Psych NPs: Do you touch your clients?

[resilientnurse]

Perhaps this topic has been explored here before, so please forgive me. But I am curious about any current thoughts on the topic. I do not touch my patients. Although, on 1-2 occassions I have gone to stand up after a session and to my surprise clients simply lunge towards me for a hug AND JUST TAKE IT. I learned not to touch very early on in my training. In fact, I did clinicals with a psychiatrist who was absolutely up in arms and about to resign because it was suggested that she might have to take VS during an evaluation so that the agency could maximize it's reimbursement. "I will absolutely NOT touch a patient! They could be traumatized." I understood her point and subscribe to the no touching. Recently, I have been working in the Southwest (on locums) and I am amazed at the number of clients that come in, meet me for the first time and extend their hand to be shaked. My clients don't do that back home. This is such a foreign practice for me coming from the Midwest. Ironically, here if the RN takes off the clinicians are expected to take VS. This has happened to me once. I reluctantly did it, but am truly hoping that this nurse stays put.

[FolksBtrippin, BSN, RN]

Interesting. I'm not a psych np, but I've worked in psych for about 12 years. The hospital that I started in had a very strict no touching rule. No contact between patients either. I assumed that it was standard practice everywhere.

Then I started working as an independent contractor in a different state, outpatient, and touching was encouraged.

Still doing similar work, and touching is encouraged, between patients also. In fact, I do a handshake lesson every few months as part of an interpersonal skills class.

[elkpark]

Interesting post. I'm a psych CNS, not an NP, and have worked as a psychotherapist for many years. I don't do much touching, but I've never heard of anyone having a problem with shaking hands when the client initiates it. That seems kind of extreme to me.

I've also never run into a situation in which a client was likely to be "traumatized" by having VS checked in a medical setting, esp. when you inform them of your intentions (which, of course, you would do) and get their consent to do so before touching them. In my experience, most people coming into medical settings expect to have things like VS checks done to them and have no objection.

[PG2018]

I shake their hands. I've had a couple of kids hug me. I'm really skittish of that. Did I spell skittish correctly? I don't do any kind of physical examination or anything. One reason I like shaking is that it tests their social skills. It also breaks the barrier of me being cold and distant which I work hard to be because I run my practice like a business.

[Jules A, MSN]

I don't particularly like shaking hands with anyone so I don't ever offer but don't ever turn it down either when a patient extends to shake. I think that would be rude and I'm aware of the stigma in psych and don't want to make anyone feel as if I don't want to shake hands with them because they are a mental patient rather than just that the universal human germy hand thing kind of creeps me out, lol.

With my inpatient kids I tend to be do the occasional pat on the back or shoulder. If my little ones or adolescents want to hug they are all schooled to know we do side hugs only and I'm ok with that if they ask first. Some of my older lady outpatients will bombard me with a hug at the same time as asking and I just kind of go with it. I definitely don't do any untoward touching of anyone but don't freak if it happens of their volition.

[zenman]

There are just too many uptight people in this profession! You're no special than anyone else. Shake a person's hands like any "normal" person. Maybe your cooties won't rub off on them.

[AtomicWoman]

I am a primary care NP who has seriously considered becoming dual-certified in psych, although I have not made up my mind. Knowing how important something like BP is, there is NO way I wouldn't take someone's vitals or have an assistant do it if I were practicing as a psych NP. I believe every heathcare encounter is an opportunity to do health promotion and check important details like someone's BP. Not only that, but certain medications can affect BP and heart rate (bupropion comes to mind immediately). How would I know that is occurring if the patient's vitals aren't checked?

[(Sofie)]

Hi everybody! In school we were thought: DO NOT TOUCH psych patients... However, I do believe that sometimes for some patients it can be extremely therapeutic and healing! With enough experience and expertise in the field, you should be able to figure out when/if it is possibly useful. I found a great article about this:

"Since touch is such a fundamental, powerful and potentially healing form of communication, yet one that contains so much risk of client exploitation, it is important for training programs and clinical supervisors to ..."

Read article in its entirety: A.D.P.T.C. - Newsletter

[matthdrn]

I will shake hands, otherwise, I will stop the client and tell them it is a universal rule that I do not hug clients.

[Conqueror+, BSN, RN]

When I worked psych we never touched. I later found that many of my patients had boundary issues and hugs etc.. just made it harder to manage.

[Psycho-APRN]

I have two patients who hug me every appointment at my SMI clinic. They both have told me this is the only human contact they have and it feels comforting to them. In inpatient with the kiddos we do side hugs once again I take care of a lot of kids who have been in DHS custody for a long time and have not had nurturing contact. I pat their hands when I see them in my office if they are upset. I think sometimes we forget the healing power of touch. I NEVER initiate contact with a patient nor do I even side hug a child where there is not a camera recording it.

[cjcsoon2bnp, MSN, RN, NP]

I have worked in psychiatric/mental health for my entire nursing career and at times consider obtaining my PMH-NP. I understand the no touching rule but I think that not shaking someone's hand is overkill and sends a very clear and potentially stigmatizing message to patients. I think that hugs and other intimate forms of touching are a big no-no and it is perfectly appropriate to set that boundary with patients in a polite and respectful way.

As far as not taking vital signs, I can understand why providers might not want to obtain them because it would be more appropriate for the nurse or tech. to obtain them but I think that threatening to quit or being up in arms about it is a little extreme and not taking them at all because a nurse or tech. isn't available is poor practice and lazy IMO.

It is very interesting to read people's responses on this issue, good question OP!

!Chris