I had a situation happen to me awhile back and I just wanted your thoughts on it.
I was doing my psych rotation and was on a unit where I would never expect to see a person of the same religion as me (due to the location I was in). For this clinical, all we did was sit and talk to patients, so after group I approached him because I thought it would be a good ice breaker. There are only a few communities with this particular religion and he started naming everyone he knew from mine!! I was trying to be very nonchalant as to not disclose which community I was from. He started telling me that I'm welcome to ask these people about him because they all know him! He then preceded to ask me out on a date after our conversation (I replied that I'm here to maintain a professional relationship with him, which is what our instructor told us to say if anyone were to ask us such a question.)....I was very thankful my last name was covered on my name tag!!!
So my questions to you...
I obviously did not tell anyone his name or any identifying information about him, but would you have if he gave you permission to do so? He was A&Ox3 and we had a pretty long conversation.
Secondly, since this was my first experience on a psych unit and I'm a nursing student, I wasn't completely sure how to approach this situation. How would you have approached the conversation?
Even if he had given me written permission, I would not ask about him in the community. That is just begging for trouble for you, especially when the question comes up, "so, how did you meet/know X?"
It's a fact that you may encounter people you know IRL in a psych setting and vice versa. However, given that you two have a very small community in common and that you are a student, I would ask your CI to place you into another unit for the next clinical, or at least allow you to get another patient.
A different perspective, a bit too late unfortunately, but you did ask. When we're assigned patients and we become aware that we are "known" to each other.... we change assignments to protect everyone involved.
If you're knee deep in a conversation and then you realize your knee deep in, I say "I'm worried about a conflict of interest and providing you the best care, I have to excuse myself now and another nurse will take over for me".
And I BOLT! In the future, as soon as you hit that FIRST identifiable link in the community, you get outta dodge. It's not fair to the patient or you. It doesn't matter that the patient initially has no issue with your "relation", at first they welcome it... especially with psyc when they try to manipulate you. So Run quick and early because I promise you, later, when these psyc or other patients find a way to change your interaction against you, it is way too easy. Forget them giving you verbal permission, "this is great that we know the same people...."
I promise you no good ever comes of it and it very likely will get twisted against you. Protect yourself ALWAYS and leave the situation and seek out your instructor to clarify if it's iffy. You'll learn as you go how you're getting yourself in a bad spot, and YES, you were in one.
I would like to add that I wouldn't freak out because you happened to know people in common. Psych patients are people too, they have their lives and their social circles and their relationships too, and it's a bit naive to expect that their life will never intersect with yours. I don't know why it would be necessary to discuss his status with a religious leader just because he happened to host him for a meal.
It was just the first time it happened, so yes I was a bit freaked out. I understand they are people with social lives. The unit I was on had a very high acuity and some of the patients were a danger to others, so I was a bit on edge. Our instructors also told us that many students felt more comfortable with their last names covered on their name tags before we started this clinical, so that made me nervous as well. I agree that I am still a bit naive and the whole environment just made me uneasy. The unit wasn't so nice (the coloring/furniture...it made me depressed just being there!) and I've never seen patients with security before.
I also have to reiterate that I never discussed anything about him outside of clinical. It was just a thought that crossed my mind because he was telling me I should ask about him. I started thinking about it more because of him asking me out on a date. That's all.
A different perspective, a bit too late unfortunately, but you did ask. When we're assigned patients and we become aware that we are "known" to each other.... we change assignments to protect everyone involved.
If you're knee deep in a conversation and then you realize your knee deep in, I say "I'm worried about a conflict of interest and providing you the best care, I have to excuse myself now and another nurse will take over for me".
And I BOLT! In the future, as soon as you hit that FIRST identifiable link in the community, you get outta dodge. It's not fair to the patient or you. It doesn't matter that the patient initially has no issue with your "relation", at first they welcome it... especially with psyc when they try to manipulate you. So Run quick and early because I promise you, later, when these psyc or other patients find a way to change your interaction against you, it is way too easy. Forget them giving you verbal permission, "this is great that we know the same people...."
I promise you no good ever comes of it and it very likely will get twisted against you. Protect yourself ALWAYS and leave the situation and seek out your instructor to clarify if it's iffy. You'll learn as you go how you're getting yourself in a bad spot, and YES, you were in one.
Food for thought to protect you later.
Thank you, that's why I ask. I made sure he was not my patient the following day. During the conversation, I just didn't know how to get myself out of it.
I think it's a good thing that you thought about your own safety. I'm not saying you have to be skeptical of every patient, but as you know, there are nurses who have had patients track them down outside of work in person, through facebook, phone calls, etc. It sounds like you did a good job in this situation. As you gain more experience, you will be able to better identify unsafe situations and how to deal with them.
Congratulations on seeking help and experience from your allnurse peers. This website has been a source of great knowledge and sometimes comfort for me. As you see, you will get many different perspectives on each and every situation.
As a new nurse it is very hard to learn bounderies and what works and doesn't work. As I have grown as a nurse I have come to see that you can take good care of pts and make them feel special without sharing too much personal information. This is the best way to protect patients and yourself.
Be careful about sharing too much information with staff members initially too. You will find out that first impressions aren't always accurate.
Be sure and come ask all of us whenever you are not sure. And of course don't forget that you should always talk to your instructors as soon as you are not sure about something.
When I was doing an internship in high school at a psych facility in their activity room, I ran into the ex-husband of a family member of a guy I was dating. I didn't notice him and recognize the connection at first until after we began interacting toward the end of my day. He was only inpatient a couple of days, so I didn't have to deal with it for long, but I did so by keeping myself at a distance and in a professional role. I didn't ignore him as a patient at all, and would talk with him as he did his art projects, but the focus was on HIM as a patient. Neither of us acknowledged the connection at the time, but later he brought it up to the guy I was dating and said I was cold-hearted! I agree that patients will just try to manipulate connections they have with you, or it will affect the professional nurse-patient relationship. My ex asked me why I didn't tell him, but I'm well aware of HIPAA and chose not to disclose any information.
I also ran into this situation in my med-surg clinicals, and one of my patients was from my husband's small town and knew his mother well, so she had seen pictures of me but I had no idea who she was! When she asked me if I was married to [husband's name], I said yes but that I couldn't discuss anything in detail with her if she was my patient. She said she was going to tell my MIL about it, and I said that was fine but I wouldn't be able to talk about it with his mom either! Sometimes I feel like patients really push the line if they do happen to know you in some way. The key is to remain professional and refocus on them and their needs.
I have psych clinicals next semester and can't wait! Psych is where I think I want to go.
Working in the hospital and in Psych, the rule for me is simple: Don't talk about your patients outside of your unit. Don't discuss them to people outside of the health care team. And don't even talk about the circumstances surrounding his issues.....because if you divulge some information, you might eventually be revealing obvious clues as to who this person is. Stay out of trouble. Always remember HIPAA!
You revealed too much information about yourself from the start. It seems like you felt you were from small community this would give you some anonymity but he was from the same group. By being conversational you opened yourself up. This is why you need to keep conversations about the patient, not you. And this is what you say when they ask about you, you say you are here as a professional and don't share private information, like where you live, family details or anything personal. The fact that they are an inpatient means they have pathology that may or may not be fully revealed or diagnosed. Because of this, they may not be competent to allow you to break HIPPA, which you should never do in any case, even when the patient says "its OK". You are held to higher standard. Imagine how you would sound in court explaining yourself- "but the mentally ill patient said it was OK in passing conversation". Don't feel bad, this is a common mistake for newcomers but hopefully you have learned an important lesson. Some patients will use any personal information to manipulate or provoke you. What they don't know can't hurt you.
Specializes in critical care; community health; psych.
You are operating under an occupational license which is public information. Not just some public, ALL the public. It is not your identity and information which is protected under HIPPA, it's the patients'. It is unprofessional not to disclose your last name. It doesn't say much for the nursing profession either. Either we are professionals (with last names like our MD counterparts), or we're not.
Specializes in Professional Development Specialist.
I just want to be sure you understand that AO3 doesn't mean that he isn't compensating very well at the moment for the reason he is in a psych unit. I don't know his diagnosis (and don't want to know) but some patients can be very good at manipulating people. Some have excellent instincts for connections and areas you might be vulnerable. You did the right thing by being sure he isn't your patient the next day. Someone mentioned that some patients can get overly attached to a caregiver very quickly. Continue to be careful.
My ex asked me why I didn't tell him, but I'm well aware of HIPAA and chose not to disclose any information.
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
Even if he had given me written permission, I would not ask about him in the community. That is just begging for trouble for you, especially when the question comes up, "so, how did you meet/know X?"
It's a fact that you may encounter people you know IRL in a psych setting and vice versa. However, given that you two have a very small community in common and that you are a student, I would ask your CI to place you into another unit for the next clinical, or at least allow you to get another patient.