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PDN and boundaries

Private Duty   (9,468 Views 30 Comments)
by quickkarma quickkarma (New) New

quickkarma has 2 years experience and specializes in Private Duty, Case management.

1,217 Profile Views; 14 Posts

I am curious of others opinions on private duty nursing and the extensive boundary crossing that is seen in this type of setting. I've seen it all, gifts, vacationing together, planned lunches, visiting while on maternity leave. Both sides-family and nurse. Sometimes nurse is on duty, sometimes not. Just bizarre. I do understand the need to share phone numbers because communication is more accurate without a middle-man. But Ive heard of nurses bringing in loads of baby gifts after a minor disagreement between client's family and nurse. Yikes. I just try to follow the rules, but some of these families seem offended that I'm simply cordial and don't become their close friend. And then it becomes awkward. I'm not in this job to expand my friend list! The latest family, which I thought were the most "normal" yet, have insisted it's impossible to not be close with the nurse. I just don't agree.

I am, however, hoping and planning on switching out of this type of nursing soon. At any rate, looking for thoughts and opinions here. Am I too conservative? Is this as common as it appears to be?? Thanks...

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2 Followers; 14,620 Posts; 103,779 Profile Views

I've never done private duty nursing (and can't imagine wanting to), but I think you are correct about the importance of clear, healthy boundaries. Like so many other things in nursing, just because lots of other people are doing it, that doesn't mean it's a good idea.

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RNperdiem has 14 years experience as a RN.

1 Follower; 4,205 Posts; 29,497 Profile Views

Good strong boundaries are a healthy thing. Maybe some nurses get more personally involved, but if that is not your style, don't try to be what you are not.

You are not a family friend, you are the hired nurse, and when drama gets stirred up, a family can turn on you.

I work in a hospital and am a little suspicious of families who praise me too much, seem overly friendly. Even if well meant, I can sense an underlying control and manipulation going on. Those families can turn on you too the first time you deny them anything.

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OrganizedChaos has 10 years experience as a LVN and specializes in M/S, LTC, Corrections, PDN & drug rehab.

1 Follower; 1 Article; 6,877 Posts; 64,507 Profile Views

I have worked PDN before & I always set clear boundaries because I never wanted to get get mixed into anything.

The last case I was on the day shift nurse would constantly buy or bring stuff for the patient. It shocked me. She mostly bought clothes but because the patient didn't have any but I refused to cross that line.

I have also been on cases where nurses would gossip with the mom, take the patient to their house (off the clock), and one nurse even would go so far as to drive all the way to Dallas on the weekends to take care of a patient.

I'd rather lose a case than ever be pulled into family drama or any other crap like that.

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Alex Egan has 9 years experience as a LPN, EMT-B and specializes in Home Health (PDN), Camp Nursing.

6 Articles; 855 Posts; 23,208 Profile Views

The rules I live by

1. I can be your friend, or I can be your nurse. I cannot be both. This is the foundation of my boundaries. When I follow it I am safe.

2. I can speak to the parents like a coworker if I'm very familiar with them, but I can never complain about my job, or the company

3. I will never discuss another nurses performance or any other employee's business

4. I will not offer health advice about anyone other than my patient

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smartnurse1982 has 7 years experience.

1,775 Posts; 24,298 Profile Views

My main gripe is the agencies that do not enforce their own darn rules.

The exchange of phone numbers seems to be encouraged by my agency even though it says in the handbook to not give out your personal phone number.

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Adele_Michal7 has 5 years experience as a ASN, RN and specializes in Pediatric.

893 Posts; 8,305 Profile Views

I was never able to do it- one of the many reasons I left pdn

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Elektra6 has 14 years experience as a ASN, BSN, RN and specializes in Home Health, LTC, subacute.

537 Posts; 11,192 Profile Views

How about the patient's aunt driving a nurse to a surgical procedure (the nurse's surgical procedure, not the patient's) and then said nurse recovers at the patient's house because she is single and doesn't have any family!!!

- Heard about this from a family, a nurse brought her kid to work every day in the summer. Supervisor didn't notice because there were other kids in the house at the time. Family didn't care because the kids occupied themselves playing. Nurse was going on maternity leave and quitting, I think she didn't care.

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OrganizedChaos has 10 years experience as a LVN and specializes in M/S, LTC, Corrections, PDN & drug rehab.

1 Follower; 1 Article; 6,877 Posts; 64,507 Profile Views

- Heard about this from a family, a nurse brought her kid to work every day in the summer. Supervisor didn't notice because there were other kids in the house at the time. Family didn't care because the kids occupied themselves playing. Nurse was going on maternity leave and quitting, I think she didn't care.

I've heard of nurses doing this, I don't understand it. I would never do it myself. Some things nurses do in PDN really scare me.

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nursel56 has 25+ years experience and specializes in Peds/outpatient FP,derm,allergy/private duty.

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I am curious of others opinions on private duty nursing and the extensive boundary crossing that is seen in this type of setting. I've seen it all, gifts, vacationing together, planned lunches, visiting while on maternity leave. Both sides-family and nurse. Sometimes nurse is on duty, sometimes not. Just bizarre. I do understand the need to share phone numbers because communication is more accurate without a middle-man. But Ive heard of nurses bringing in loads of baby gifts after a minor disagreement between client's family and nurse. Yikes. I just try to follow the rules, but some of these families seem offended that I'm simply cordial and don't become their close friend. And then it becomes awkward. I'm not in this job to expand my friend list! The latest family, which I thought were the most "normal" yet, have insisted it's impossible to not be close with the nurse. I just don't agree.

I am, however, hoping and planning on switching out of this type of nursing soon. At any rate, looking for thoughts and opinions here. Am I too conservative? Is this as common as it appears to be?? Thanks...

It's very common, and I believe sometimes the process occurs over months and years in some cases, the nurse not quite realizing how it occurred.

When you look at it from parent's perspective, there is an underlying anxiety fueled by fear their child will not get the care he or she needs. They've probably had some nurses who gave good reason for their fear.

When they find a good nurse, they naturally want to cling to the nurse and find various ways of flattering and encouraging an emotional investment, including the offering of "perks" such as offering to sign off timesheets for hours the nurse was not on the premises, gifts,etc.

I don't think it's a healthy situation for nurse or family, but it's often the path of least resistance, and one I would actively resist. Over a period of years I've seen most such intertwining end very badly.

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smartnurse1982 has 7 years experience.

1,775 Posts; 24,298 Profile Views

I have thought about buying one of my patients some Artificial Tears and Culturelle(both are an ordered treatment for the client) because the caregivers either refuse to buy it or cannot afford it.

The child really,really needs them.

I know Medicaid does not pay for meds that are OTC even if ordered by the physician.

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Kitiger has 40 years experience as a RN and specializes in Private Duty Pediatrics.

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I have thought about buying one of my patients some Artificial Tears and Culturelle(both are an ordered treatment for the client) because the caregivers either refuse to buy it or cannot afford it.

The child really,really needs them.

I know Medicaid does not pay for meds that are OTC even if ordered by the physician.

You'd best clear that with your office first.

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