Is the hospital a good solution? or a crutch?

[Think About It...]

Hi,

I posted several months ago about a friend who is also my medically complex son's full-time nurse. She has worked with us just short of a year now, and her work has consistently been affected by her condition - primarily due to her tumultuous relationship with her boyfriend.

She has accepted that she has BPD and did intensive DBT late fall/early winter. Things seemed to be looking up. But upon returning this week from a 2 week vacation that she planned for 6 months -- specifically to get her mind off of her issues and "have something to look forward too" -- she is suicidal. In addition to the post-vaca downer, her boyfriend is being very distant.

She asked me if she could still work here if she took a break and admitted herself to a hospital. I told her of course she could.

But now I have at least two reservations.

1) that's even MORE time off, in addition to all the days she missed due to her monthly breakdowns, her days when she's barely here leading up to her breakdowns, her time off to go to the DBT therapy, and what ended up being 3 weeks off for her vacation.

2) I've read that hospitals can be bad for people w/BPD? She doesn't expect it will help, I think it's a place she can go to hide, and be protected from self-harm.

I feel at my wits end. ** Am I being co-dependent by assuring her that her job here is safe if she continues to "need" as much time off as she feels she needs? Or am I being supportive in case she really is going to self-harm? **

I also feel frustrated because though in therapy and on meds, she continues to a) eat only 1 meal a day and 2) drink Coke all day. Healthy people who adopted this habit would feel completely like crap physically and mentally within weeks, or even days.

** Is it wrong to tell her that yes, she can take time to check into a hospital, but she needs to change this eating pattern? **

I would never make such demands on anyone else, and it feels weird to consider this. But I also feel like the burden is on me, all the time, to make concessions. And I resent that she won't change this aspect of her health, when without changing this, there is no way she can feel better.

I want the healthy version of her, which I've seen and really like. And I'd take the unhealthy version of her -- as a friend -- but it's not fair that a year into this, I'm still dealing with it while she's on work hours.

And I don't know what to do.

thanks for listening.

[catherinegerard]

Hi,

I posted several months ago about a friend who is also my medically complex son's full-time nurse. She has worked with us just short of a year now, and her work has consistently been affected by her condition - primarily due to her tumultuous relationship with her boyfriend.

She has accepted that she has BPD and did intensive DBT late fall/early winter. Things seemed to be looking up. But upon returning this week from a 2 week vacation that she planned for 6 months -- specifically to get her mind off of her issues and "have something to look forward too" -- she is suicidal. In addition to the post-vaca downer, her boyfriend is being very distant.

She asked me if she could still work here if she took a break and admitted herself to a hospital. I told her of course she could.

But now I have at least two reservations.

1) that's even MORE time off, in addition to all the days she missed due to her monthly breakdowns, her days when she's barely here leading up to her breakdowns, her time off to go to the DBT therapy, and what ended up being 3 weeks off for her vacation.

2) I've read that hospitals can be bad for people w/BPD? She doesn't expect it will help, I think it's a place she can go to hide, and be protected from self-harm.

I feel at my wits end. ** Am I being co-dependent by assuring her that her job here is safe if she continues to "need" as much time off as she feels she needs? Or am I being supportive in case she really is going to self-harm? **

I also feel frustrated because though in therapy and on meds, she continues to a) eat only 1 meal a day and 2) drink Coke all day. Healthy people who adopted this habit would feel completely like crap physically and mentally within weeks, or even days.

** Is it wrong to tell her that yes, she can take time to check into a hospital, but she needs to change this eating pattern? **

I would never make such demands on anyone else, and it feels weird to consider this. But I also feel like the burden is on me, all the time, to make concessions. And I resent that she won't change this aspect of her health, when without changing this, there is no way she can feel better.

I want the healthy version of her, which I've seen and really like. And I'd take the unhealthy version of her -- as a friend -- but it's not fair that a year into this, I'm still dealing with it while she's on work hours.

And I don't know what to do.

thanks for listening.

[Steph]

 I would look at what you and your sons needs are, and go from there, making that your ONLY priority.

 I am a nurse so what follows comes from someone who knows nursing well.

The patient and family is NOT there to meet my ( any nurses ) needs, ever...this means that my focus is on my patient only and that it is unethical for a nurse to break the boundaries she has and expect you to take care of her. In my opinion, she is not being at all ethical to be dumping all of this on you, and in fact, this is a situation that is reportable to the board of nursing.

  I know you like her...but she has done things that are unprofessional and unethical, which compromise the nurse/patient relationship, his care and even her license.

I would look for another caregiver, quickly. Perhaps utilize the services of a professional agency. She is in no shape to be caring for others. If she were, you wouldnt know about all of these issues. It is not professional or ethical for her to be sharing this part of her life with you, at all.


Steph

PS It is also a boundary violation for her to be friends with you, going forward, and can get her in alot of trouble. This really is a mess and you need someone who will keep healthy boundaries for the sake of your son, and the health of your family. I am sorry this is going on.

[catherinegerard]

Thanks Steph. You've given me a lot to think about.

I'll add a third reservation that silly me, I just realized:
I believe she is seeking hospitalization to get attention from her boyfriend.

My husband warned me not to sway her one way or another - he's worried she'll do something to herself, and I'll blame myself.

I told him, that's exactly the problem - that I even have to worry about that.

Tomorrow I am going to attempt to set boundaries. I truly don't nkow that it will work -- on her end. But they will stand on mine. She is to be professional and clear headed at work, and not to bring her personal issues here. It's unfair to my family, and mostly to my son.

And if she wants to take more time off to sort out her personal issues, I can't guarantee she will have a job waiting for her. The drama never ends, and she can't expect me to wait patiently believing that one day it magically will.

As for finding another nurse, that part isn't so easy. We do work with not one, but two agencies. She is the most attentive to my son of anyone he's had. Whether that's healthy or not for her... I don't know, and am not going to worry about.

It is hard to be this distant to someone in need... wow, boundaries...

[catherinegerard]

Any advice for how to set boundaries? And what to expect?

I'm awake at 4:30am right now, thinking about this.

If she's dysregulating, how can I tell her that her job isn't safe if she's hospitalized?

But I need a nurse here who is going to be stable enough to do the job. So how can I *not* lay down some ground rules for her continued employment here -- a year into this drama?

Then again, since her only goal is to marry this guy, what the hell difference does anything I say make anyway? She doesn't want to get better. There are several things she would have done by now if she'd wanted that. All her moves in that direction are to toe the line her boyfriend sets, under threat of him leaving.

I have so many things I need to get done tomorrow, and this week -- and here I am, again, considering her mental health situation and how to navigate it.

In my "ideal" situation (if you could call it that), I tell her she's still on an unhealthy path of pain, that there are things she shoudl be doing to help herself, and that she needs to be doing them if I'm to have faith that her priority is to get better.

They include: Calling her therapist; Eating 3 meals/day; showing true willingness to move beyond her belief that without this guy in her life she's better off dead.

Is this even possible? And if not, what do I do? Call the agency and have her removed? I can't do that.

Please help.

[Auspicious]

Any advice for how to set boundaries? And what to expect?

I'm awake at 4:30am right now, thinking about this.

You highlight the problem there, in a nutshell.

You are choosing to have weak or non-existent boundaries with her. You are choosing to involve yourself in her problems. And this isn't helping you or her.


Nothing about her and her boyfriend and all that is any of your business, or problem. Is it?

You need a different nurse for your child. Someone that messed up is not in position to properly care for someone. Whether you want to be her friend or not is a separate question, and up to you.

If she threatens to harm herself or others, call 911. Beyond that, you are hurting her and you.

Have you considered a therapist for yourself?  Something is appealing to you about involving yourself so deeply with her drama. What is it?

[catherinegerard]

Homecare, by its nature, makes boundaries difficult. My husband and I have gotten to know each nurse who has worked here quite well.

But normal, healthy nurses have an innate sense of boundaries, so it's fairly safe. Perfectly safe? No. But it's hard enough having "staff" in our house. Being people we're not -- distant -- isn't sustainable. Especially when these folks see us in our pjs, see us resuscitate our son, etc. It's an intimate affair.

Her issues came out slowly, before I had any idea of BPD. Eventually I knew I was dealing with a hot mess.

And when it was clear what was going on, my husband and I discussed it and agreed that she is good for our son, and this is a safe place for her, and we would support her. Unorthodox? maybe. Unwise? maybe. But if we can bear it, then it's the right thing to do. maybe.

I also put up boundaries, stopped engaging in personal conversation.  And she has tried too. We've gone long stretches without talking about her issues, at least not in any depth.

Yesterday, I asked (thinking it was safe) when her BF was comign back to town, not realizing what state she was in, or that it was currently a very touchy subject.

Your points and questions are understandable. But I don't "need" this or want this drama, hence waking up at 4:30 resentful.

[Auspicious]

But normal, healthy nurses have an innate sense of boundaries, so it's fairly safe.

Right. But for someone with BPD, you can't rely on them to maintain boundaries. That won't reliably come from their side.

But I don't "need" this or want this drama, hence waking up at 4:30 resentful.

In that case, a blunt question - will you find a different nurse?

[Steph]

 Ive been a nurse forever...including pediatric intensive  home care, so I understand everything you say...I know how tough it can be and when you are working within the confines of a family setting, it seems natural for the nurse to become part of your family.

However, that is NOT as it should be. That, as you have seen, compromises the care that the patient recieves and as you well know, you become the caretaker, not the other way around.

 In a nurse/patient relationship, it should be the nurses that set the boundaries. In this case, you have a mentally ill nurse that is unable to provide decent care in your home because of it. She may technically do fine with your son, but look at the bigger picture.

 If I were you, I would go straight to the head of the agency and tell them about her unprofessional behavior. Your nurse needs help...and it is NOT up to you to provide it. Your son needs care, and it IS your responsibility to ensure that he gets a nurse who is professional, caring and competent, as well as nurturing with your child.

I would dump this problem on the agency and ask for someone else to take her place. If other nurses are not effective with caregiving, then it is your responsibility, again, to work with the agency to make sure someone is professional with the care.

As I mentioned before, her behavior is also reportable to the board of nursing. Serious boundary violations as you described are dealt with that that level, usually with education and counseling and that would not be a bad thing for this nurse. If she hasnt done anything dangerous or otherwise incompetent, likely they will ask her to take some classes and meet with nurse educators, and she would come out of this a much more professional nurse in the process.

 I would stop worrying about fixing her, tell the agency what has happened and insist on another staff member who can be professional and nurturing at the same time, for your child. Your nurse has issues that she needs help with, but that is not something you can or should try to fix.

A professional leaves her cares at the door. A professional is competent, caring and patient focused. I know home care is a bag of worms, boundary wise, and some nurses, because of poor boundaries, do not belong in that field. This nurse may be one of them and perhaps education and counseling will enable her to be a better nurse some day.


Dont drop the ball on this one. Your child life in on the line here.

Steph

[catherinegerard]

Right. But for someone with BPD, you can't rely on them to maintain boundaries. That won't reliably come from their side.

My point is that before I knew what was going on, she'd divulged things -- suicidal ideation among them -- that I wasn't expecting. She pushed the boundaries, and I had to figure out how to react to it.

In that case, a blunt question - will you find a different nurse?

No, I won't at this point. I considered it last night, and have considered it in the past. And spoke to her today about her bringing personal stuff here, and being distracted. But the value to brings to our child's life is beyond what any other nurse has brought.

The difficulty we've had staffing this position for our son -- who isn't the most mecially stable of kids -- has been tremendous, annd far and away beats the drama of her mental health issues.

[catherinegerard]

If I were you, I would go straight to the head of the agency and tell them about her unprofessional behavior. Your nurse needs help...and it is NOT up to you to provide it. Your son needs care, and it IS your responsibility to ensure that he gets a nurse who is professional, caring and competent, as well as nurturing with your child.

I would dump this problem on the agency and ask for someone else to take her place. If other nurses are not effective with caregiving, then it is your responsibility, again, to work with the agency to make sure someone is professional with the care.

We wouldn't hesitate to let her go if we thought she was a danger to our child. We have let several nurses go in the past for less.

And it's seriously oversimplifying to say we can just get a new nurse. Worts and all, she is the best nurse we've had -- and we've waited weeks, months -- for some shifts, more than a year -- to get coverage.

Trust me, my husband and I have discussed this many times. We did a lot of soul searching when we first understood her diagnosis (before she even did.) Things got better, and she's in a crisis right now -- and yes, the question was open again, though I was pretty clear this morning that she can't bring her stuff here. And she too said she hadn't meant to -- my question just opened the flood gates. Once opened, boundaries are difficult to reestablish -- but we are doing our best. She knows she can trust me, and she knows that if she's hospitalized I will know and she will lose her job. So it was a fair question. She was feeling out the situation to see what her optinos were, at a time of crisis.

But for me, it was also a fair question to wonder if I *would* keep her with us, if the crisis mode returned and persisted. Hence my post.

Also, I am not trying to fix her. Those talks stopped this past summer, when she was in crisis and I saw the full scope of her issue, and discovered her diagnosis. She is in therapy, and did DBT.

Steph, you might be technically 100% correct, and I may regret this decision. But right now, my best judgment and my husband's is that her benefit to our son far outweighs the drama. It doesn't make the drama ok, but this is life, and things happen that aren't ideal all the time. Isn't this the point of this board -- navigating maintaining volitile relationships? (taking the word relationship in my context differently of course, and recognizing that the first wiff of my son's care being compromised -- vs. her missing work which isn't the same thing, though something to be accounted -- and she's out.)

[Steph]

>>Steph, you might be technically 100% correct, and I may regret this decision. But right now, my best judgment and my husband's is that her benefit to our son far outweighs the drama. It doesn't make the drama ok, but this is life, and things happen that aren't ideal all the time. Isn't this the point of this board -- navigating maintaining volitile relationships? (taking the word relationship in my context differently of course, and recognizing that the first wiff of my son's care being compromised -- vs. her missing work which isn't the same thing, though something to be accounted -- and she's out.) <<

 Actually, the point of this board is to learn about boundaries and communication. When kids are involved, the welfare of the kids come before the welfare of anyone else.

 I reread your old posts and this has been going on almost a year now. While I sympathize with the challenge of finding nurses, I am left wondering why it is so hard to find a competent nurse that wont offer you such a huge risk and drama? As I mentioned, Ive done this work for years, in my career, and while not everyone is a perfect fit in every home, when good boundaries are used, then patient care becomes the priority and the concentration is on the patient.

 Please keep in mind that her instability can hurt your child. Before my husband was well, he would dissociate and not be himself. There is no way he could have cared for a healthy child at those times, let alone a medically challenging one. BPD flks can become psychotic. There is some reason her BF wants her in treatment. Sounds like he sees alot of stuff you dont see, and I would truly consider her a risk to my child. Maybe she is wonderful, and has been, but given her volatility, I dont buy that as a guarantee. She sounds like a scary nurse to me.

  I know one patient..a child I had since he was 6 yrs old who actually died because of the unprofessional care of his nurse, in home care. This stuff happens. Nurses have breakdowns..( a fellow RN friend of mine found her coworker hiding under a patients bed when things were rough for her..) and people can get hurt. Emotional dysregulation with BPD can be very, very severe..to the point to where someone can flip and be a danger to themselves, or others.

Your child is about as defenseless as he can be. I would work really, really hard to find a nurse. Talk to doctors and nurses you know. Perhaps they would know someone looking for exactly what you are offering..One child that I cared for had a nurse that took care of him in the nursery when he was born..because the family asked.

There really are competent and caring nurses out there. Given what you have said, its doubtful she is safe, despite what you see. I would worry ALOT about leaving him alone with her, and what you DONT see. Truly, from what you say, if this were my child, she would be off the case.

 I have had home care nurses in my own home. I lost my husband to cancer many years ago, and I know its stressful living with nurses. Ive seen the stressors, etc, that happen to parents with kids needing 24/7 care. I also see the grief the family has gone thru whos child died because of a nurses instability. It happens.


Steph

[catherinegerard]

I reread your old posts and this has been going on almost a year now. While I sympathize with the challenge of finding nurses, I am left wondering why it is so hard to find a competent nurse that wont offer you such a huge risk and drama?

I wish it were true, but it took our agency a year to find our second primary nurse, to fill the remaining days this main nurse wasn't doing. I posted as well to a forum dealing in our son's issues, and the parents had our take on it - get her better if she's worth investing in. Not saying this is what we shoudl do, just that that IS how hard it is to find great nurses.

Please keep in mind that her instability can hurt your child. Before my husband was well, he would dissociate and not be himself. There is no way he could have cared for a healthy child at those times, let alone a medically challenging one. BPD flks can become psychotic. There is some reason her BF wants her in treatment. Sounds like he sees alot of stuff you dont see, and I would truly consider her a risk to my child. Maybe she is wonderful, and has been, but given her volatility, I dont buy that as a guarantee. She sounds like a scary nurse to me.

Thank you for sharing this. This does scare me. I did share with my husband the feedback you and the other poster shared, so that he knew that people more schooled in this think we should immediately fire her. And I've read descriptions of outrages posted on here, and realized there is alot I don't see.

We will give it more thought. It's hard to picture or remember how bad things can be when we only see a small fraction of it, and she puts on a good face (usually) here. Damn.