Unethical?

dishes, BSN, RN · May 22, 2016

I became aware via facebook posts of "in a relationship with" and other very obvious posts there was/ is in fact a relationship. I'm saddened to say that several other coworkers knew before I (via facebook) and told me that I would "get over it in a few days". I went home and slept on it and discussed it with a trusted person in my life. I did contact my manager because in fact I can't "get over it".

Seems your colleagues are blase about boundary violations, hope your manager has the acumen to deal with this.

Mandychelle79, ASN, RN · May 22, 2016

Is the OP in PA?

I do not know I responding to the post regarding the three (my error it's only two) year stipulation regarding professional relationships because a previous poster said about not being aware of a time frame. I'm in Pa so I did remember seeing it for the BON and I'm sure others have similar rules

RebecaRN · May 22, 2016

I'm not in PA. I'm from Indiana. :)

jadelpn, LPN, EMT-B · May 23, 2016

I am curious what kind of feedback you got from your manager, OP.

That your co-workers were so "eh, whatever" about it is troubling, for sure. And I get that personal and work are 2 different things, but to put it out there in social media after people who have access to same know that you just had this person as a patient is significantly pathological. And just creepy and weird.

Some people are into personal relationships where they need to feel they are superior and crave "saving" people 24/7/365 and are all into the perpetual tortured souls. For some people, it is the mental illness and not the person they find "hot". That this person is a nurse is scary. And pretty brazen. Usually, if one starts dating a patient after discharge they keep it on the down low for a bit-as to not get into trouble.

The other side of this coin is also that some people with mental illness (ie: sociopaths, for instance) that have a hypnotizing charm about them, hence why they can devastate lives and still make it seem as if it was all your idea.

I am afraid for this nurse.

TheCommuter, BSN, RN · May 23, 2016

Is it unethical to date a recent patient?

Dating a recent patient would be grossly crossing the predetermined boundaries of the nurse/patient relationship in an egregious manner.

BuckyBadgerRN, ASN, RN · May 23, 2016

Searching SEVERAL previous threads on this exact topic will give you many responses to review

RebecaRN · May 23, 2016

I'm glad that you responded that sometimes it can be the patient that is the manipulative one and the RN the vulnerable one. I do believe that this scenario is more in lines with that. Regardless of my thoughts on that I still believe that it is unethical and a significant boundary issue.

FolksBtrippin, BSN, RN · May 23, 2016

It has nothing to do with "mental illness stigma." I've been in psych for 30+ years, and I've never heard of a "3 year" time limit -- the time limit has always been "never." Within the mental health professions, we consider any romantic (or other, e.g., friendship) personal relationship with a former client to be unethical and unprofessional, regardless of the amount of time that has passed, and regardless of the professional setting in which you met the individual (i.e., no different in medical-surgical settings), not because of the nature of the client's illness, but because any personal relationship arising from a professional relationship is fatally flawed because of the origin of the relationship and inherent power imbalance in the original professional relationship. You can't go back and "undo" the previous professional relationship. Any personal relationship is inherently exploitive of the former client.

I see where you are coming from, and in general I think that it is something one should avoid, no matter how much time has passed. In the case the OP is posting about, the time is too short, the setting is inappropriate, etc, etc. It's a clear case of misconduct.

It is definitely unethical to start a relationship with a patient/former patient when the clinical setting is the only setting in which the two have run into each other. Time doesn't matter. So if I have a patient, get his contact info and then call him up a year after he is discharged to invite him out socially, that is unethical. Black and white. I don't care if the board allows it, it's still wrong.

But I could think of a few situations in which dating a former patient would be in a gray area. If you meet a patient years later while out doing something else. You are starting a new relationship in this case. I don't think many people would take issue with this if it had been a former surgical patient. The patient is not believed to be vulnerable anymore. But for psych patients, the presumption is that the patient is still vulnerable, has not healed or recovered, is still just as sick as s/he was while inpatient years ago. That is a result of stigma.

But again, this case is pretty clear cut. Way too soon and wrong circumstance to be dating this patient.

elkpark · May 23, 2016

I see where you are coming from, and in general I think that it is something one should avoid, no matter how much time has passed. In the case the OP is posting about, the time is too short, the setting is inappropriate, etc, etc. It's a clear case of misconduct.
It is definitely unethical to start a relationship with a patient/former patient when the clinical setting is the only setting in which the two have run into each other. Time doesn't matter. So if I have a patient, get his contact info and then call him up a year after he is discharged to invite him out socially, that is unethical. Black and white. I don't care if the board allows it, it's still wrong.
But I could think of a few situations in which dating a former patient would be in a gray area. If you meet a patient years later while out doing something else. You are starting a new relationship in this case. I don't think many people would take issue with this if it had been a former surgical patient. The patient is not believed to be vulnerable anymore. But for psych patients, the presumption is that the patient is still vulnerable, has not healed or recovered, is still just as sick as s/he was while inpatient years ago. That is a result of stigma.
But again, this case is pretty clear cut. Way too soon and wrong circumstance to be dating this patient.

I have never, in 30+ years in psychiatric nursing, heard that put forward as the rationale for not getting romantically involved with clients. The rationale has always been the inherent power imbalance in the (professional) origins of the relationship, and that that power imbalance creates vulnerability on the part of the (former) client and exploitation on the part of the professional -- again, regardless of whether the original professional relationship was the result of a psychiatric illness or a broken leg. I've never heard anyone suggest that the reason is because the client will be "still just as sick."

FolksBtrippin, BSN, RN · May 23, 2016

I have never, in 30+ years in psychiatric nursing, heard that put forward as the rationale for not getting romantically involved with clients. The rationale has always been the inherent power imbalance in the (professional) origins of the relationship, and that that power imbalance creates vulnerability on the part of the (former) client and exploitation on the part of the professional -- again, regardless of whether the original professional relationship was the result of a psychiatric illness or a broken leg. I've never heard anyone suggest that the reason is because the client will be "still just as sick."

Okay, so are you of the opinion that it is always wrong to date a former patient, even if it was not a psych patient and even if years have passed?

And what do you think is the reason (if not stigma) for different rules for psych patients as opposed to other types of patients?

LadyFree28, BSN, LPN, RN · May 23, 2016

Okay, so are you of the opinion that it is always wrong to date a former patient, even if it was not a psych patient and even if years have passed?
And what do you think is the reason (if not stigma) for different rules for psych patients as opposed to other types of patients?

I know this addressed to elkpark, but if one would look at the history of how mental health patients have been treated in this country, and how people were exploited and mistreated, it has become a more proactive stance to protect those who are undergoing psych treatment; the human psyche is just as complex m, if not more than the human body imagined; I think we can agree on that.

And as someone who has a mental illness in remission, having a mental illness requires a certain part of protection, at least to me-you NEVER know when you are going to have an exacerbation, or be in a position where you will need an unbiased, non judgmental safe space; since there are VERY few inpatient places, that would be potentially distressing if I was to enter a relationship with someone who was a former clinician and if it didn't work out, and then need services, then I wouldn't be inclined to seek that help-and that is not safe. :no:

elkpark · May 24, 2016

Okay, so are you of the opinion that it is always wrong to date a former patient, even if it was not a psych patient and even if years have passed?
And what do you think is the reason (if not stigma) for different rules for psych patients as opposed to other types of patients?

As I've already said, the people I've known in the psychiatric community over the years haven't felt that there are "different rules" for psychiatric clients vs. other clients -- it is the position of the general psychiatric community that it is always inappropriate to enter into a personal relationship with a former client, regardless of the amount of time that has passed, regardless of the individual's diagnosis which brought the individual into a professional relationship with you. Period. What I have noticed over the years is that people in other specialties are not as careful and sensitive about professional and personal boundaries as responsible psychiatric professionals tend to be. Witness the many threads on this site, including this thread, in which nurses from other specialties speculate on when or under what circumstances it would be appropriate to enter into a personal relationship. For me, personally/professionally, and the competent and ethical psychiatric colleagues I've known over the years, the answer is "never." For reasons that I can't explain, and for which I take no responsibility, many nurses in other specialties feel differently -- they're entitled to their opinions, I suppose. But I don't see how nurses in other specialties being more casual about professional boundaries than psychiatric professionals equates to "stigma" against psychiatric clients.