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Rookie Wit & Wisdom
Appropriate Interaction with Patients Outside of Work

It began with a simple hello and went down hill from there.

“Ah. Hi,” I stammered, as my mind frantically went into overdrive trying to figure out where I’d seen this pretty blond woman before. “Can I buy you a drink? It’s the least I can do,” she offered.

Something definitely was amiss because attractive young women didn’t generally offer to buy me drinks. I peered closer at her face. Recognition hit me like a sledge hammer. “Ah, I’m fine. I’m, ah, drinking water tonight--designated driver, you know? Thanks for the offer.”

She shrugged her shoulders. “Maybe another time,” she said, then turned to the barman. I made my escape.

“Hey, you gonna introduce us?”Jake said to me when I returned to our table. “Yeah, if you’re not interested, introduce her to me,” offered Simon. Both the boys had been behind me when Sophie (I’d remembered her name by now) had offered to buy me a drink.

“Ah, she’s not interested,” I said. The guys were angry. “What are you talking about? If you like her, that’s cool, but if not, don’t be selfish,” said Jake. “Yeah man, don’t be selfish,” echoed Simon.

What could I say? I couldn’t tell them who she was—that I had vivid memories of her foaming at the mouth and of her painting her room in feces. I couldn’t tell them that I’d looked after Sophie for two months in the psychiatric ward and that, even at her best, she would never be quite right.

So I suggested another bar, I bought a round of drinks, and Sophie was soon forgotten.

What do you think? Did I mistreat Sophie by not introducing my friends? Was I prejudiced? Well, probably, but for the right reasons. I was just using my common sense. I kept them safe, kept Sophie safe, and kept my mouth shut at the same time. We were all winners.

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11 Responses to “Appropriate Interaction with Patients Outside of Work”

  1. Lindsey Says:

    I think you did the appropriate thing. If you had introduced them, chances are they would have wanted to know how you met her, etc…

    I often see patients of mine in the mall or in the community. Sometimes I can tell that they recognize me but I’ll simply smile, say hello and keep walking.

    I don’t think you were prejudiced at all. I think you did the professional thing! Kudos to you!

  2. Nancy Says:

    Thanks for standing up and continuing to protect a patient, even when she was no longer under your care. That takes guts to do that, especially when being heckled by your friends. Don’t lose your integrity!

  3. Tracy Ridgely-Guthrie Says:

    You followed your instincts and you were right. She could be dangerous or she could be perfectly nice, but the part you saw of her while she was a patient was still a PART of her and it is still there. We have to always be careful. you a great job!!!

  4. Leona Says:

    I think you did the right thing. You were protecting the patient’s right to confidentiality. Regardless of what her hx is she has the right to complete confidentiality and that’s what you did.

  5. Rose Says:

    Bravo to you! You did the right thing for the (ex)patient and for your friends. It’s nurses like you who I look up to!

  6. Mr Ian Says:

    I wonder if she felt stigmatised at all that as an ex patient you wouldn’t talk to her? I mean, you’d witnessed her at her most vulnerable and probably crossed boundaries with her in the context of clinical care that would never happen in the real world. Perhaps she felt a sense of reassurance in your face and that this was someone who “knew” her better than anyone in this bar perhaps ever would. Perhaps you were a friendly face amongst a scary world. Perhaps you were simply a person who shared a significant time in her life that she’s never been able to acknowledge in case people started thinking of her as the crazy faeces smearing frothy mouthed woman?
    Perhaps, and maybe this is what embarrassed her the most, because you’d only ever seen her in a psychotic state that she needed to validate herself to you as someone who wasn’t just “a crazy mouth frothing faeces smearing mad woman” .. but she was a person and not ‘an ex mental patient’.
    Perhaps she just wanted to buy you a drink to say “thanks”.
    I’d doubt she noticed you and your friends sneak out as you made your second ‘escape’.

    If you’d nursed her for a broken ankle – would you have stayed and chatted longer?
    Or treated her for an STI – would that have made you fearful for the risks of confidentiality?
    If my friends knew what I did and an ex-pt bumped into me and wanted to chat – isn’t it reasonable for that ex-pt to think my friends know where I work and can add up?
    I’d say she was capable enough of knowing and realising the implications of her talking to you and that shouldn’t preclude her or you from having social intercourse.

  7. Ima Nurse Says:

    Ian you obviously must not be a nurse! Nurses are at risk of losing their job if they break a patient’s confidentialtiy (whether that be a psychiatric patient or a patient with a broken ankle). If encountered by the right sue happy person a nurse can be fired from a job for even mentioning they saw a visitor they recognized at the hospital they work at.

    And NO it’s not acceptable to tell friends why someone recognizes you just because they approached you in a public place.

    Example… In court:
    And Mr. RN did you tell your friends how you knew this woman?

    Yes, but I assumed because she approached me she would know that my friends would ask questions and I figured under those circumstances it would be ok to break confidentiality.

    Do you have personal insurance in addition to your hospitals coverage? Because you have breeched confidentiality despite extensive training you are required to complete related to protecting patient’s rights.

    Not to mention a nurse is required to always under every circumstance not only be tolerant but nurturing and supportive of every single patient they will ever come into contact with. No one on this planet LIKES everyone they ever come into contact with. Off the clock and in public this nurse is no longer required to validate this patient or to put himself and his friends aside and think only of her needs as he has to do when he is at work. That doesn’t mean he has to be rude to her it just means that outside of work he now has the basic right to think of his own needs and not strictly the patient’s.

    Kudos to you for taking care of yourself and your friends! It would have been unwise to linger with this woman. You handled the situation with respect, while maintaining the woman’s dignity and confidentiality!

  8. bryn Says:

    The good thing about your comment Ian is that you try to look at the situation from a different perspective. Perhaps you are right and she did want to validate herself, to show her normal side. And perhaps I was a friendly face in a hostile world, and perhaps she just wanted to buy me a drink.But at the end of the day I have to think of what is best for me and her.
    I felt in this instance it best to be polite but excuse myself. My friends would never let up otherwise, plus by staying and then trying to avoid her, it would make my friends more curious.
    Single guys out on the town tend to one track minds and it wouldn’t be healthy for my friends and for Sophie if things went further.

    So, Ian, I agree with what you say, and it says a lot about your character that you are able to see things from another perspective, good things that is, but I still did what I think safest.

  9. Mr Ian Says:

    Ima Nurse:
    I have not mentioned anywhere about breaching confidentiality. Nor did I suggest it was a great idea to be mixing work with pleasure. I was merely stating that people are not stupid. Well, most.

    There is no breach of confidentiality if an ex-patient approaches you and says hello. If that ex-pt then wants to join you and others for a drink then they are taking responsibility for that decision in the full knowledge that the question of how they became acquainted might come up. Obviously it is not for the nurse to disclose that detail – but the patient is not bound by confidentiality of any sort.

    I’ve sat and drank at a pub with a a patient of mine – this particular one had an acquired brain injury and he had a few odd mannerisms so he tended to be left alone by others. My mates knew where I worked – at the local secure mental health unit – so when this ABI ex-pt comes over to say hello to me, they didn’t take long to figure this might be a patient of mine I’d know from the hospital.
    I didn’t breach any confidentiality by disclosing any details of his ABI or the offending behaviour he’d committed since. In fact he now socialises with my mates who he introduced himself to when they meet at the pub occasionally.

    What I was trying to get at – which you have succeeded in demonstrating so well – is that nurses tend to treat patients always like patients and yet turn their compassion off outside of work. They tend to forget these patients are people and – more so – do not understand that people seeking recovery from MH issues never really ‘recover’ from the experience of being so completely vulnerable.
    It’s a significant moment in anyone’s life to be admitted to psychiatric care. It’s as if to say to them – “you just can’t cope” and that can be quite soul destroying.
    The purpose of my post was to ensure nurses understand the difference between a ‘tactful retreat for the benefit of the (ex) patient’ and simply ‘alienating’ someone in a stigmatised way.

    Your decisions based on fear for your license is a disappointing indictment of how nurses tend to make decisions – license; employment status; colleagues; patients – in that order of importance.

    It is also interesting you should quote nursing ethics at me – but only those that you choose.

    My Nursing Councils (Australia and UK) both expect me to act as a nurse 24/7. So that includes inside or outside work.
    As it happens, Bryn’s actions are in no way – bad nursing ethics – but to make decisions on patient welfare based simply on the preservation of your license is an absolute farce. Your license is only in jeopardy if you do something (or omit to do something) that compromises the well being of a person.
    As for employment status; well I can only sympathise for my American colleagues who seem to have the worst employers in the world.

    But all this doesn’t mean as nurses we go out of our way to be helpful to everyone all the time – but nursing is a job held in high social esteem – because society recognises and trusts us to take care of them. That philosophy does not stop simply because we clocked off work.

    Or – imagine going to your car and across the way is an off-duty cop who recognises another man nearby as an ex-con. He hasn’t broken a law and that cop cannot come up and tell you about him as he’s served his time. Should he just walk away from the situation and say “well I’m off duty” and make his escape?

    I’ve no doubt you did what you thought was best at the time and I’ve no reason to dispute that. I’ve always appreciated your patient centered-ness.

    As I thought you’d appreciate my cat amongst the pigeons :o)

    Maybe I should write a similar post about the time I dated a young girl – then found out that she was the current girlfriend of one of my in-patients?
    Now THAT was ethically challenging. :o)

  10. bryn Says:

    you’re clever Ian, your perspectives refreshing.

  11. Mr Ian Says:

    It’s a divided opinion Bryn – but thanks :o)

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