nurses getting involved with patient,right or wrong?

leslie :-D · May 16, 2005

I am a nursing student. My assignment for calss is to get responses from practicing nurses about nurses "crossing the line" (getting involved with patients). I'd really appreciate the input. Thanks!

i think it depends on where you work as there are settings that are more conducive to developing relationships w/pts than others.

i am not sure and hope to be corrected if i am wrong, but working in an er or or would give you little chance to get involved.

on the end of the spectrum would be ltc and hospice.

but regardless of where you work, there are nurses that just do not get involved while there are others who do.

i was taught in school not to get involved, don't cross that line.

but as a hospice nurse, i've gotten attached to so many of my pts and their families, yet still knew when to draw the line.

but yes, i've cried w/many a patient and have shared my 'unprofessional' side, my human side as i have also been to dozens of funerals/wakes.

the key point is to remain objective enough that it does not interfere with making nursing assessments, judgements and plans.

leslie

Pediatric Critical Care Columnist · May 18, 2005

This is a hot-button issue in our unit at the moment. We had a patient earlier this year (toddler with complex CHD) who was at the extreme end of critically ill. The family was from a town an 8 hour drive away, but had relatives and friends in the area. The child was with us for exactly three months, on ECMO for the first 29 days. He had a baby sister who was only a couple of months old when he came to us; mom was nursing so baby was always present. Everyone on the staff thought this healthy, normal little one was just the best medicine for the stress in our unit, and some people, physicians included, would play with her, carry her around the unit and take her for walks to let the parents have a break. Some staff members became so enmeshed with this family that they were inviting them to their homes on their days off, buying things for the kids and generally usurping the support role usually left to extended family and friends.

When this little boy died, there was an orgy of grief amongst the staff. People who had never cared for the patient but who were attached to the sister needed debriefing. One nurse took the parents to her home for two nights while they dealt with the details. The same nurse and one other collected money to buy a memorial for the child. Several staff members got time off to attend the funeral. When the incongruity of all this was pointed out, the worst offenders became righteously indignant, stating that "we do this for all the kids who die in our unit", a patently false statement. I cannot remember another time when we did this for anybody. Now the family is back in its community and no one knows how to help them, because they were never allowed to help them in the middle of their hell.

I have become attached to patients and their families and will continue to do so, but I have always been able to maintain a professional distance. I cared for this little boy many times when he was at his sickest, and it never occurred to me to invite his folks over for dinner, or any other such activity. Our medical director is examining ways of re-erecting professional boundaries and it will be to the benefit of all concerned.

hypnotic_nurse · May 18, 2005

It is very important to keep professional distance no matter where you work, but especially in psychiatry. We were advised that it was unethical to ever see a patient socially, and if we happened to come across one of our patients in daily life outside the hospital, to allow the patient to acknowledge us or not.

Good advice, too; I've seen many, many instances where things ended badly, and only one time it went well (and that was a friendship which started out with the caregiver and the patient both volunteering at the same organization post therapy).

lil'nurse · May 18, 2005

I work in psych and this is ABSOLUTELY frowned upon. I would not have a job. We don't use our last names on our name badges and NEVER give out personal information.

DDRN4me · May 18, 2005

Working in pedi homecare it is very difficult not to get enmeshed with families, you are in their home caring for thi=eir child and often have to interact with extended family as well. I find the nurses who are too distant do not do as well as the ones who are able to let down their guard a little (without going overboard) . Families need to know that we c are; and that their child is important to us. The most touching thing that was ever said was at the funeral of a little girl i took care of for years ( respite and school). Her parents hugged me adn said "thank you for loving our little girl as much as your own":o I carry that wiht me as testament that sometimes you need to go a little beyond the safety zone.

Ruby Vee, BSN · May 18, 2005

i've seen nurses get overly involved with patients' families, and it almost never works out well for everybody involved. when i moved back home from the big city, i worked at the university medical center about 90 miles from my hometown. (that was "home" enough for me! lol!) i worked on a heme/onc floor, and one of the patients there was the best friend of my cousin jim. jim used to bring danny to family weddings, barbecues, etc. they were teenagers -- you know how teenagers are. so i knew danny. he became involved in my orientation to the unit, showing me how to use the pneumatic tube system, etc. he was a nice kid, and i'd always liked him.

one of the nursing staff who was about five years older than danny fell in love with him. they "dated" -- difficult for a 22 year old nurse with less than a year of experience and a 17 year old who was dying of leukemia. she used to get him day passes, and they'd go out. danny's parents weren't around as much as they would have liked. he had younger siblings at home, and his dad had to work to keep up the medical insurance. so pam and danny maybe got away with more than they should have. he was in and out of the hospital, going into remission, then relapsing.

after a year, i recognized that the unit was a bad fit for me, and transferred to the icu (with the encouragement of my manager, but that's another story.) danny went into crisis one night and transferred into the unit when it was my turn to admit. i admitted danny and took care of him that night. a mistake was made on the part of the medical staff, and danny died. it wasn't my fault. i'll never forget, though, how badly i've always felt. or how hard it is to face my cousin after his best friend's death. and pam, who was taking care of him when he went bad and needed to be transferred to the unit? she was so upset that she left nursing. she was sure that if she'd been paying more attention to his care (rather than their plans for the future), she may have picked something up sooner. maybe she would have. she shouldn't have been taking care of him anyway. nor should i have been.

Scuttlebutt · Mar 17, 2012

I can tell you its wrong esp when there is infidelity involved but I have been blindsided by falling for my patient and I have not spoken a word to him of my feelings but I have been honest with my husband about it and I am working through it and trying to get over it. There are so many factors in play that had me at a disadvantage for this pithole that I fell into. But I believe I can overcome it without jeapardizing my career. If I feel I need to quit I will. That is more important.

MomRN0913 · Mar 17, 2012

I think it's OK. I usually became close to patients and families. I know a nurse who met her fiancee by taking care of her father.

In my new job (home hospice) you are encouraged to get involved, and go to the funerals when the patients die to show support. You actually get paid for it too, if it's on a day you work and you chose to go, you just don't see patient that day.

Nursing is a whole, mind, body, spirit. I think poeple tend to see nursing as a technical job these days, which is fine, but nothing wrong with treating the patient as a whole.

Silverlight2010 · Mar 17, 2012

Crossing the line to me means any relationship that becomes personal or intimate (avoid at all costs!!). No dating, exchanging contact info, or arranging to meet after discharge. No exceptions. To do otherwise is a violation of my professional responsibilites to my patient.

That being said it is hard to keep to strict professional boundaries (not giving ANY personal information etc..) when in my role I frequently see people that are stressed, scared, getting life changing information (they need open heart, are dealing with being told they had a major MI or cardiac arrest....).

What I find works on my unit and for me personally is to take my cue from the patient and their family. Do they want the straight forward approach and see only my professional role or does some casual conversation help them cope with what's going on? I'll answer some questions in general if I get the sense it helps build rapport, such as a patient with children at home wanting to know if I'm a parent.... it helps them feel I can understand their stress and worry about being admitted with an MI but are worried more about the kids and "who will take care of things". Are they making jokes, then I might joke back when I'm about to remove the defib pads and rip off a large patch of chest hair "and to think people pay to have their hair ripped out..."

Pretty sure my former nursing instructors might frown on this as unprofessinal though. One thing I learned though once I was out practicing was that sometimes I had to bend a little to do my best for patients. You do tend to get to know your more long term patients more than the ones here and gone in a day or two though.

MN-Nurse, ASN, RN · Mar 17, 2012

I am a nursing student. My assignment for calss is to get responses from practicing nurses about nurses "crossing the line" (getting involved with patients). I'd really appreciate the input. Thanks!

There is a line for a reason. Crossing it is wrong.

"Wrong" can range from inadvisable to a felony.

xoemmylouox, ASN, RN · Mar 19, 2012

I think it is almost impossible to not grow attached at least one or two patients in your career. We have a patient that we all loved. They died very suddenly and we all felt the loss and attended the funeral. His parents still come to see us now and then to talk. That is not the same as dating a patient. That is a HUGE no no.