Relationship between SN and client

ellakate · Aug 21, 2009

Although others may have different experiences, for me, my patients get better care than my friends. So I try very hard not to become friends of patients. Also, you are a student and must not let any one patient monopolize your time. This is a time management skill that you will have to learn.

rn/writer, RN · Aug 21, 2009

It's obvious that you are a kind and caring person. Those attributes probably figured heavily in your decision to become a nurse. But you are right in asking where to draw lines with patient relationships.

When I was in nursing school, we learned about what is called the "therapeutic relationship." A basic definition is an interaction between the nurse and the patient that is, out of necessity, one-sided with the patient being the primary focus. It can feel friendly, but it doesn't meet the criteria for what we normally think of as a friendship.

Why not? Because a friendship requires giving and taking on both sides of the equation and a peer relationship that doesn't exist between a nurse and her patient. You are in a position of power while the patient is vulnerable and dependent. You are paid to be there, but the patient is there out of necessity. You are concerned with what the patient needs at the same time she may be more in tune with what she wants.

So, how do you draw the lines?

First, get the majority of your emotional support and self-esteem away from the job. Look to family, friends, spiritual outlets, and other interests to feed your soul and make you feel worthwhile. People who don't take care of themselves in this way are more likely to cross the line when it comes to inappropriate bonding with patients because they haven't gotten their own needs met. It's hard to feed someone else (and not dip in) when you're really hungry.

Second, learn the difference between friendly (sociable) and familiar (intrusive). It's okay to converse while providing care, but keep your personal disclosures to a minimum. When possible, turn the topic back to the patient. Read between the lines. A patient may try to draw you out as a way of having someone to feel close to in a frightening situation. That "getting to know you" effort is probably more about looking for comfort than really wanting to hear your life history. Even a casual chat can sometimes tip you off to a patient's concerns or anxieties. Then you have the opportunity to connect on a deeper level that will truly benefit the patient.

Third, when you have a patient who is demanding (even in a nice way) or shows signs of becoming dependent (Do you think I should have the surgery?), it's time to rely on strong professional boundaries. (Incidentally, the best time to develop such boundaries is before you need them.) It's crucial to be able to extricate yourself from situations that would lead you to act or speak outside of your role as a nurse. (It might be helpful to imagine a number a hypothetical situations and come up with a list of good answers. If you brainstorm this with your peers, you can practice on each other.)

In your case with the patient who wanted you to stay and visit, you can say something like, "I know you'd like for me to stay and chat, Mary, but I need to take care of my other patients. I'll come back in an hour to check in with you. Is there anything I can get you before I go?" DO come back and check in. And when needed, gently remind the patient that you have a job to do (as you did when you chose to remain standing).

With a patient who turns to you for advice or starts relying on you overmuch, put your boundaries to work. "You aren't certain about the need for surgery? Let's make a list of your concerns for Dr. Whatsis. She needs to know what's on your mind." If the patient says he'll take his pills for you, come back with, "I'm flattered, Mr. Williams, but it's better if you take them for your own sake. Do it because you want to be healthy."

There are instances where intense and/or long-term contact does allow a friendship to develop between a patient and a nurse. But this has to be in addition to the therapeutic relationship, never in place of it. If the two conflict, the nursing role has to take priority. I think of what I told my kids when they were growing up. I really enjoy being both your parent and your friend, but if I ever have to choose, parent will win every time.

Confusion about the nurse's role sometimes results from the fact that we use one word, "care," to mean both emotional concern and connection AND the educated and skilled performance of our nursing duties.

Just remember that the therapeutic relationship is always about the patient.

Hope this helps.

brokenroads27 · Aug 21, 2009

that is a great response, thanks! i was confused when we first learned about therapeutic communciation with the clients because like i said, i never knew where to draw the line. but that really clarified my concerns. :)

Goingthere · Aug 21, 2009

I just had a similar experience. Where do I stop caring? When I realize that being emotionally involved will allow me to make mistakes. My pt turned out to have a psych diagnosis, and so her actions were guided by this. Theres nothing wrong with being caring, and it feels great to be so trusted, but be careful this is work.