Nurse and Patient Relationship

Nurse and Patient Relationship

Have you heard stories of nurses falling in love with patients? 

What about a patient falling in love with their caregiver? 

Or a nurse and patient romantic relationship? 

Ever wonder... 

• Can nurses date patients? 

• Is this really a thing? 

Hi I’m Christen

I was just a tired, exhausted, burned out nurse dreading work and imaging what I could do instead of nursing. It affected me professionally AND personally!

Now I help nurses struggling or wanting to prevent the struggle using the same strategies and tools I used to create a happier, healthier life.

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I started nursing at a younger than normal age. Took my first nursing class at 16 years old, had my first job by 18, and my first hospital job by age 20.

I was the youngest nurse on most units I worked on for a long time. 

As a baby adult, some of my colleagues were the unfortunate recipients of my dating stories.    

My coworkers at the time, trying to be kind and supportive, would say encouraging things or offer helpful advice.  

Others, while trying to be helpful, would say things like: 

“Maybe you’ll meet a nice patient.” 

“Have you ever talked to the patients that come through?” 

“Maybe you’ll take care of a nice patient.” 

While well-meaning, this was obviously terrible advice. And don’t worry, it’s not something I ever took seriously or acted on.  

This is a taboo subject that makes most medical professionals cringe just thinking about it.

I know I feel that way even writing this blog.

But, sometimes it happens. It’s one of the things we know has happened but don’t talk about it. 

Even as I sit here and write this, I have at least 5 stories coming to the top of my head from my nursing school instructors and colleagues over the years. 

If you or someone you know falls into this category, this blog isn’t meant to bring judgement or condemnation.

The truth is many nurses struggle with healthy boundaries and navigating the unique nurse-patient relationship.

This blog’s intent isn’t to point the finger at any person/relationship, but to discuss a complex topic to help nurses honor their integrity and boundaries while working with patients in a healthy way.

Let’s start at the beginning:

How do you define an appropriate, therapeutic nurse-patient relationship? 

What is the nurse-patient relationship? 

Nurse-Patient Relationship Definition

Nurse-Patient Relationship Definition

When I think of the nurse-patient relationship around this topic, I try to break it down in simple terms.  

To me, it’s a unique one-sided relationship between a nurse and a patient. The nurse is the expert providing care and the patient is the consumer who’s reliant on the nurse’s expertise and work ethic.

Because the patient is reliant on the nurse or medical professional, hasn’t been medically trained, and is likely feeling unwell they’re vulnerable. 

In nursing, we all know it’s unlikely a patient’s able to tell a good nurse from a bad nurse because they don’t have the knowledge we do. 

Usually only other nurses can tell a good nurse from a bad nurse.

The nurse-patient relationship is one-sided because the patient isn’t required to give back. In fact, it’s even looked down upon.

Your reimbursement for the nurse-patient relationship comes from the paycheck you receive.  

I also call it unique because outside of work, I try to avoid one-sided relationships.

We know how we feel after work: drained, exhausted, we have nothing left to give.  

Why would we want to feel that way outside of work?  

That’s the time to focus on you and give yourself what you need! The time to engage in mutually beneficial and fulfilling relationships.   

For a more formal definition of the nurse-patient relationship, check out the March 2022 edition of Nurse Ethics. There’s a study called: Defining and Characterising the nurse-patient relationship: A concept analysis. This study defines the nurse-patient relationships as  

“…a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change.”  

If you look at the ANA’s Scope of Practice, regardless of the edition, you’ll find words like “ethical” and “ethics” all over the place.  

If you think of the nurse-patient relationship in simple terms, then it comes down to a simple question: 

Is it ethical for any licensed professional to engage in a romantic and/or sexual relationship with someone who’s vulnerable?  

Is it much different than a therapist sleeping with or dating their client?  

Although my specialty is nurses, doctors definitely cross these boundaries too. This problem isn’t nurse-specific. 

Let’s look at the different types of general relationships we all come across in our lifetime and examples in nursing below.

Nurse Patient Relationship

Nurse Patient Relationship

While there aren’t different types of nurse-patient relationship, there are phases to it which is the next topic down.

Although we could make an endless list for all the types of different relationships there are in the world, let’s just break it down to 3 basic categories: 

• Social

• Intimate

• Therapeutic

SOCIAL

Primary goal is for friendship, socialization, and enjoyment. Everyone’s needs are met and you’re free to share ideas, feelings, and experiences with one another.

INTIMATE

Having an emotional commitment to another person. It’s easy to relax and be yourself around this person. This is a mutually satisfying partnership where both parties care about the needs and growth of one another. This type of relationships also involves many physical components.

THERAPEUTIC

This is the only type of nurse-patient relationship. The professional uses communication, training, and experience to enhance the patient’s growth. The focus is on the patient’s experiences and wellness.

There’s normally not an exchange of ideas. It’s learning what the best needs of the patient are and moving forward. It’s a one-sided relationship that doesn’t factor into you needs.

Therapeutic nurse patient relationship can be a little tricky because it involves elements from the other types of relationships. Even though it has aspects of the social and intimate categories, it’s still falls under therapeutic.

Let’s look at a couple nursing examples that mix the therapeutic definition but take elements from the other types of relationships:

EXAMPLE 1

I was assisting in my first bone marrow biopsy and the patient had never had one before either. If you’ve never assisted in this, it can be pretty rough. Many nurses and nursing students have been known to pass out during this procedure. 

I didn’t pass out but it was pretty brutal to watch and hear. I remember talking about it with the patient after.

It was a shared experience because neither of us had experienced it before. It was easy to feel more connected to the patient with an almost friend-like vibe.

It seems like that could move the relationship from therapeutic to social, but I’m the professional and it was an experience from different perspectives. That’s still a therapeutic relationship. 

EXAMPLE 2

Oncology is a sad but lovely specialty because you can get to know your patients and their families pretty well since they’re often in and out of the hospital.

I remember this lovely couple I took care of. All the staff adored them and when the husband lost his battle to cancer, the family mentioned our unit and hospital in his obituary thanking us for his care.

All of us were sad he lost his battle. Sometimes you can’t help but form emotional investments with patients. We saw him on his worst & best days, helping him with intimate tasks like showering and eating. We wanted to see him be able to grow and move forward.

This may feel like it’s moving toward an intimate relationship, because characteristics are similar, but it’s still therapeutic.  

The only type of nurse-patient relationship that exists is therapeutic.  

There’s no way to completely separate the 3 because we’re human.

This is where having solid boundaries will protect you. My Beside Nurse Survival System has module and practice exercises to help nurses form and reinforce their space.

I’m passionate about nurses having boundaries because you’ll be protected both in and outside of work.  

Boundaries are probably the most important thing you can do to ensure you keep thriving as a nurse and in your personal life. Having solid boundaries will also help protect your:

• resilience

• energy

• likelihood of ending up in a situation that crosses the therapeutic line.

If you have trouble saying no to people and/or just know this is something you could use support in, I’ve got your back! 

Contact me here! 

Phases of Nurse-Patient Relationship

Phases of Nurse-Patient Relationship

We all know the importance of the nurse-patient relationship and the many factors that affect it.  

A therapeutic nurse-patient relationship is divided into 4 phases:

• Orientation

• Identification

• Exploitation/Working

• Termination/Resolution

ORIENTATION

Or for our purposes the boundary phase. The nurse introduces herself, says why she’s there, and sets the expectation in this phase. This is the start of therapeutic and professional interaction. Everything becomes all about the patient at this point.    

IDENTIFICATION

When you’re figuring out the patient’s problems, needs regarding their problem, and arranging the care plan. You’re in the identification phase when you’re doing a history, medication reconciliation, reviewing the chart, taking vitals, doing an assessment, etc.

This is collaboration between the nurse and the patient with the goal of the patient to return to maximal health. This phase are the days caring for the patient in a health care setting or during sessions of home health. This can mean a quick ER visit or a lengthy hospital stay. The patient/families ask you questions, follow instructions (we hope), and trusts your expertise. You provide the amazing nursing care you do every day up until the patient is discharge ready. 

TERMINTATION/RESOLUTION

I prefer the term termination because it gives the relationship an ending. This is when the patient is back to their prior level of health, self-reliant, and treatment goals were achieved. The relationship ends here. 

Many nurses understand and excel in the different phases but it’s my opinion the termination phase is the most difficult.  

Many nurses struggle with the termination phase and don’t realize they aren’t completing it. While the following examples sound innocent and well-meaning, it doesn’t set you up for a successful relationship.

Termination does NOT mean:

• you and the patient exchange numbers and keep in touch.  

• you’re invited to the family reunion so they can connect you and their son who thought you were such a pretty and smart nurse.  

This is where the patient discharges and you go separate ways.  

Those examples sound nice enough, but when you’re entering these relationships from a professional starting point you’re at a disadvantage.

One way comes from your job requirements. The nurse-patient relationship is all about the patient’s needs and not your own. The foundation is laid for a one-sided relationship.

Another way you’re at a disadvantage is if something goes wrong and the relationship doesn’t work out, you may find yourself in a very difficult position.

Can you imagine:

• How awkward it may be to take care of a patient or family member of a patient you just had a bad break up with?

• Telling your colleagues why you can’t care for the patient?

• The patient/family telling your colleagues why they don’t want you as their nurse?

If the patient appreciates all your amazing care, they can nominate you for a Daisy Award. 

If you created a meaningful connection with a patient and/or family, it’s likely other colleagues did too.

A great way to connect with your colleagues while honoring your connection to the patient is talk about the experience with your work besties who also cared for them. Journaling is another great option!

If you have trouble letting go, I’d love to connect about how we can help you let go easier and move forward!

Nurses Falling in Love with Patients

Nurses Falling in Love with Patients 

Unless you work inside the prison system, I don’t think nurses falling in love with patients is really that common. Most of us just aren’t thinking that way at work.

I don’t know about you, but once someone puts on a hospital gown it completely shifts my perspective. 

If you’re working inside the prison system or thinking about working inside one, then know it’s a real problem among female nurses.

Prisoners have all day to think of ways to manipulate your good nature and before you know it, the nurse-patient relationship is compromised.

I interviewed for a position at a correctional facility and they were very upfront about it. I’ve also spoken with nurses that have worked at correctional facilities and the stories were…interesting.

Nurses sleeping with or falling in love with inmates is an issue. 

It’s especially dangerous because once a nurse crosses that line, inmates manipulate and blackmail nurses into: 

• Sleeping with their inmate friends 

• Doing tasks for them 

Inmates have even threatened to harm them outside of work. 

It puts the nurses' license and livelihood in real jeopardy and potential danger.

Correctional nurses need to make sure their ability to say “no” when necessary is strong, self-confidence is in check, and walk that fine line between compassion and empathy vs firm boundaries.  

If you work for a correctional facility, I’d love to support your success and boundaries in that specialty.  

Feel free to contact me here! 

Outside prison walls, when people think of a nurse and patient romantic relationship, Florence Nightingale syndrome is usually the first thing that comes to mind.

There’s debate about the meaning behind this phrase because even though it’s associated with describing a nurse falling in love with a patient, there’s no actual proof she ever fell in love with anyone she took care of. She also never married.

Fun fact, there’s now even a reverse Florence Nightingale syndrome when a patient falls in love with their nurse. 

Regardless of who falls in love with who, the nurse is the professional. The nurse is responsible for keeping the relationship therapeutic.

If you find you can’t or a patient isn’t honoring your boundaries, ask for a different assignment or trade tasks with your work bestie for the day. 

Also, the NCBSN published A Nurse’s Guide to Professional Boundaries you’re able to access online, for free, at any time.

Here’s the link:

https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf

In just 5 minutes you can:

• Feel balanced and at peace by turning off overthinking and 2nd guessing yourself so you can increase your confidence and feel like yourself again.

• Decrease stress and anxiety by using the very same tool I did so you can finally stop tossing and turning and get some good sleep tonight….naturally!

• Practice 1 secret to improving boundaries and decreasing burnout: letting go of what isn’t yours to carry so you can decrease overwhelm and protect your space.

I was just a bedside nurse, exhausted, stuck, and feeling dead inside. Dreading both home and work I dreamed of having a life that I loved. After turning that dream into reality, I now help women connect with their inner power and step into their dynamic, authentic self to create a life they love.

I made a promise to myself at 30 that each year would be better than the last…..and I’ve been able to keep that promise!