Speaking of facebook...inappropriate...but am I within my rights...?

Nurses General Nursing

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I'm head nurse at a long term care facility. I have a truly wonderful team and we have a great working relationship. Several of them are friends on facebook.

The other day I noticed one of the facility's residents leaving a message on one of my team member's page. When I checked I noticed that three of my team members were friends with this resident. Some of this resident's comments at work suddenly made sense to me....that's where it came from.

As far as I am concerned, it is most definitely not appropriate for caregivers to have an outside relationship (even on facebook) with a patient or resident under their care. I spoke with the director of the facility and she agreed with me. So I spoke with two of the three and both of them said that they agreed to take the resident as a friend and now they regret it. They don't know how to remove the resident as a friend and explain it. I told them to tell the resident that it's not appropriate and that the head nurse asked them to do so. That's the easy part.

The third team member is my assistant head nurse. She's in when I'm off. She is always chatting with the resident on-line and I seriously doubt she will want to stop.

Now the question here is this: am I within my rights as head nurse to tell her to stop and remove the resident from her list of friends?

To SilentMind...I agree that it can be part of helping another human to have contact that is more friendly than just being the job, but it still is unethical, and seen as unethical, by most facilities. I've worked lots of places. Every single place had rules and consequences against personal contact in the Policies manual, up to and including firing, depending on what the contact was.

As to risking a lawsuit or firing....it's nice to be nice, but I don't have thousands and thousands of dollars to risk to go outside my job description...

It just doesn't sit well with me. Are nurses expected to be machines? Are we really just keeping the profession in trust until we can program computers to find the vein?

The wording you used there is interesting too. It said personal contact. Not contact outside of the facility. So nurses should avoid getting too personal even during their shift, and should try to hide their humanity as best as possible so as to not seem inappropriate. And we haven't even touched on physical contact. What kind of world do we live in where giving someones hand a comforting squeeze is considered taboo.

One of the driving reasons I want to become a nurse is because hospitals depress me. I had a close friend that was hospitalized for a few nights, and being there more vulnerable then you've ever been in normal life, completely alone in a strange dark room, lonely and in pain. It's depressing. I stayed with her overnight, but it still had a depressing feel to it. I don't want my patients to have to feel completely alone in between my frequent machine-like rounds.

This is a LTC facility. These residents live here. And a lot of them don't have family around. It's only natural that they make friends with people in their environment. And that includes the staff. In an hospital ER, maybe I can understand not getting too attached to the patients. But if you're working with the same people day in and day out for extended periods of time, its inhuman not to become friends with them.

Specializes in Community Health, Med-Surg, Home Health.

While it can be debatable for some if this is ethical, it can certainly be compromising. Somehow or another, the patient may compromise the staff member. Even this situation that the OP is discussing is part of that compromising position...I mean, the nurses are being approached on their jobs about this.

I think that if you are the head nurse-this means that you also probably supervise this assistant head nurse, therefore, if you were able to speak to your other subordinates about this behavior, I can't really see how she would be exempt from the same.

Specializes in Community Health, Med-Surg, Home Health.
It just doesn't sit well with me. Are nurses expected to be machines? Are we really just keeping the profession in trust until we can program computers to find the vein?

The wording you used there is interesting too. It said personal contact. Not contact outside of the facility. So nurses should avoid getting too personal even during their shift, and should try to hide their humanity as best as possible so as to not seem inappropriate. And we haven't even touched on physical contact. What kind of world do we live in where giving someones hand a comforting squeeze is considered taboo.

One of the driving reasons I want to become a nurse is because hospitals depress me. I had a close friend that was hospitalized for a few nights, and being there more vulnerable then you've ever been in normal life, completely alone in a strange dark room, lonely and in pain. It's depressing. I stayed with her overnight, but it still had a depressing feel to it. I don't want my patients to have to feel completely alone in between my frequent machine-like rounds.

This is a LTC facility. These residents live here. And a lot of them don't have family around. It's only natural that they make friends with people in their environment. And that includes the staff. In an hospital ER, maybe I can understand not getting too attached to the patients. But if you're working with the same people day in and day out for extended periods of time, its inhuman not to become friends with them.

I understand that you have compassion for the patients, but please allow me to say this without sounding insulting; you are a pre-nursing student, and maybe after some experience you may see the reasoning why this is a touchy subject. When a person is in need, they can be very friendly, understanding, etc...but then, if there is a moment that they or their families do not get what they want, they can easily turn on you and compromise your position.

It is okay to show empathy, be friendly, hold a hand, etc... while on duty, but there has to be a limit placed on your personal private time. What if the person emails you and tells you they feel that they are mistreated and want you to intervene NOW? See personal things about you that can then be manipulated to pull your heartstrings?

There are times when nurses have been friends with patients before admission/treating them; there may also be a time when after discharge and coincidently seeing each other in a social setting that can spark further communication as well. Then, there is the blue moon situation where maybe, just maybe, it may be okay...but one must use discernment and thorough evaluation. Personally, I don't advise it...it is more risky. It is one thing to share while on the job, but limits should be placed on private life.

Specializes in psych, addictions, hospice, education.

I would never expect a nurse or other health caregiver to be other than warm and caring. That's within scope of practice surely and the reason most go into nursing, because they ARE warm and caring. It's part of us!

I've seen it backfire though if a person is too warm and caring (who knows where "too" starts). It's a huge thing if the client misinterpets the caregiver. Besides having implications for the caregiver, imagine how the client is feeling--it's not ok to put a client in an uncomfortable situation, even if it is a misinterpretation. So, it's best to remain caring, warm, and keep it at work. Facebook isn't at work. I guess it could be if the staff person is online while at work, but that's a whole other topic.

By personal contact I meant contact outside the role we play in the work we do. Maybe I should have said contact that would be what a friend does compared to what a staff person does. I know there's a fine line between lots of this. It just bears using care. When you are a friend rather than a caregiver (yes, I see the two overlap and should sometimes) you might not see everything as objectively as you would otherwise.

Specializes in Home Care.

I've worked primarily in the corporate world and am now just entering nursing.

I wouldn't add a patient to FaceBook; there are just too many issues that can arise as mentioned above.

In college I took Ethics in Healthcare and we reviewed the Nursing Code of Ethics.

Take a look at the Nursing Code of Ethics under section 2.4 Professional Boundaries.

http://nursingworld.org/ethics/code/protected_nwcoe813.htm#2.4

and also Patient Privacy and Confidentiality.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I will chip in as another voice of an "experienced" nurse. Boundaries are extremely important in nursing. There are certainly good examples of nurses who have cared for a patient in the hospital, during an acute medical intervention, and then established personal relationship later, when the "patient" is no longer in the that professional relationship. I know of a nurse who married a young man who was her former patient on the ortho floor. They ran into each other at a holiday party months later and discovered that they had mutual acquaintances, etc. The minister who performed my wedding ceremony was one of my husband's former burn patients. The key is that in order to maintain professional boundaries, you must avoid developing personal relationships with persons with whom you have a professional relationship. To do otherwise puts the nurse in a very difficult position. We are expected to exclude ourselves from the care of family members or friends. We cannot be expected to make professional, objective assessments and recommendations for care when we are emotionally or personally involved with the patient. In a LTC setting it is already relatively easy to become emotionally attached to our patients. Encouraging and strengthening that personal relationship outside of the confines of work "sets us up" for psychological and emotional ties that may interfere with our professional performance when that patient experiences a change in his/her health. Even if we, as professionals, feel that we can "handle" those type of personal relationships with patients, the patients themselves will not automatically understand the ramifications or dangers associated with these situations. As a result, it is always recommended that we keep our professional relationships professional and seperate from our personal lives.

Yes, Yes and Yes. I have never been one for fraternizing outside of work with patients I take care of (and still do).

It's a different thing to already know the patient outside of the hospital and maintain that friendship, but starting one outside of the professional boundaries just reeks of trouble waiting to happen.

I think you're within your boundaries to do so, it is then left for the nurse to comply or not.

And except a policy is already put in place, I figure, you can't do much to her.Except you make up new rules as you go along.

Specializes in Education, FP, LNC, Forensics, ED, OB.
I've worked primarily in the corporate world and am now just entering nursing.

I wouldn't add a patient to FaceBook; there are just too many issues that can arise as mentioned above.

In college I took Ethics in Healthcare and we reviewed the Nursing Code of Ethics.

Take a look at the Nursing Code of Ethics under section 2.4 Professional Boundaries.

http://nursingworld.org/ethics/code/protected_nwcoe813.htm#2.4

and also Patient Privacy and Confidentiality.

Exactly correct. It is a "Boundary" violation and should be addressed in BON NPA.

I would tell the person that you had defriended the patient and FB and the reasons why you did so. If she chooses not to follow suit then she can suffer the fallout and consequences of her actions by herself. IMHO this would be grounds for termination.

It is a very serious error to mix business and private life, I have just never seen it end well. The two must be kept separate and I believe this person may find this out the hard way. If I was interviewing and found out this nurse had residents as FB friends it would not make me want to hire her.

is it possible that these two persons knew each other prior to the patient/nurse relationship??

op, yes, do speak with your asst and share your concerns.

then, as advised, document thoroughly.

i'm with those who say it is inappropriate.

to all the pre and current nsg students, take a peek at your nurse practice act and specifically, professional conduct.

we have boundaries for a reason.

this in no way, means you cannot be "compassionate" or "human".

and there are situations where these lines can and do, become blurred.

it is during these times that you need to confer w/a mentor or other (trusted) colleague.

i've made the mistake before, and it came back to bite me.

you just never know what can happen, or how a pt can start becoming needy, dependent, even demanding.

while the BON isn't really our friend, i do understand their 'laws' and appreciate that we are expected to adhere to them.

wishing you the very best.

leslie

Specializes in NICU.

No one has said why it's bad to do this sort of thing, just that it's unethical and crosses boundaries. Can anyone give any specific reasons why this is bad?

I still don't see how what you do outside the workplace is any of the hospital's business as long as you don't treat patients differently in the hospital and don't violate HIPAA.

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