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?

[FolksBtrippin, BSN, RN]

SilverBells,

I'm glad you feel better after some detachment.

It seems like this particular patient triggered you to blur boundaries in a way that other patients normally do not. You got carried away, because you weren't able to identify it early and address it. Maybe that's because it's generally not a problem for you.

Don't fall into the trap of deciding that this patient is just toxic or manipulative. That's another type of boundary issue. We need to maintain boundaries despite patient behavior. If we have good skills no one is toxic or manipulative. If we don't, anyone can be toxic or manipulative.

It's good to see you working out what it is that got you overly attached.

It is okay to want to be appreciated for your work and it's okay to feel good when this comes from a patient. It's okay to get some emotional needs fulfilled by the work you do and I think that is even necessary for most people to have a fully satisfying career. It really isn't what you feel that creates a problem here, it's more what you do. Blurring boundaries is an action, not a feeling.

What you are experiencing is not a mental illness and you can talk it through. It doesn't have to be talked through with a mental health counselor, as long as the people you're talking to can empathize well enough not to shame you back into not seeing the problem.

Just make a few rules for yourself and follow them.

I work in community psych where boundaries are both very important and very difficult.

My rules for myself are to not talk at all about my personal life with my patients, even in ways that seem innocent, and to accept a maximum of 1 phone call per working day per patient. I also do not say anything bad about other staff members, doctors, etc. to patients no matter what. That's what I can think of off the top of my head. But each of my rules came from a time I didn't follow that rule and wound up in a boundary dilemma.

Your rules will be different, because you have a different specialty, but I'm sure you can think of some right away.

I know you will solve this because your insight on the issue is good.

[Blondie28]

GIRL WHAT??? You are telling me you spend TWO HOURS with a patient? That is literally insane and beyond unfair. You are stating you get annoyed with your actual patients, because they have family and aren’t dying, like what? Do you realize how selfish and uncaring you sound? I would be so mad and would absolutely report you if I were a family member and knew you were speaking of my family (the pt) like this. And nightly foot soaks? Not to sound rude, but isn’t that type of patient care the CNAs responsibility? It sounds like you have really taken to this patient for some reason, and I get it, we all have our favorites. I think you need to take a step back though and realize what you are saying here. You are admitting you put your actual patients second to someone who isn’t in your case load, ever think maybe management did that for a reason? Also, let me add, If I worked with a nurse who spend TWO hours in a patients room every night, I would be beyond annoyed, you should be out on the floor available in case of an emergency, not soaking mrs Jones feet for two hours. Anyways, seems that everyone here agrees you have crossed a line, if she is nearby, say the same floor, two Quick visits A day is more than enough, other than that any other visit should be on your own time when you don’t have your own patients to attend to, whom are your main responsibility when you are on the clock, as you should already know.

[SilverBells, BSN]

Update: Just found out this lady passed away this week on a day I wasn't at work. Disappointing, it seems like all of my "favorites" pass away when I'm gone.

[SilverBells, BSN]

Same thing happened two years ago. There was a lady that I really enjoyed working with who was eventually put on hospice that was gone between my work shifts. I've obviously had to attend to deaths before, but they're always for patients that I didn't know as well/work with as long

[SilverBells, BSN]

Now that I think about it, there was a third patient that this happened to as well. Worked with her for about 3 years, very pleasant lady. Again, gone by the time I came to work next. I seem to have horrible timing when it comes me being there for these people when they are ready to leave this world.

[TriciaJ, RN]

34 minutes ago, SilverBells said:

Same thing happened two years ago. There was a lady that I really enjoyed working with who was eventually put on hospice that was gone between my work shifts. I've obviously had to attend to deaths before, but they're always for patients that I didn't know as well/work with as long

It might actually be better that way.

[RNNPICU, BSN, RN]

1 hour ago, TriciaJ said:

It might actually be better that way.

Sometimes I think it is better that way, you can grieve the loss but then still be able to think, okay, on to thinking about the next set of patients.

Sorry for your loss OP

[Littleblackdog, ADN, BSN, RN]

On 6/12/2020 at 2:24 AM, Florence NightinFAIL said:

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

Me too. I mean, who the HECK has 2 hours to spend with any patient/resident??

[Littleblackdog, ADN, BSN, RN]

I am sorry to hear that your patient you were so fond of died while you were off. I know that was difficult. And I compliment you on realizing - at least, I think you realized - that you were getting too attached and spending too much time with her and ignoring your assigned patients/residents. But, I just have to ask,,,,,,,how and where did you ever find you had 2 hours to dedicate to her every night, getting her to bed, soaking her feet, and praying with a minister when she was still assigned to you? I now work in long term care after 34 years of working in a hospital. I work day shift, and I have 28 resident to give meds to and a few get skin treatments as well. And then there are about 4 to6 daily that get charted on by hand (no computer here yet). I am running with my tongue hanging out after 12 hours (I don't take a lunch break and I pee about once in 12 hours ). Where did you find time for this?? And ignoring your assigned folks while implying that since they have family visiting , you shouldn't have to attend to them is just wrong.

[Littleblackdog, ADN, BSN, RN]

On 6/24/2020 at 4:01 PM, Blondie28 said:

GIRL WHAT??? You are telling me you spend TWO HOURS with a patient? That is literally insane and beyond unfair. You are stating you get annoyed with your actual patients, because they have family and aren’t dying, like what? Do you realize how selfish and uncaring you sound? I would be so mad and would absolutely report you if I were a family member and knew you were speaking of my family (the pt) like this. And nightly foot soaks? Not to sound rude, but isn’t that type of patient care the CNAs responsibility? It sounds like you have really taken to this patient for some reason, and I get it, we all have our favorites. I think you need to take a step back though and realize what you are saying here. You are admitting you put your actual patients second to someone who isn’t in your case load, ever think maybe management did that for a reason? Also, let me add, If I worked with a nurse who spend TWO hours in a patients room every night, I would be beyond annoyed, you should be out on the floor available in case of an emergency, not soaking mrs Jones feet for two hours. Anyways, seems that everyone here agrees you have crossed a line, if she is nearby, say the same floor, two Quick visits A day is more than enough, other than that any other visit should be on your own time when you don’t have your own patients to attend to, whom are your main responsibility when you are on the clock, as you should already know.

I agree with every single word. Well said.

[Hoosier_RN, MSN]

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

If I'm having to compete with other staff members (at least, that's how it feels), clearly she is being cared for.

this statement is very alarming to me. You are way beyond crossing a boundary if this is how you feel. I suspect everyone in that facility is on to you, and I would be surprised if you don't end up in some hot water. If I were your manager, I'd counsel you, then begin the paper trail for termination

[Florence NightinFAIL, BSN, RN]

Let me just ask...

Were any of these patient's wealthy and you were hoping they will leave you something in their will?

Otherwise it doesn't make sense. Event the most LOVING offspring don't do what you do.