Was I Inappropriate

[rachelita]

I need some opinions. The other night I was helping out in PACU. (I am usually in ER or Preop, but occasionally go to PACU when needed) I was asked by another nurse to transport her patient upstairs. The patient was early 30's female, very nice, always saying thanks when people helped her. We talked as I took her to her room. She had surgery for a cancer recurrence, so we talked about the surgery, her young kids, her family, etc. It was shift change, so I ended up having to wait with her for quite a while to see her nurse, the PACU nurse has to have face to face time with the receiving floor nurse. During this time we chatted some more. Then I left when her nurse got there.

The next day I was off. I was thinking about this patient and how nice she was. I called her room to check on her. I just let her know I had been thinking about her, and asked how she was doing...get well soon, etc. She seemed very appreciative.

A few days later I told her PACU nurse that I had spoken with her. This nurse was very offended with me and said I had broken HIPPAA (sp?) laws by calling the patient to check on her. Is this true? I just thought I was being nice. When I had my daughter, the L&D nurse called the next day to check on me. I know hospitals can be lonely places and thought one might like to hear a friendly voice and know someone was thinking of them.

Did I do something wrong?????????

[Meraki]

I don't know about HIPAA as I am not from the U.S but I would say it was a boundary crossing for sure. When the LD nurse called you - it was likely a discharge follow up call and related to patient care. It is quite possible they call all patients or all patients who meet x criteria. We do discharge follow-up as well and that is completely different than calling patients from home just to chat because you liked them and you thought they were lonely. As much as your intentions may have been good you have to establish boundaries between your professional role (RN) and a personal role (friend who calls to chat). In this case, it ended fine, but you could set yourself up for all kinds of problems by befriending your patients.

[Flare, ASN, BSN]

Well, from what you've provided it sounds like it was just you calling her up. I'd imagine that if you were at the hospital with a family member and dragged them in with you while you chacked on her, then maybe there would be a hipaa violation. sounds like the higher ups are just misinterpreting and overreacting.

[CoffeemateCNA]

I don't understand why the other nurse would be upset, unless you were discussing aspects of that patient's care within earshot of others (and it sounds like you weren't).

I work in LTC and several of the day shift CNAs and nurses call and talk to their residents in the evenings. I think it is rather sweet, and the residents look forward to receiving their calls.

[Spacklehead, MSN, NP]

I don't see how that would be a HIPAA violation - you were talking directly to her and not discussing her care with anybody else (like a family member). We used to do this in our ED - we would call patients at home a few days later if they were D/C'd from us to see how they were doing - and it helped to boost our ratings.

Where I can see it getting a little sketchy, though, is if she started asking you questions about her condition, treatment, follow-up, etc. and you answered her. This may be out of the realm of the info you, not being her main PACU RN, could provide. But just to call and check up, I can't see how that is in anyway a HIPAA violation.

[Phase2Pro]

I do think it is a professional boundary crossing but not a HIPPA violation unless you speak to a family member and not directly to the patient. I know it happens all the time and is relatively harmless, so I don't see why the PACU nurse got her knickers twisted.

[LPN_2005/RN_10]

At the facility that I'm working it is against policy to check on a patient's status after your nurse-patient relationship ended. So if I had a patient that was either discharged or transferred to another unit, I can't look in his chart or call him/her at home or their hospital room to check on their status. They do have certain nurses whose job description allows them to check on a patient after dischage or transferring between units, but most of the staff nurses are not allowed to do that. Your best bet is to check with your hospital's policy to make sure it's ok if nurses can check up on past patients. Every facility policies are different, so what might be ok at one facility might not be tolerated with another.

[Meraki]

I don't see how that would be a HIPAA violation - you were talking directly to her and not discussing her care with anybody else (like a family member). We used to do this in our ED - we would call patients at home a few days later if they were D/C'd from us to see how they were doing - and it helped to boost our ratings.

Spacklehead - do you really see those two things as the same?

You calling from the hospital as part of a follow-up protocol to a list of discharged patients about impersonal topics such as hospital care/patient experience vs You at home on your day off calling into the hospital to talk to one particular patient that you hit it off with that you think is lonely and you want to cheer up?

I'm just curious - to me they are completely different scenarios. What you do (discharge follow-up) wouldn't be a boundary crossing in any way as it is protocol, non preferential, part of your job responsibility, about professional and service related topics and impersonal.

[mamamerlee, LPN]

It's unlikely you 'broke' any Hipaa regs. And I think many people are getting a bit difficult about relationships. Haven't some of us known people who have dated or married their nurse?

The boundary would be broken if you asked to see her chart, or in some way disseminated information. You called to say hi, and to be supportive.

I was very friendly with a patient post-hospital for a long time; we really hit it off when she was my patient. And I sold Mary Kay products for quite a while after being introduced to them by a former patient!

Everything within reason, here.

[Spacklehead, MSN, NP]

To just call a patient in the hospital to check to see how they are recovering and to say get well soon as what was mentioned in the OP? Yeah, that sounds just like what we said to our patients from the ED. I see no wrong in saying, "Hi, I was one of the nurses from the PACU who helped with your care yesterday and was just wondering how you were doing?" If the converstation got much more deeper and personal than that, though, I agree it would be inappropriate. If the patient felt uncomfortable about it, she could have just said, "I don't feel it is appropriate to discuss this with you."

My one question is - how did the OP get the number to the patient's room? Did she call the nurses' station and they transferred her call? If so they, techinically, could be in the wrong. But if the nurse got the number from the patient before she left, then I don't see the problem.

Would it be viewed as inappropriate if, on her next day of work, she went up to that unit and popped in to say exactly the same thing to the patient that she did on the phone? I've seen ED nurses do that on occasion with patients they wondered about, and no one batted an eye.

[Meraki]

And I think many people are getting a bit difficult about relationships. Haven't some of us known people who have dated or married their nurse?

Not just from your post but from the others, it is surprising to me how different the policies and boundaries are in many of your hospitals. In my hospital it would be completely unacceptable and grounds for termination to date your patient. Not allowing this would never be seen as people being difficult about relationships, but rather in setting boundaries that protect staff and patients. Developing non professional based relationships of any kind with a patient is very frowned on here, nor would we be allowed to market or try and sell products to our patients. Once a patient is discharged then that is a greyer area.

And personally having been a patient myself many times I would find it very uncomfortable and strange to have a nurse I met in passing (transported me between units) call me from home on her day off to tell me she was thinking of me. Probably because that is just so different than our policies and practices here.

And from a nursing perspective I can see a hundreds things that could go wrong from hearing patient information while I'm off duty at home.

Nurse: So how are you?

- Patient: Not good, I've been in pain for hours, I asked for meds but they haven't brought them..is there anything you can do?

- Patient: I've actually been having blurry vision today.... The nurses are so busy, I don't want to bug them, if it gets a lot worse I'll tell.

- Patient: Well the nurse I have today isn't very friendly, you were so much nicer. When are you working next?

- Patient: oh I'm so glad you called, I needed someone to talk to, my husband...

- Patient: Well, I just heard bad news from the doctor and I'm not sure what to do / how to tell my family - what do you think i should do?

- Patient: Can you please bring me x.y.z tomorrow? I really need them and have no one to get them, I'll pay you when you come.

Or patient later says to roommate..oh I just had a call from that sweet nurse Jackie, she called me from home on her day off to see how I was- wasn't that nice of her? Rommate: Is Jackie the one with the long black hair? I had her yesterday too but she didn't call me.

Or Patient says to nurse at end of shift...my visions been blurry now for awhile and its getting worse.

Nurse: you should have told us

Patient: Well I did tell that nurse that called me

And if you answer these with I can't talk about that, or no there is nothing I can do, or whatever...then the patient is going to be left with a well why did you call and ask how I was if you don't want to hear the answer.

[mamamerlee, LPN]

Although I am very careful to not initiate a conversation with a former patient that I may bump into in, say, the supermarket, I do not deny that person the right to greet me first. Can I get fired if they hug me? If they turn to their shopping companion and introduce me? Would the hospital have me turn and run in the opposite direction?

Yes, there is certainly a difference between a professional relationship and a personal one, but sometimes the lines blur. If someone I know is admitted to my unit, it is appropriate to refuse to be assigned to her. If her nurse needs assistance and I am the only one around, if possible I would ask the patient if it is okay with her that I assist.

These are two things that happened to me, both more than 25 years ago. I worked in acute dialysis, and was scheduled to be the off-unit person one day. The pt turned out to be one of my nursing school instructors. I did my job, she was quite ill, we spoke only briefly. I then had to treat her mulitple times after that. She told me later that she was very comforted by seeing someone she knew, someone she could trust, so she felt she could relax while I was there.

I lived for a while overseas, and worked in a neonatal ICU. On one of my days off, a woman I knew gave birth to a baby with multiple problems. The prognosis was grave. When I went to work the next day, I saw the baby (only 2 of us worked in the unit most days) and could easily see it was deformed. The mother came to the nursery to see the baby, and literally fell into my arms in tears. The next night, at someone else's home, the father asked me if I could 'help the baby die'. We all knew that the baby was going to die fairly soon, he just wanted it to be over. I told him that I couldn't do anything to harm the baby in any way. He cried, too, for his wife's agony, and the baby we all knew that wouldn't live much longer. The baby died before I worked again. My coworkers knew that I was familiar with the family, and offered me support. It was so sad at the time.

Should we never visit friends/family if they are patients where we work? Mt dad has his open heart surgery at the hospital where I trained, and I knew many of the staff. What then?

And, by the way, I never solicited my products to the patients - that would be crazy! But I went to the meetings with my former patient, and we became good friends.

Good sense needs to prevail here, and we need to stop using HIPAA as the almighty shield when it doesn't apply.