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.

[Esme12, ASN, BSN, RN]

You all assume the OP has such a lack of judgement that she cannot figure out who would welcome the gesture. If sent addressed to the person in a sealed envelope there is no HIPPO;) violation. She has her managements support and permission.

Seriously, I know many have been burned by a lot of things in acute care, but I do not feel she is taking some horrible risk of getting into trouble or burned. Also, an acknowledgement in these circumstances is not crossing the lines into inappropriate boundry territory.

I know that some people would send them inappropriately, cross boundries, pick the wrong person, but the OP does not sound as though she would have that issue.

No lack of judgement. Lack of information. She says she has the "written consent" of her bosses at this particular facility.....she should be fine.....however I would ask for it in writing more formal than a e-mail and that still won't protect her if something ever happens.

Different parts of the country might view this differently and if she ever works else where they might find it grounds for dismissal.

These are truly words of wisdom meant with the best of intentions.

[CrunchRN, ADN, RN]

I believe your intentions are good Esme. I just disagree with you on this particular subject. Which is rare for me as i usually agree with you on most things. Then again, maybe the rules were different because i worked outpatient verses inpatient.

I just do not want to see the lovely compassionate part of the OP beaten out of her by the overwhelming majority of negativish (yes, I know that is not a word!) posts in response to her original one.

[BiohazardBetty]

No lack of judgement. Lack of information. She says she has the "written consent" of her bosses at this particular facility.....she should be fine.....however I would ask for it in writing more formal than a e-mail and that still won't protect her if something ever happens.

Different parts of the country might view this differently and if she ever works else where they might find it grounds for dismissal.

These are truly words of wisdom meant with the best of intentions.

Company email = legally binding... I've confirmed this with both an outside attorney & the hospital attorney.

I know y'all have good intentions & I appreciate that!

[JustBeachyNurse, LPN]

Since the other background information and warning has been definitely reiterated in this thread, I think my issue would be the "thank you for being my patient" rather than a "thinking of you/hope all is well". Thanks implies that they gave you something to be thankful for (other than job security). Thank you for being my patient implies a choice (such as thank you for choosing Bob's Discount Appliance for all your entertainment needs) and would be expected on the facility level. We all know how facilities like to push customer service and survey rankings.

A thinking of you/hope all is well generic note might be a better "name" for your communication.

I think some of the responses are in reaction to your reaction to the thread title of "thank you notes to patients" which implies thanking them for getting sick and choosing your facility, generally not a topic even considered by healthcare staff (hospital administrators maybe but not direct care staff).

No one here is qualified to state whether an email from a supervisor is legally binding, but you stated you consulted with the hospital attorney and an outside attorney as well...remember rules change, policies change and all it takes is one complaint. It seems that you are now well aware of the worst case scenarios that may occur...and will keep that in mind so that the blurry lines of patient contact outside the formal relationship of the nurse-patient in the hospital are not crossed.

[carolinapooh, BSN, RN]

I just do not want to see the lovely compassionate part of the OP beaten out of her by the overwhelming majority of negativish (yes, I know that is not a word!) posts in response to her original one.

And this isn't what we're doing - at least, I don't think we are. We're not negative about the intent behind the action; we've only asked her to consider that she could be setting herself up for serious trouble. I have no problems with the intent nor the sentiment behind the action; it's what could result from the action that could cause the OP serious issues. Some of us have seen good intentions get railroaded - and the person taken with it, generally to their detriment.

We take no umbrage with the intent nor the compassion behind it.

[CrunchRN, ADN, RN]

carolinapooh,

I do get that. Good intentions and not wanting the OP to get burned. From most, but a few old crusty types.:***:

[wooh, BSN, RN]

You all assume the OP has such a lack of judgement that she cannot figure out who would welcome the gesture. If sent addressed to the person in a sealed envelope there is no HIPPO;) violation. She has her managements support and permission.

...

I know that some people would send them inappropriately, cross boundries, pick the wrong person, but the OP does not sound as though she would have that issue.

Management's support and permission, UNTIL there's a complaint. At which point, however "legally binding" that email is, all it takes is a subsequent change in policy or a manager saying, "But we told her not to after later judgment," and that "legally binding" email means NOTHING.

I just do not want to see the lovely compassionate part of the OP beaten out of her by the overwhelming majority of negativish (yes, I know that is not a word!) posts in response to her original one.

Getting fired for her well meaning actions because of one complaint is going to be a lot more of a beating to her compassion than some posts telling her she may want to find a different outlet to express her compassion.

Company email = legally binding... I've confirmed this with both an outside attorney & the hospital attorney.

"Legally binding" until that understanding that you have is revoked via an oral conversation that will be your word against management. If management is in hot water, who is going under the bus?

No one here is qualified to state whether an email from a supervisor is legally binding, but you stated you consulted with the hospital attorney and an outside attorney as well...remember rules change, policies change and all it takes is one complaint. It seems that you are now well aware of the worst case scenarios that may occur...and will keep that in mind so that the blurry lines of patient contact outside the formal relationship of the nurse-patient in the hospital are not crossed.

Quoted because it's important.

We can't give legal advice here. But common sense says, "When in doubt, don't."

OP is going to do what OP wants to do. Hopefully others coming upon this will think twice. Hopefully anyone that chooses to partake in this practice won't face a worst case scenario, but if it happens, they can't say they weren't warned.

[jadelpn, LPN, EMT-B]

Company email = legally binding... I've confirmed this with both an outside attorney & the hospital attorney.

I know y'all have good intentions & I appreciate that!

Well, something that someone said must have struck a chord if you consulted with attornies, so good that you did that.

With that being said, there are so many more important parts of your practice than you peseverating on the note writing. There are more cons than pros it seems.

Certainly not trying to "sqaush your compassion" but remember, work is work, and friends and outside interests are different. You are seemingly a successful nurse with a career you love, You do not need to drive the point home by sending personal notes.

And make sure you read your privacy policy. And that you are aware of the rules and policies regarding the accessing of people's personal information for a personal note. As it stands now, what is your "need to know" their home address?

Your intent is what you need to look at, as well as the potential risk to you, your license, and your patient's privacy.

Would it not make more sense to just write a little line of "thinking of you" above your name in the group card?

One final thought--patients who receive personal notes from nurses that are more specific in nature lends itself to a relationship that is beyond patient/nurse. The expectation could be that they could expect some extraordinary and more personal care when they return. That is not always feasible in an inpatient setting.

Find another outlet. One of the nicest things that you could do is to say a few words of kindness when you are doing discharge teaching "you have worked so hard, and I wish you nothing but the best". Heartfelt, true, and said face to face. Then you have to let your patients go and live their lives until they come back again.

[BiohazardBetty]

Well, something that someone said must have struck a chord if you consulted with attornies, so good that you did that.

With that being said, there are so many more important parts of your practice than you peseverating on the note writing. There are more cons than pros it seems.

Certainly not trying to "sqaush your compassion" but remember, work is work, and friends and outside interests are different. You are seemingly a successful nurse with a career you love, You do not need to drive the point home by sending personal notes.

And make sure you read your privacy policy. And that you are aware of the rules and policies regarding the accessing of people's personal information for a personal note. As it stands now, what is your "need to know" their home address?

Your intent is what you need to look at, as well as the potential risk to you, your license, and your patient's privacy.

Would it not make more sense to just write a little line of "thinking of you" above your name in the group card?

One final thought--patients who receive personal notes from nurses that are more specific in nature lends itself to a relationship that is beyond patient/nurse. The expectation could be that they could expect some extraordinary and more personal care when they return. That is not always feasible in an inpatient setting.

Find another outlet. One of the nicest things that you could do is to say a few words of kindness when you are doing discharge teaching "you have worked so hard, and I wish you nothing but the best". Heartfelt, true, and said face to face. Then you have to let your patients go and live their lives until they come back again.

Not really. I was just curious because my dad, who was an attorney before he died from cancer almost 2 years ago, had tried a case where emails from one employee to another were a deciding factor in the case because it was ruled in a previous case (in Missouri or Montana or somewhere) that emails were considered binding written agreements. So I contacted a couple of my dads friends, one who happens to be the hospitals current attorney to see if that was still true.

I appreciate everyones opinions about the boundaries I should observe with my patients. I get that y'all think its a bad idea & I respect that.

[dishes, BSN, RN]

Your BON are in a better position to give you the meaningful advice, as sending personal cards to patients homes after discharge is more of a nursing ethics and professional boundaries matter then it is a legal matter.

[BiohazardBetty]

Your BON are in a better position to give you the meaningful advice as sending personal cards to patients homes after discharge is more of a nursing ethics and professional boundaries matter then it is a legal matter.[/quote']

I don't think it's either, but it doesn't matter anyway cause y'all sucked all the fun out of writing them about 6 pages ago :) Funny how that works.

[nursel56]

You are under no obligation to reply or return to the thread and you can ask the Administrators to close it if you feel anonymous opinions on this message board are affecting your outlook regarding other aspects of your life.

As someone else alluded to these threads take on a life of their own sometimes. The fact that this turned into a hot button means that there is interest out there and other readers may benefit from our thoughts on the subject.

Although at times it seems personal, it really isn't. You've been very polite and civil.