About a million years ago, during the last semester of nursing school, we had to watch a video on ethics. The video was all about the tragic, fictionalized story of Judy, a pert, red-haired nurse with a turned-up nose, who got too chummy with a teenaged patient in the psych ward where she worked. After discharge, said patient showed up in her living room, having let himself into her house through the back window with a brick, and offered to take her away from her lousy life. We watched breathless as Judy got rid of Scary Teenaged Stalker-Boy, appeared before The Stone-Faced Commission Of Nursing, and finally Learned A Valuable Lesson about crossing ethical lines.
If only it were that easy. Truth is, there are moments in every work week when you wonder (unless you work, say, in the ER or a vent unit) if maybe a patient isn't getting a little too close for comfort.
Luckily, before you or a patient crosses a big line, there are lots of little lines. Keeping scary stalkers off your couch is a matter of figuring out how to redirect or contain weirdness early, before it gets out of control. Likewise, not every personal question or inappropriate remark is necessarily an ethical or privacy violation.
For example: If a little old lady tells me I'm pretty and I ought to meet her grandson, that's not something that's going to flip me out. For the same reason, a patient with a huge tumor in his frontal lobe can say nearly anything he wants without my throwing up walls. The converse of this is the neurologically-intact guy of about my own age who, while I'm starting an IV, asks if I have a boyfriend. *That* sort of thing, given who it's coming from and the situation, makes the alarm bells on a German submarine pale in comparison to what's going on in my head.
On the flip side, there's the problem of how personal to get with a patient. If I have a person who's dealing with sticky emotional issues in addition to a brain tumor, I might give them a very small detail about a similar situation in my own life and how I handled it. I *might*. It depends, again, on the person and on my gut feelings about them.
I have only a few hard-and-fast rules about personal relationships at work. One is that I don't date patients, doctors, or other people I work with. Another is that I won't allow inappropriate comments or questions to slide when they come from the neuro intact patients. The final and most important one is this: I always listen to my gut when it comes to those little lines.
I've only been wrong with the gut reaction once. My gut overreacted and the person it overreacted to was okay. Still, I'd rather overreact in a quiet, careful fashion to protect myself than end up with a friend I don't want.
So far, so good. I've not had any teenaged stalkers show up on my couch, and I've made one or two valuable friends out of past patients or family members. I've had to have the rare come-to-Jesus meeting with the rare pushy male, but that's only been two or three times in five years.
I still wonder about little fictionalized Judy. I mean, how dumb do you have to be to give a teenaged boy in a psych ward enough information about yourself so that he can find you later? Shouldn't the nursing board have cut her loose to be Darwinized by another patient down the line?