Thank You Notes to Patients?

[BiohazardBetty]

Hey y'all!

Do any of you hand write thank you notes? If you do, what do you say? My facility sends pre-printed notes that all of us sign, but for the last month or so I've started sending a relatively generic hand-written note to all of my patients who are discharged home... I work on an oncology unit, so many of our families receive sympathy cards instead. With that said, what is or is not appropriate to say in a thank you note?

Here's what I typically say in my thank you notes:

"I wanted to tell you how much I enjoyed being your nurse during your stay on 12 East. You were a great patient and I'm so happy you're feeling better.

I hope you keep getting stronger every day!"

Lots of times I personalize the note with something I've learned about the patient or their family... and if I truly did not enjoy being their nurse or if they were NOT a very good patient (rude/demanding) I leave those parts out or replace them with something different.

What do you think?? I always use hospital stationary and never take patient info away from the hospital, so no HIPAA violations.

[BiohazardBetty]

This is all such good advice... y'all are bringing up so many points I never even considered. I'm glad I asked for your guidance, even though the thread went in a totally unanticipated direction!

[KelRN215, BSN, RN]

I don't think it is a good idea at all. Our hospital does "call backs," hoping to improve our satisfaction scores, but that is as far as it goes. The only time we would send a card is in the event that an infant or child dies, on the one-year anniversary date of the death, and then we all sign it.

I agree. When I worked in the hospital the only time cards were sent to patients' families were when the patient died. These were generic cards that were sent to the families of all patients who died. It would have been frowned upon for an individual nurse to send his/her own card.

As a patient, I'd feel very awkward if I received a card from a provider. It would feel like a customer service thing... "we know you have a choice when flying (choosing a hospital) and we thank you for choosing us."

[BiohazardBetty]

Of course my intention was NEVER to "invade" a patient's home, but I'm SURE I would feel invaded if I had received a "one-year anniversary" card after I lost my child like applewhitern mentioned, so I COMPLETELY see where you are coming from. It's all about perspective.

Do you think the same principal applies with discharge phone calls and the generic cards signed by all of the staff on the floor? Especially if they are called on their home phone and the hospital's thank you note is mailed to their home address...? It doesn't sound like it's the content of the card/call, but the fact that they are contacted.

That someone would access my information, NOT for a legitimate reason of improving my health or even for billing/insurance problems, but to invade my home, which is how some would see such a note, as an invasion... That takes them back to the vulnerable state they were in. And who wants that?

[NicuGal, MSN, RN]

We have to have permission to contact patients after discharge. Has to do with professional boundaries. Once your care is done and they have been discharged, you should not be accessing personal info unless it is for follow up or only if the patient has given you say their email, etc.

[KelRN215, BSN, RN]

Of course my intention was NEVER to "invade" a patient's home, but I'm SURE I would feel invaded if I had received a "one-year anniversary" card after I lost my child like applewhitern mentioned, so I COMPLETELY see where you are coming from. It's all about perspective.

Do you think the same principal applies with discharge phone calls and the generic cards signed by all of the staff on the floor? Especially if they are called on their home phone and the hospital's thank you note is mailed to their home address...? It doesn't sound like it's the content of the card/call, but the fact that they are contacted.

I wouldn't be so sure about that. I've never heard a bereaved parent say such a thing. They know it is the anniversary of their child's death and they usually appreciate that someone acknowledges it and remembers that their child lived. Many bereaved parents love hearing their children's names and many people who know nothing about pediatric illness/childhood death will refuse to mention the child's name out of fear of upsetting the parent. (I have been working with bereaved families for 9 years.) Many of these parents will tell you that it upsets them MORE when people pretend that their child never was.

Discharge phone calls are not really in the same boat as what you are talking about. A follow-up call saying "do you have any questions? Were you able to get all your meds filled?" etc is directly related to the patient's health. I have never seen a hospital "thank you" note signed by staff on the floor. That's just weird.

[BiohazardBetty]

I have personally lost a child and feel like it would upset us a lot to have received a sympathy card on the anniversary of his death... but then again, it looks like I'm very different than a lot of people here from the start :)

After a search on this site, it looks like many facilities send thank you notes signed by staff on the floor.

I address the envelope while they are still my patient and send the whole thing down with the chart to be broken down when the pt is discharged... no accessing anything after my care is done. I talked with my nurse manager and our DON this evening regarding this and they agreed that what I am doing is both professional and within my limits as a nurse, especially considering my patient population. My nurse manager even said she had just received an email this morning from a patient saying how much he enjoyed getting my note :)

I will continue to use my professional judgement regarding who I send notes to, keeping in mind all of the excellent advice I've received here. Hopefully I will continue to get advice related to my original post regarding specific things nurses who choose to write notes may say.

I wouldn't be so sure about that. I've never heard a bereaved parent say such a thing. They know it is the anniversary of their child's death and they usually appreciate that someone acknowledges it and remembers that their child lived. Many bereaved parents love hearing their children's names and many people who know nothing about pediatric illness/childhood death will refuse to mention the child's name out of fear of upsetting the parent. (I have been working with bereaved families for 9 years.) Many of these parents will tell you that it upsets them MORE when people pretend that their child never was.

Discharge phone calls are not really in the same boat as what you are talking about. A follow-up call saying "do you have any questions? Were you able to get all your meds filled?" etc is directly related to the patient's health. I have never seen a hospital "thank you" note signed by staff on the floor. That's just weird.

[ekev12]

I'm about to work abroad before the year ends. I think it's a good idea to make something special like that for our patients. :)

[carolinapooh, BSN, RN]

Please keep in mind I'm not talking about ER patients or even typical med/surg patients... I'm talking about usually terminal cancer patients.

I've been in oncology six years. I've been in BMT four years.

There is no way I would do this.

IMHO, this is crossing a line, and once you do that, you can open yourself up to all sorts of stuff that you want nothing to do with. Yes we see our patients A LOT - and sometimes our transplant patients come in and never leave again. I've been to a couple of funerals of people I really felt close to out of respect for the family and especially the patient, but I didn't send thank you notes. Sometimes I see them in the hall or at Target or if I'm down in the clinic, and invariably we strike up a conversation, and I've posted comments on some folks' FB page after they'd passed away (I'm even a FB friend with a patient documenting his transplant journey, but only because he's made his story very public). If our folks end up in the unit, sometimes we'll walk down there just to check in, let them know they're still 'ours', that we're thinking about them. But I don't do that for everyone and I don't go out of my way, I must admit. I do go down there if I was the RN who transferred them; that's the only time I feel obligated to go (I mean, I was the last face they saw; I was the last contact with the family - ICUs are scary as hell and I think a familiar face is comforting).

But that's the limit. They know I care - I care very, very much about all of them - but I'm their RN, and IMHO, there's a line we don't cross.

If I got a 'thank you' card from my own RN, I'd think either it was a bit creepy or hospital leadership put her up to it. I still can't wrap my head around the term 'thank you' card. What's to thank? I think 'personal note' would be a better way to term this, because there isn't a darned thing you can literally thank them for (well, that you could get away with: I have plenty of folks I'd like to thank for not being outrageous and treating me like a hotel maid, but that's beside the point).

I'm glad you've gotten positive responses, but I think you're setting a precedent. What about the days when you discharge five patients and admit five new ones? I've gone in for report in my pre-transplant days where I handed off five and got five new ones the next day because the unit had almost 100% turned over. What if it gets in the way? What if you send one to Sally Sue this time, and the next time, and the third time, and then not the fourth for whatever reason? Is Sally Sue going to think she'd done something wrong? What if Sally Sue approaches you and asks was she a bad person because she didn't get your typical note?

I think your heart is in the right place, don't get me wrong. But there may be ramifications that you nor your leadership has considered.

[jadelpn, LPN, EMT-B]

It really is a lovely gesture, however, I would much rather put a little note "Thinking of you!! helloberry, RN" on the note that the hospital sends out to begin with. Keeping other contact, which is such a nice thought, is crossing over a line that may or may not be appreciated. And it will just take that one patient, who perhaps wants to go back to their "real life" after a long hospitalization and terminal diagnosis, that would not appreciate the gesture--and can complain that you are accessing their information when you shouldn't be.

Be mindful of the specifics that your privacy policy, that all patients in most facilities receive a copy of. It may unknowingly be a violation of that policy.

Because you have verbal permission from your managers is all fine well and good until a patient complains. And it would seem that the most unlikely patients are sometimes the ones that would. No matter how well you believe to "know" a patient, sometimes in "real life" things are vastly different. Even if it is that a former patient wants to put out of their mind their stay in the hospital until it happens again.

The bottom line for me would be--what is the goal of the card? That you are a nice person? That you are a good nurse? Because becoming that attached to a patient in a personal way is a good road to burn out. And again, I think it is a lovely gesture, just not one that I would be confident would have a leg to stand on when one of your patients (even in the progression of their disease) takes offense to receiving a personal card.

[CharlieTaco]

I like to keep thank you notes short and to the point for example: Thank you for pooping in the bed or please come back soon we miss you. Things like that.

[Esme12, ASN, BSN, RN]

I have personally lost a child and feel like it would upset us a lot to have received a sympathy card on the anniversary of his death... but then again, it looks like I'm very different than a lot of people here from the start :)

After a search on this site, it looks like many facilities send thank you notes signed by staff on the floor.

I address the envelope while they are still my patient and send the whole thing down with the chart to be broken down when the pt is discharged... no accessing anything after my care is done. I talked with my nurse manager and our DON this evening regarding this and they agreed that what I am doing is both professional and within my limits as a nurse, especially considering my patient population. My nurse manager even said she had just received an email this morning from a patient saying how much he enjoyed getting my note :)

I will continue to use my professional judgement regarding who I send notes to, keeping in mind all of the excellent advice I've received here. Hopefully I will continue to get advice related to my original post regarding specific things nurses who choose to write notes may say.

I would not do this without hospital sanction......all it is going to take is one person to feel their personal private space was violated by you using the information gained by being their nurse for personal gain or on your "personal time" (because it isn't a hospital sponsored/sanctioned activity...)and it can be construed as a HIPAA violation for using private patient information for personal use.......its a very fine line. Whether you gain that information "before the chart leaves the floor" has no bearing on whether this is proper use of protected healthcare personal information.

While you may feel these occur regularity.....in reality they do not. The "follow up" post discharge phone calls are hospital sanctioned and are in regards to patient needs, questions, condition, satisfaction to ensure they get past the time limit to avoid readmission.

While I have "kept track" of a few patients over 35 years.....I have never contacted any at home. I have, on occasion, sent condolence cards...but only after their address/information was published in the obituary.

I think your heart is in the right place. I also think this will wear thin for over time you will need to develop a barrier between you and your patients ot this kind of emotional investment will take it's toll. I have ALWAYS cared for my patients as if they were my family...but there is a line you will eventually have to draw in order to survive.

Be aware that while this facility says it's ok now......if a patient complains and they (the hospital) realizes they are going to get in trouble...... you will be shocked on how quick you will be tossed under the bus......new regulations are going to allow for individuals to be fined for HIPAA...trust me you kind gestures will be an example for disciplinary actions. I wish I was wrong.....and I might be. Be sure you have malpractice insurance for HIPAA is going to be the next lawsuit craze.

Your efforts are admirable.....but I would go forward with caution. Good Luck!

[TheCommuter, BSN, RN]

We do not write personal thank-you notes to patients at my workplace, but management is throwing the idea around that we start doing this. They think it will boost the patient satisfaction scores.