If this is your first time joining this series, I would encourage you to visit the page dedicated to this series so you can start from the beginning. Please click anywhere in this paragraph to get full context.

I really try to keep these articles short enough to be read in 3-5 minutes. My readers are busy, and they work a lot of hours. Today’s subject will challenge my desire for brief yet helpful material. I can bloviate with the best of them. In college I was able to take the simplest of subjects and write page after page of (mostly boring) material. Simply put, I am an expert on my own opinion, and I like sharing it with anyone who will listen.

Boundaries

Only charting at the bedside stands above boundaries when it comes to the big challenges for hospice nurses. A lack of maintaining healthy boundaries with patients and caregivers will destroy a hospice nurse.

1. Turn off your phone

Recently I decided to address this with all my staff. I called the meeting to order, and I instructed everyone to hand me their name badges. I promised everyone they were not getting fired. Then I looked at everyone with a big grin on my face and said, “Okay, you are all now unemployed.” After a few seconds of awkward silence I continued.

”We happen to have two openings here at Interim. Actually, we have six openings now that none of you work here. We have five RNCM openings and one on-call opening.”

I told everyone in the room I was going to offer them a job, and there better not be any surprises with the answers. I then grabbed a name badge one-by-one from the pile and started calling out names.

”Mike, which position do you want? RNCM or on-call nurse?”

Mike: “Case manager please.”

”Jennifer, which position do you want? RNCM or on-call nurse?”

Jennifer: “Case manager please.”

I continued this way until all five positions were refilled. We had a good laugh at how absurd the whole thing was, but my point was made with a little humor. I then addressed the issues we had been having with our cell phones. I’m going to have the same talk with my readers now.

On call exists for a reason. It is there to provide relief to the staff. Regardless of how your organization is set up, there are times you are supposed to be off work. Your work phone should be turned off within an hour of the end of your shift, and an hour prior to the beginning of your shift. Our patients or their caregivers should not expect to be able to reach us around the clock.

”James, can I get your cell phone number so I can call you if I need something?”

”I can give you my number, but please understand I work 8:30am-5:00pm and you will need to call our main number outside of those hours for urgent needs. I will get your messages, but I can’t guarantee you how quickly I can return your call.”

Even when I’m on call, I do not answer patient calls or texts after hours. This is an important boundary I have set for myself. Patients calling me directly also circumvents the system. Their issues and concerns after hours do get logged into the system as an on-call need.

We have to train ourselves to be really good at this boundary. Do whatever it takes. If your company won’t give you a phone, get a cheap pay-as-you-go phone from walmart. Download the Google Voice app and use it for a second number on your phone. Do something. Do anything. Just don’t turn yourself into a 24 hour resource for your patients. It’s not healthy for you and your personal life. It trains our patients and caregivers to rely on just one person. It’s also against Part 3 of this series.

2. Read something that will help with boundaries

A few years ago I discovered this amazing, and short, book by Andy Stanley. It’s an important reminder on the importance of family over work. You can also check out something my wife told me a few weeks ago. Go back and read Part 3 of this series. Are you becoming too much of the centerpiece for your patients? Consider this fantastic book by Henry Cloud and John Townsend on the subject of boundaries.

3. Don’t have favorites

Now this is super hard. We all have patients we enjoy over others. It’s human nature. We have those patients who we feel like we can relax around them. Maybe we have something in common with them. I personally love my military men. My father-in-law is a Vietnam combat Marine veteran. I feel a deep sense of responsibility when I find out one of my patients served in the armed forces.

Becoming too invested emotionally with our patients can have dire consequences. Our visits start to get too long. We start trying to do things beyond the real reason we are there. We are cleaning the bathroom, or joining the family for meals. We are doing grocery shopping, or picking up snacks on our way over to the house.

We are not there to replace family and friends. We will move through their lives over a period of a few short months, and then we are gone. Eventually, we may not even remember their names. This is a harsh truth of what we do.

We are representatives of the federal government. What we do at each visit is actually regulated by CMS. We need to ask ourselves this question: “What is Medicare paying me to do here?” This will help us clarify what our goal is for each visit. This doesn’t mean we can’t enjoy our patients. This doesn’t mean they can’t enjoy us. It means we are constantly aware of our place and how much of ourselves we are giving away.

We must provide equal and same care to all of our patients regardless of where they live, how cute they are, how clean they are or how nice they are.

4. Hospice is not about me

I have to remind myself of this all the time. This is the patient’s care plan, not mine. These visits aren’t about me. I can fall into this trap so easily. I love to be fun. I want to entertain everyone. In another life, I would love to be a stand-up comedian. I can generally get any room laughing. I have the kind of personality that wants to take over a room the minute I walk in. I want to be close friends with everyone. If I find out someone doesn’t like me, I’m flabbergasted.

“What? They don’t like me? That’s crazy! Everyone likes me. Just come and hang out with me for a few minutes. You will like me. I promise. Something is wrong with that lady. She doesn’t seem to like me.”

Hospice is not about us. Not ever. It’s about someone’s mom or dad or brother or sister who is in the last months of their lives. We should not interject ourselves in a way that we become the center point of the experience. We are one member of a larger organization with the singular goal of providing end-of-life care. This isn’t a chance for us to gain a new friend. This isn’t a chance for us to find a new mentor. This isn’t a chance for us to prove ourselves. This is a chance for us to bring the gift of hospice to the community.

Be friendly. Be encouraging. Be uplifting. Be fun if that is what your patient wants. Smile when they smile. Cry when they cry. Talk about sports, or the weather. Find things in common. All of these are fun and enjoyable, but when it moves to the point that we are starting to be treated as immediate family, it is time to take a step back and reconsider the situation.

We do not want to get so close to our patients and families, that when we are no longer there, more loss is experienced. Eventually we will have to pull ourselves away. When we do, the connection should not be so strong that someone gets hurt. That someone could be us, and that will contribute to hospice burnout.

Visit The Hospice Nursing Community for more assistance in avoiding hospice burnout.

James

James worked on-and-off as an LPN for over 20 years. In 2014 he completed a bridge program and became an RN. James became a hospice nurse in January 2015. He lives in the Kansas City area with his wife of over 30 years, 4 daughters and 2 sons in law.