The “I know you” Patient-What Do you Do

You just got your assignment for the day. As you are looking at your patient assignment list, you recognize one of them. It is your neighbor from down the street. You do not know them very well, but see them almost everyday. Do you go ahead and take them as a patient or ask for a different patient? This is something to think about ahead of time as you will likely run into this situation. Maybe not necessarily with a neighbor, but perhaps a family friend, close relative, peer, previous coworker, and/or acquaintance.

Personally, I would explain to the charge nurse the situation and ask for another patient. Here are 3 reasons why this is what I would do:

1. Patient Privacy: They might not feel comfortable with you seeing them in the condition that they are in during their hospital stay. Many patients also have medical conditions that they may be embarrassed or ashamed about. Most people do not particularly want to reveal these things to people they know and understandably so. There is also the potential that a patient’s “private parts” may be exposed for assessment purposes. Even though, as a professional, this may seem like “no big deal, this is my job”, its not their job and its not your body part being exposed. This may make the patient very uncomfortable and also makes the nurse’s job more difficult, as they are not able to completely assess them properly (if that is an area that needs to be assessed). The patient may not speak up about this. It is important that we consider and protect their privacy, even if that means asking for a different patient.

I had an experience once related to the above, but I was actually the patient. I knew the nurse taking care of me. I felt a little awkward with her doing an exam/assessment on me. Even though I am in the medical field and she was completely professional about it, it just felt like someone else needed to be my nurse. It just made me feel weird, uncomfortable, and exposed. There wasn’t anything sensational or news worthy about my exam, social history, or health history. But it just didn’t feel right to me as a patient. Sometimes we feel this way even when we don’t the the nurse, thus knowing them has the potential to double those feelings.

We assume that medical professionals always follow HIPPA, but some patients don’t completely understand the extent of this law and/or legal repercussions. Patients may feel extra vulnerable and worry that their nurse will talk to mutual peers, friends, neighbors, and family about their medical conditions. The last thing a patient needs is the extra stress of worrying about something like this. Patients have a right to keep personal situations personal and separate from their outside lives.

HIPPA is crucial to our ethical, legal, professional, and moral obligations as a nurse. It is an oath that we commit to religiously as a medical professionals. We should not engage in anything that could potentially compromise this promise that we have made.

2. Favoritism: Question: Would you take care of other patients exactly the same as the patient you know? We would like to think so, but in reality this may not actually be the case. Sometimes the patient may even expect more because they feel they should get the “hook-up” aka-special treatment. Sometimes as nurses we also feel obligated to do more. And even though we don’t mean to treat them differently, we may worry about what they might say to mutual friends, family, etc. Of course we want them to tell others that we are a GREAT nurse. We may feel obligated to go above and beyond what we normally do. So naturally, people tend to put on their best behavior: do more favors, spend more time, go the extra mile, and make exceptions. As the nurse or the patient you may say “well its a perk of being in my circle” or “It’s good thing I have a nurse as a friend/family..”. But on the flip side of things, what does this take away from our other patients? Are we spending more time in our acquantaince’s room? People we know may also want to share stories and talk for long periods of time to “catch up”, and course you don’t want to be rude. But you are also a professional who is taking care of others, with tasks that need to be done in a timely manner. You also have priorities. As a nurse, we all know our time is crunched-limited. We also know that just because you are two steps ahead at 1300…that may just mean that you are not 10 steps behind at 1800.

You may also get “do I really need to do this?” from the patients. Lets face it, many of the tasks that we do as nurses, are not the most pleasant activities for the patient. But are necessary for progress and good outcomes for our patients. Painful Procedures, nursing tasks, lab draws, finger sticks, debridements, vaccinations, dressing changes, physical therapy, increasing activity post surgically, waking them up at 4 am for vitals, etc..are not usually a patient’s favorite things to do. Even though, one would like to think that our first inclination as nurses would be to explain to them the purpose behind the task, however, sometimes (not always), we may be a bit more lax on those we know. We need to be able to do our jobs without bias, favoritism, or special expectations coming from our patient. Every patient may have a different diagnosis, to do list, medical history, or med list. But every patient should be treated with as much respect, dedication, commitment, dignity, concern, and care as the next. There are always exceptions to rules, but rules are also in place to protect ourselves and our patients. Our goal is to achieve the best outcomes and progress for our patients.

3. The Happy Hostess Effect : They are not hosting a party and you should not put them in that position, even if they are know for “hosting”. We are there for the patient, not the other way around. Even if you are excited to potentially see a patient who you know..they may not be as excited to see you, because they may not feel like their normal self and just don’t feel like putting on the hostess roll while they are there. And you shouldn’t expect them to do this either or put them in that position. We naturally try to be consistent with who we are when we are around others, but sometimes we are just not ourselves. And that is ok. As medical professionals, we often see people when they are at their worst. And along with that comes; they may not feel like putting on a show. We want them to be able to feel comfortable to ask if they need something, to complain, to cry, to tell us when they are in pain, and/or to speak up if something doesn’t feel right. Sometimes out of guilt, patient will avoid complaining or asking you for anything because “I don’t want them to wait on me”. Therefore, patient may neglect to ask for things that they might normally request. We hate to think that people are being fake. I hate to call it that, rather, I think it is more that socially, we do wear different mask. From person to person, place to place, situation to situation..that is just how people are. It is how we handle things. It is important to be courteous, cordial, have manners, etc, but nurses are trained to understand when patients aren’t these things. Some of the “meanest” patients I’ve ever had, passed away the next day. I did not take their anger personally, instead I tried to have empathy. Pain, procedures, surgeries, disease..are all very stressful things on the body and the patient’s mental state. We get that as medical professionals. This doesn’t mean that patients should treat us terribly. Instead, we understand that they are not being the nicest person because they just don’t feel well!! Manners and appreciation are expected and important from both sides. But we don’t want patients to feel like they are hosting a party for our convenience. Going back to the personal example that I used in #1, I also felt like I didn’t want to bother her as much because I knew her. I would wait longer to ask for pain medication and other things I needed. We don’t want to do this to our patients. Sometimes being in the patient’s position is the best way to see it literally and figuratively through their eyes.