I have been working as a nurse practitioner for over 10 years. Oftentimes, we as nurses come across patients that cross professional boundaries. In my clinical experience, I’ve noticed that many of these difficult patients are medical professionals themselves.
Some of these patients like to direct how they want their patient care to be done. For example, I’ve cared for nurses and nurse practitioners who remove their own peripheral IV, change the pump settings because they feel they don’t need the fluids any more or think that they are receiving too much fluid, and some who disconnect their IV tubing because it’s easier for them to ambulate in and out of bed.
I have also encountered a physician, who requested a staple removal kit after a routine cervical laminectomy, so he could remove his own staples from his head prior to his post-op visit with the neurology surgeon. I’ve had physician patients who come into the nurse’s station to see their chart, request that I bring up their lab results on the computer so they can evaluate them, and dictate their medical care in regards to what they do and do not need to have done during their hospital stay.
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However, the most memorable patient was a gastroenterologist attending that I admitted with abdominal pain and nausea due to a possible bowel obstruction. He was very anxious when I went to see him in the middle of the night. I assessed him, and then notified the senior resident on call after my evaluation. At the institution where I worked during that time, professional courtesy is given to medical attending who work in the hospital when they are admitted. Senior residents on call are in charge of their care.
I ordered an anti-emetic medication along with a dose of lorazepam to help with his symptoms until the senior resident returned my page. After 10 minutes of the attending receiving the medication, I went back to reassess him. Since the senior resident had not returned my phone call in a timely manner, I decided that I would need to insert a nasogastric tube if the patient still had severe nausea or vomiting.
To my surprise, when I went back into the room I saw that the nasogastric tube was inserted in my patient’s nostrils and he was asking the nurse to connect it to the suction for drainage. Apparently, while I was at the nurses station placing orders and waiting for the senior resident to call back, the physician (a well known GI attending to the nursing and medical staff) had requested the supplies with plans of inserting the NG tube himself, because he felt waiting 10 minutes was too long.
The patient placed the nursing staff in an awkward situation. He overstepped his boundaries as a patient by exerting his hierarchical authority on the medical staff. When he decided to treat himself, his actions made me feel that he thought I was incompetent in doing my job.
As medical professionals, it is easy to say that patients overstep professional boundaries and make obscene or ridiculous requests. When we as medical professionals become patients ourselves, we need to remember to respect the same boundaries that we expect our patients to recognize.
In nursing one of the most important things imbedded in our training is to respect a person’s boundaries, ethics and cultural beliefs. We need to remember these values, show respect for our fellow medical providers and give them a chance to provide appropriate medical care that is in line with their institutional policies.
Next time you become a patient remember to show professional courtesy and acknowledge the competency of the staff that is providing your care, because we all have a specific job carry out.
Lenora Brown is a family nurse practitioner in New York City.
