Wednesday, December 17, 2008

nurse-patient relationships (and the ambiguous line)

I had a patient going in and out of afib yesterday. When she was out of afib she was generally bradycardic (in the 50s), however this was quite dependent on her positioning. When lying in bed, she would get down to the 40s, when walking she would be up in the 70s. Cardiac consult came in and ordered a dig load and an increase in her beta-blockers. I was looking at her heartrate (53 at the time) and thinking NO WAY am I giving a digoxin LOAD and a beta-blocker! I clarified this with them, they wanted it given. I discussed it with the charge nurse. I ended up giving the dig load first, and having her stand/walk for about an hour after. Her heartrate stayed over 60. I gave the beta-blocker several hours later, and she again brady'd down to the upper 40s, but was asymptomatic. I had her get up, she was in the upper 60s. Craziness!

So that was my first experience with Afib (and with hesitating to follow a medication order). But another issue arose when it turned out that the patient and I got along very well. We chatted a lot and found out that we knew a lot of the same people. But I felt the eyes of the other nurses on me every time I was sitting down and talking with her. I did not neglect my other patients nor did I reveal any information about anyone else to her. But I felt the pressure of carrying on as a professional at the same time I was becoming someone's friend. Where is that ambiguous line drawn? She wanted to give me her email and I did feel ambivelant about that, too. When is it ok, if ever, to develop a friendship with a patient? Is it ever ok to continue a friendship after the professional relationship ends? I suppose this is left somewhat up to individual judgment. I just did the best I could.

I had to re-evaluate my loan payments. There is no way I could make the monthly payment they were requesting... I am going down to 4% of my monthly income. Tough break! Maybe I should go back to school so I can defer...

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