The Fine Line

As part of our job, nurses can develop relationships with patient's and their families through the daily contact we have caring for them. Sometimes, the professional relationship line can get a little blurry, and it is hard to keep boundaries in place - friendships can be made. I have sometimes faced this dilemma - and I am glad for my decisions.

Published

The fine line between being a professional with compassion and empathy with CLEAR boundaries versus being, well - me, runs a bit blurry. I remember this being pounded into my brain in nursing school - and I have never really learned the lesson. Sometimes it wears me thin, and at other times, I am glad that I chose to give a little extra.

I have many friends from work and when I talk to them, I know I am not alone in my feelings. I wonder if the reason we sometimes get more attached is because we work with children. I have never worked in a hospital setting with adults, so I have no foundation for my thoughts, and I have no reason to believe that this is actually true. Yet, I still wonder.

I admitted my infant patient into the PICU from a simple procedure - a heart cath. However, the news that the parents received from the cardiologist was not good, and the baby would be going into surgery the next day. I explained what the cardiologist said many times throughout the day. When you are hit with a bomb, sometimes things don't make sense. I see this over and over - you have to explain things to parents many times for them to understand, especially if the illness was not expected.

The morning of the surgery, the parents were anxious. Mom and dad held their precious baby throughout the night, rarely putting her down. Strong in their faith, I asked them if they wanted me to pray with them in case the chaplain they asked for did not arrive before the baby was taken to OR. They did, so I did.

I cared for their precious one many times, over several admissions into the PICU. I became close to the parents - and they trusted me with every aspect of care for their baby. The family moved to a new town, and one day, I got a text message from the mother saying they lost the battle, and the baby passed away, the funeral would be nearby, and could I come? Of course, I would.

Another child was admitted into our care for an illness that eventually left her without any brain activity. Over the days and weeks we spent fighting for her life, it was hard to get through to her mother, who seemed very aloof. One day as I was talking to the mother about withdrawing life support, she finally let me in to her private world. We talked about the life her daughter had lived, and who she was. Mom sent photos of her daughter from her phone to my work email, and I printed out the photos to hang in the room. Mom opened up about many details, including the fact that her daughter loved to straighten her hair and paint her nails. On the day the mother chose to withdraw life support, I brought a hair straightener to work, and another nurse brought pink fingernail polish. Mom painted her daughters nails, and I straightened her hair. She looked more like "her old self", mom said. And mom hugged me and wept. When we withdrew support, my lovely patient was surrounded by her friends and family. I received an email from the mother several weeks later, telling me thank you.

A beautiful baby was in our care for months. His parents were very young, and the entire staff became attached to the young mother, who was there the majority of the time, and our patient. She doted over her son, and she had to make some very grown up decisions for the plan of care presented to her. The parents never wanted to give up fighting for their son. I talked to the mom for hours over the course of her baby's stay with us. I learned her hopes and dreams, her fears, her plans. I listened - as did the other providers - and we supported. We admired her tenacity and hope. In the end, the parents both realized their precious baby was suffering immensely, and decided to withdraw support. The bravery they showed and love of their child more than their own desires to keep him alive another painful day was nothing short of courageous. The young mother still keeps in contact with me, and I know she is now expecting another baby.

I have cried more tears being a nurse than in almost any other aspect of my life put together. It pains me to see parents cry, a child die, and to fight and not win. I doubt I will ever learn the lesson or clearly define that fine, blurry line. I'm not sure I will ever want to.

Julie Reyes, DNP, RN

44 Articles   260 Posts

Share this post


Farawyn

12,646 Posts

Has 25 years experience.

I've always been "afraid" to work with kids. I thought I couldn't bear it, that I didn't want to get that close. But of course I have gotten close with my older patients, too.

No, it's not just working with children. Some patients and families just touch your heart, from age 0-100.

Julie Reyes, DNP, RN

44 Articles; 260 Posts

Specializes in pediatrics, occupational health. Has 6 years experience.
I've always been "afraid" to work with kids. I thought I couldn't bear it, that I didn't want to get that close. But of course I have gotten close with my older patients, too.

No, it's not just working with children. Some patients and families just touch your heart, from age 0-100.

I LOVE that! Thank you for sharing! I really do love talking to older people, and I am sure that if I had the opportunity to work in geriatrics, I would have been very happy. I just never had the opportunity. I love how we are made to have different callings, but all in the same field of nursing!

dudette10, MSN, RN

1 Article; 3,530 Posts

Specializes in Med/Surg, Academics. Has 12 years experience.

I have always wanted to work with kids, but I never had the opportunity to do so. I'm a little jealous.

The story I want to share is one where I did draw emotional boundaries, and it affected my patient in a way I never could have anticipated. I had a cancer patient for two shifts in a row. She was very anxious, very scared, and her prognosis wasn't good. I spent a lot of time listening to her, comforting her appropriately.

About two weeks later, I was working a unit that share the same floor as the Cancer Center and infusion room. Her husband came to the nurses' station where I was charting and told me she was in the waiting room for the Center. I was very busy that day, but I stood up, poked my head out, and waved at her with a smile, then went about my business. I noticed that she was in the Center for about six hours, which I found very unusual. But, when I thought about it, it made sense given her personality. Cancer had become her life, and she feared being away from the medical environment. She felt safe there.

As my shift drew to a close, she was still there, and she saw me leaving. She called me over and said, "It really hurt my feelings that you didn't come talk to me." I apologized (for nothing, really, just to let her know I acknowledged her hurt), and told her that I was busy with my patients that day. To attempt to smooth things over for her, I asked about her day. She was waiting all day in the waiting room for the results of a CT, which she didn't really have to wait for there. Her waiting at the hospital was indicative of her personality when it came to her care. I said goodbye and walked away, but I had the impression that she was still angry with me.

I do care genuinely about my patients, but there is a line I have to draw for my own sake. I take pride in the level of care I give, and I am satisfied when my care comforts a patient and their family. But, I am an introvert, and the care I give for 36-48 hours a week drains me. Although it was natural for her to feel a connection with me because I sat to listen to her, and I understood her misunderstanding of my compassion, I still walked away feeling like her expectations of me as a person was too far.

I don't mean to derail your thread about connections, but I don't think it is inappropriate for me to include a different take on connecting with patients.

Julie Reyes, DNP, RN

44 Articles; 260 Posts

Specializes in pediatrics, occupational health. Has 6 years experience.

I don't mean to derail your thread about connections, but I don't think it is inappropriate for me to include a different take on connecting with patients.

I appreciate your view! I don't connect with every patient I care for either, and it is just reality! I loved your story! Thank you for sharing!

Specializes in Med nurse in med-surg., float, HH, and PDN. Has 43 years experience.

I have also been 'afraid' to work with kids, too, but for a different reason. I was bullied as a child by other children; so, I didn't 'like' or trust or understand kids. I have a maternal instinct for animals and old folks. But kids?....I just don't 'get' them, especially sick ones. Having never had children myself, I have a hard time 'reading' them. Now, give me a crabby old person and I'm in my mileau! Isn't it great that it takes all kinds of people to make the world go 'round?

Thimbalina

119 Posts

I felt afraid of children for similar reasons until after I had my own. i've been a pediatric nurse ever since. You would probably be great because most children experience bullying at some time in their childhood and are fearful, even bullies. You are probably sensitive and kind so would be very good with children if you ever tried it for any length of time. (imo) But this is an aside...

I know a couple of nurses that were fired for accepting a friend request from a family on Facebook. So be careful not to cross that line. Another nurse got fired for coming in on her day off when a child was dying. She fought it and won but never came back. BE CAREFUL. Having them contact you on your business email is the best idea.

CHAVNY

26 Posts

This is such an interesting topic to me. Working in the NICU, I found it impossible to not love my patients. How can I not be moved at my very core by the the tiny little person who fits in my palm but has more fight than any great warrior, real or imagined. Who's constantly having to connect touch with pain---if not agony---but still reaches that tiny hand or foot to just touch you. These little people, who against the worst of odds, show more bravery than any gallant man or woman I know. They are amazing and I do not want them to be in that walled little pod and feel alone. But I love them as their nurse. And I believe that love is it's own kind of love. I put their health first, I do what needs to be done, and I take up their fight with all I've got to give. I reward their bravery with my vigilance watching for cues of their condition and needs. I make a point to let them hold my finger or curl their tiny toes around it, so they can know sometimes touch is nice. It won't always hurt. They don't know they're sick, they don't know it's supposed to be ever so different, this is their life and they make the most of it. They have been cheated out of so much, I will not cheat them out of the caring that I have to give --as their nurse. I know it may never happen, but nothing will make me happier than the day they go home to be with their family, and I know I'm not family. But I was: their nurse. And for these littles that has it's place in their lives, too.

Julie Reyes, DNP, RN

44 Articles; 260 Posts

Specializes in pediatrics, occupational health. Has 6 years experience.
This is such an interesting topic to me. Working in the NICU, I found it impossible to not love my patients. How can I not be moved at my very core by the the tiny little person who fits in my palm but has more fight than any great warrior, real or imagined. Who's constantly having to connect touch with pain---if not agony---but still reaches that tiny hand or foot to just touch you. These little people, who against the worst of odds, show more bravery than any gallant man or woman I know. They are amazing and I do not want them to be in that walled little pod and feel alone. But I love them as their nurse. And I believe that love is it's own kind of love. I put their health first, I do what needs to be done, and I take up their fight with all I've got to give. I reward their bravery with my vigilance watching for cues of their condition and needs. I make a point to let them hold my finger or curl their tiny toes around it, so they can know sometimes touch is nice. It won't always hurt. They don't know they're sick, they don't know it's supposed to be ever so different, this is their life and they make the most of it. They have been cheated out of so much, I will not cheat them out of the caring that I have to give --as their nurse. I know it may never happen, but nothing will make me happier than the day they go home to be with their family, and I know I'm not family. But I was: their nurse. And for these littles that has it's place in their lives, too.

Oh, I love your heart! I would want you to be the nurse for any newborn I know!