Navigating the gray area between excellent professional care and inappropriate behavior can be difficult.
Oncology nurses should aspire to give care that goes above and beyond what is necessary to assure the safety and wellbeing of their patients. They are charged with reducing the suffering of patients with cancer but also should do what they can to ensure a positive patient experience. Today’s healthcare environment is competitive, and, practically speaking, care is partially judged by patient satisfaction.
There is, however, a gray area between what qualifies as excellent professional care and what crosses the line into inappropriate behavior. Is doing a favor for a patient simply providing excellent care? What determines if a favor is reasonable? Ask these 3 bottom-line questions. Is the behavior:
The first 2 questions may be easier to answer, but the last can be tougher. It might help to consider if the action could be done for any patient. The real-world scenarios below might also help guide you.
SCENARIO #1: Martin is on the inpatient oncology unit on bed rest, with only bathroom privileges. He asks if anyone going downstairs would be willing to buy him a couple of magazines using his money. As his nurse, you agree to do so.
The exchange of money between a patient and healthcare professional can be tricky and could become a he said/she said situation. Having someone witness when the patient gives money to the nurse and providing the patient with the receipt helps protect staff. Consider contacting volunteer services, which may offer reading materials, lending libraries, or humor and art carts.
The next day, Sarah, another patient on the same unit, learns that Martin had staff get him some magazines. She asks if someone could pick her up some chips. Your colleague who is caring for her states, “Sorry, I can’t do personal favors for patients.” Now Sarah thinks that Martin got special treatment.
It is not that one nurse was right and the other wrong—different nurses have different boundaries regarding personal versus professional behavior. In this situation, the action was not illegal or unsafe but might be considered outside the scope of professional care.
SCENARIO #2: John finishes a treatment in the outpatient infusion area and learns that his ride can’t pick him up after all. He asks his nurse if the cancer center volunteer could give him a lift just this once. She lives about 10 minutes from his house, and they have formed a special relationship.
Hallie comes alone to the same cancer center because her family members are day laborers—if they do not work, they do not get paid. This rural area has no mass transit, ride-share, or taxi service. The nurse navigator usually offers her a ride home because Hallie lives along her commute.
John asks a favor of a volunteer (just this once); Hallie's nurse navigator offers (frequently) to give her a ride home. Is there a difference in policy or guidelines for a volunteer versus an employee? Is the situation different if the patient asks for a favor versus a nurse offers it? Does it matter if a favor occurs once versus all the time?
Although these situations differ slightly, the main concern is the same—safety. Suppose there was a car accident or the patient fell while walking from the car. Who would be liable? This behavior most likely violates the employer policy for both the employee and the volunteer. Employee guidelines usually apply to volunteers, who are considered an extension of hospital staff and follow the same privacy and safety rules.
If a ride is given 1 time, the patient (and probably coworkers) might expect it again. When other patients hear about it, the situation may escalate to where many patients assume that staff can provide transportation services. Bring the matter to management’s attention so that a proactive plan can be put in place for these situations.
SCENARIO #3: Mariana’s fluorouracil pump is due to be disconnected Thursday afternoon. Her daughter, who usually drives her, unexpectedly had a work situation she could not get out of come up, and Mariana has no way to get to the office. If her pump is not disconnected, the alarm will go off and might upset her. One of the infusion nurses realizes that Mariana lives in an area that’s on her commute, so she stops at Mariana’s home, disconnects the pump, flushes the line, and brings the pump back to the office.
This action is likely unsafe and possibly illegal. Providing home care is likely outside the scope of practice of an outpatient infusion nurse. If something were to happen, the nurse—and potentially her employer—could be held liable, since this is a patient under their care. Alternative solutions include coaching Mariana over the phone about how to turn off the pump or seeing if a home care nurse could help.
SCENARIO #4: Rajesh is a patient with end-stage disease and not yet on hospice. He has run out of his narcotic analgesic. He lives alone and is unable to come to the office, but if his meds are not refilled, he will begin to have a great deal of pain. His office nurse asks his physician to write a script, which she delivers to Rajesh on her way home from work. His sister will be able to take it to the pharmacy the next day.
Although this may not be illegal, unsafe, or unprofessional, the issue is that it cannot be done for everyone. What if another patient learns that a prescription was delivered? Could delivery become an expectation or seem like favoritism? Alternative solutions include calling in the prescription to a pharmacy that delivers or connecting with a volunteer organization that serves Rajesh’s community.
Helping in a personal relationship is very different from in a therapeutic, professional relationship. Knowing the differences can promote early recognition of a potential boundary crossing and prevent workplace conflicts.
Before doing a favor, quickly reflect on its consequences and impact. Think through potential perceptions from all sides—patients, colleagues, managers, employer. Consult with trusted colleagues. Consider contacting a manager to make sure actions align with employer guidelines. Favors may be done with good intentions but backfire if the behavior is illegal, unsafe, or unprofessional.
Sometimes oncology nurses get into sticky situations with favors because they try to do everything themselves, but that can cause the nurse to have feelings of inadequacy that can lead to moral distress, compassion fatigue, and burnout. Reach out to social work, volunteer services, management, or other team members to explore potential resources or help brainstorm possible solutions.