The official guidelines for patient/caregiver relationships?

[tariqblaze]

I know there are a few threads on dating patients. I have a few questions that go a little deeper than just dating but all relationships, whether they are intimate or non-intimate. What are the boundaries?

In many of the threads I have read, most of the replies are personal opinions of the posters but few actually tell what the law says or what most facilities codes are on these issues. Some facilities have policies on this but are limited to a few issues but there are other issues to consider. I know it is probably safer to avoid any form of personal relationship with a patient, but just for reference, what are the official codes to these relationships?

And when answering, please give the answer from both the official policy or code perspective, and from also what is just generally socially accepted or what the unwritten rules are about said practice. Sometimes one is there but the other isnt and vice versa.

On duty friendships with patients

====================================

---Personal conversations while giving care---

I think everyone is taught that this is not recommended. Telling too much information about yourself to patients or getting too personal or talking about religion etc is not recommended. However I have never read anything about this being company policy. Socially it may not be accepted but could situations vary?

---Flirting---

I guess this is to be judged individually. What some consider flirting, others consider friendly nature. Another tricky line.

Off duty friendships with patients

===================================

--Visiting patients---

Making personal relationships with patients which include visiting on duty but when not giving direct care of the patient or off duty, on breaks, etc. What are the guidelines to this? Is patient/caregiver only restricted to the care they are receiving directly and after care is given, all other interactions are prohibited? Facility policy or social standard?

---Communication with patients--

This includes getting or giving/exchanging personal numbers, emails etc. If taking a patients room number is not accepted, what about their cell, or their emails.

If none is allowed, what about giving the patient your number, email, business card, social networking site name, etc and letting them contact you?

Friendships with ex-patients

================================

---Personal relationship with ex-patient---

If the care relationship is terminated, when is it acceptable to pursue personal relationships/friendships? How long/what setting/what course of action can be taken?

Intimate relationships with ex-patients

=====================================

An intimate relationship should obviously never be pursued with a patient. But how much time should pass after a care relationship is terminated before an intimate relationship is established?

Do situations/types of patients vary?

========================================

If there are no strict guidelines to all of this do situations vary? Not every patient is the same. Some come in for only minor issues, are there for a few days and never return. Others are terminally ill. Obviously both situations vary so professional discretion should be used for both. If sound professional judgement is used what is the issue?

---What if the patient is the one that initiates all personal boundaries?

---What if you are sure both you and the patient know you two were made for each other, the love of each others lives for eternity. Still you gotta walk away forever? Professional discretion can be applied no? Some situations have to vary right?

I know policies and social standards differ from facility to state. Just wanted a general idea of what is accepted for most places.

Like I said, it is probably best to avoid all of the above just for safety issues, but for sake of discussion, action without comprehension never brings complete understanding. Learning complete truth about actions brings knowledge, which plants the seeds to complete understanding as to why certain things are the way they are.

[jadelpn, LPN, EMT-B]

The wording may be different for any facility, however, clearly the policies of a facility state in lots of fancy or not so fancy words that as nurses, we need to have professional boundries, Which means that one doesn't seek outside relationships of any kind with their patients.

If one is becoming a nurse for the sake of making friends, getting dates, or for work outside of the facility (ie: private duty) it is a conflict of interest.

Most BON websites have language regarding conduct of licensed nurses. Again, wording may be slightly different, however, it is not in a nurse's best interest to have their conduct questioned.

And as far a dating patients--it has and could be considered sexual harrassment should a nurse pursue a patient in a romantic way.

All in all, just not a professional standard to adhere to.

https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

[tariqblaze]

Who makes the universal laws on the issue though?

Whos word do we follow?

For example the General Media Council actually did the opposite and stated it is up to the caregivers discretion and no real time limit is imposed.

Green light for doctors to date former patients so long as they use their 'professional judgement' to decide if it is appropriate | Mail Online

[tariqblaze]

Reading that boucheur from the ncsbn it says,

"There are no definite

lines separating the zone of helpfulness from the

ends of the continuum; instead, it is a gradual

transition or melding.

This continuum provides a frame of reference to

assist nurses in evaluating their own and their

colleagues’ professional-patient interactions. For

a given situation, the facts should be reviewed to

determine whether or not the nurse was aware that

a boundary crossing occurred and for what reason.

This is kind of what my last point was. Every situation needs to be evaluated individually. A patient who is misdiagnosed even and doesnt even need treatment and will probably be gone by tomorrow is a much different situation than a patient who is terminally ill for years. It would seem excessive to tell a caregiver interaction with this patient is not valid until 2 years later. I dont think there are any real guidelines. Except for maybe when it is clear a real violation has occurred like the intimate relationships. Other than that, according to those fancy words you speak of, every situation is different.

[jadelpn, LPN, EMT-B]

You can only speak to yourself, OP, and what it is that you are willing to do or not do that you personally feel is appropriate. Most facilities the policies are clear.

Your character and ethics as a nurse is what people remember and respect. What you do in your personal life is your business, however, deciding that Dr. Such and So is your soulmate while ya'll are working is probably not the best idea. Ever.

As I have stated many times in other threads, if you are unsure whether you are going to be helpful to a patient beyond a professional relationship, then there are loads of people to help. Like social work, palliative care, etc etc. You can be a compassionate listener and actively involved in the care of a patient without become personally meshed up in conflict, family dynamics, and the like. If it feels like you are crossing the line, then chances are you are correct. But you should know who you could go to that is equipped to help the patient with their concerns.