be mean but honestly it seems like you need a psych eval.

Please read my additional replies throughout the thread. As you can see as this thread progresses, I actually do not condone any of that behavior. I sought feedback because I felt that some of my behaviors/feelings were wrong, and I'm almost relieved that others were feeling the same way. With that said, if you've only read a few of my replies, I can definitely understand your response. I feel that at this point that if I can start maintaining more professional boundaries, I wouldn't necessarily need a psychiatrist, but am not trying to dismiss any suggestions of the benefits of therapy either. Regardless, this thread has become quite long so I can understand not wanting or having time to read through every post either. Thank you for your feedback

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1 minute ago, SilverBells said:

I sought feedback because I felt that some of my behaviors/feelings were wrong, and I'm almost relieved that others were feeling the same way.

If you need permission to dial back now that this situation has evolved in a way that has gotten out of control, you have permission to dial it back. Nursing ethics would support the reestablishment of boundaries.

Maybe at this point you would feel guilty for disappointing the patient when you withdraw from some of what you have been doing. That is very hard--it is indeed an example of the rationales for professional boundaries. Put your visits on a short taper so that within the next few days you are checking in for a brief hello at the end of your shift only (or at the beginning of the day only). Then...just take it as a learning experience. Engage in introspection to help you understand how things got to this point and you will emerge with a healthier perspective.

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Specializes in Rehab/Nurse Manager.

I'm thinking at this point I probably should avoid making contact with her unless other staff members specifically ask for me to assist with her. Based on conversations with other coworkers, I'm not the only one that wants to see her. I think she'll probably be fine if I don't visit her for a bit; I'm not working this weekend and haven't received any notifications about her so far (as a nurse manager, sometimes staff members will send out relevant updates when I am not there). It appears that the separation is causing me more distress than it is anyone else; I feel as if I'm grieving someone that is still alive. For a while, I've had the mindset that since I'v worked with her the longest, I know her best, and should be the one managing her care, which is illogical. If staff members do reach out to me with any questions about her or want me to help intervene, I don't see anything wrong with that, and I'd be more than willing to do that. However, if no one asks for my assistance, it's probably safe to assume they are doing fine with her and there is no need for my intervention. In the past, staff members have noted that I am "obsessed" with this resident, even when she was on my unit. I also had some thoughts about leaving the nursing profession once this lady passes as I thought my work as a nurse must be done, but that makes no sense either since I did not even know this person prior to attending nursing school. It makes me sad, but for everyone's sake, I feel it's best if I don't visit her for a few days while at work.

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On 6/12/2020 at 10:14 PM, KatieMI said:

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?

As a manager, I think she is still able to give bedside care without violating HIPAA or functioning outside of her scope of practice. As a Manager, she needs to be familiar with all of the patients. And a Manager can certainly give bedside care. If these things are not so, I need to retire totally and get out of this insane profession once and for all.

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Specializes in Rehab/Nurse Manager.
1 minute ago, Kooky Korky said:

As a manager, I think she is still able to give bedside care without violating HIPAA or functioning outside of her scope of practice. As a Manager, she needs to be familiar with all of the patients. And a Manager can certainly give bedside care. If these things are not so, I need to retire totally and get out of this insane profession once and for all.

In my facility, we are actually expected to assist with bedside care, including floating to other units. The other manager and I also assist each other with our residents, including covering each other when the other is gone, so it is not necessary HIPAA if we access charts from other units in order to do so. Our facility also has the mentality that every resident is everyone's patient

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
10 hours ago, SilverBells said:

Shoot, that message may have came out wrong. A previous poster had questioned what my true motive may have been regarding devoting a large amount of time to this patient, and I thought it was possible that it may be because this patient had always shown appreciation. All I meant by this was that if I spent the time other patients needed, I may find that some of them would appreciate my help as well. I definitely agree that as a nurse, and especially as a nurse manager, my goal should be meeting the needs of each individual regardless of their reactions to my assistance. I am being paid to manage the care of many patients, not to be one particular patient's private duty nurse. If I truly feel the need to focus on only one patient, then perhaps a career change would be needed; at this point, I do not believe this is necessary. Also, as a manager, I am in a leadership position, so I should hold myself to higher standards. Showing favoritism to anyone, whether it be residents or other staff members, does not bode well for someone in my role. Hopefully that makes further sense...

But this is only part of the picture. The other part is why are you so hungry for expressions of appreciation that it becomes any motivator at all?

We all appreciate being appreciated. We'd all rather look after the nice patients than the surly ones. But that should not drive one single nursing decision. I'll try asking again: what's missing from your life? You don't have to answer that question for strangers on the internet, but I do believe you need to give the matter some thought.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
23 minutes ago, SilverBells said:

In the past, staff members have noted that I am "obsessed" with this resident, even when she was on my unit. I also had some thoughts about leaving the nursing profession once this lady passes as I thought my work as a nurse must be done, but that makes no sense either since I did not even know this person prior to attending nursing school. It makes me sad, but for everyone's sake, I feel it's best if I don't visit her for a few days while at work.

Please seek some help ASAP. When you look back on this with a clearer head you will be shocked at how off-whack your compass has gotten. Stress can do strange things. Please find some help.

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