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The Nurse Card

Boundaries of Care

Published June 10, 2016 12:18 PM by Diane Goodman

As new nurses, we manage our careers carefully, knowing we might get attached to patients and families easily. Policy and procedure manuals warn us about boundaries. We know not to spend time with patients or families other than in our professional status. We follow those rules to the letter. We don't want to form relationships with patients where boundaries get murky.

But somehow, in a nursing career, those boundaries get murky anyway. Ask any nurse who has spent time arranging the last minute details of a wedding at the bedside of a dying patient, and she will tell you of the hours spent getting the cake, the guests, a little music, and having it come off without hospital administration blowing three gaskets....a few rules and boundaries were bent, broken, and blasted way off kilter for that one! And no nurse would disagree that this was necessary, regardless of policy or procedure.

In nursing, we all meet our nemesis at some point. Mine was a 94 year old ICU patient with no family near the area. He knew he was dying, and didn't care what anyone said to him about anything except what could be done for his dog. I tried everything. I called the neighbors. I called what little family he had. I called the Humane Society. Nothing would please that man except for me to go retrieve his dog and find him a new home, which I did, thank God. The poor animal had been sitting at the gate in the rain for five days waiting for his master to come home. We eventually found a young man who loved the dog and took him home, and the man died peacefully thereafter.

He was the first patient where I took the keys to a patient's house, but not the last. One oncology patient we had in another hospital seemed to form a close bond with me. I knew her anxiety was really a demonstration of loss of control and fear, so her endless stream of questions didn't bother me as they did a few of the newer nurses. I encouraged her to ask about anything that was bothering her. Ironically, of course, this had the opposite effect, and she usually had very few questions. She did, however, ask that I help donate a few supplies she no longer needed. That was the least I could do for her. (I had them in my office for weeks!).

Since that time, I have broken more boundaries when needed, as have several of my peers. Nursing is a lot like coloring; we are creative human beings and it really is difficult to stay within the lines. Once you've seen the full spectrum on the color wheel, it's almost impossible to go back to less vibrant hues.

There is always another wedding to plan, hand to hold, or another homeless dog to pick up and place, God willing.


Nurses fill many roles, in and out of the hospital setting.  Depending on the role, the situation may need us to blur the lines to provide holistic care for our patients and their families.  In my role, as a nurse educator/ home visitor, education and support comes in many forms.  Educating a parent about child development, care and feeding, bathing, etc., may be followed with information such as why her clothes dryer is not drying the clothes and the importance of cleaning out the lint trap to prevent a house fire.  

Suzanne June 28, 2016 3:04 PM

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About this Blog

    Diane M. Goodman, APRN, BC, CCRN, CNRN
    Occupation: Clinical Educator
    Setting: Advocate Condell Medical Center, Libertyville, Ill

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