Maintaining Professional Boundaries when Working with Hospice Patients

Medical professionals are usually people who care to help those in pain alleviate their suffering. But it takes a unique person to devote their lives to helping those who are facing death. And it is easy to get over involved with these very needy patients.

Hospices provide palliative care. That means a patient has decided to no longer seek aggressive measures to find a cure for their illness. Instead they wish to be helped to be as comfortable and free of pain as possible for the remained of their days. If you chose to go onto hospice care your primary care physician will become the hospice doctor. Nurses, social workers and CNAs will assume the responsibility for making your last days as easy and pleasant as they can. They will be there or family members to help them with their feelings of grief and loss. They are sincere, caring and very involved professionals.

When working with patients who are counting on you to help them feel well on a daily basis it is hard not to get over involved in their lives - possibly at the expense of damaging your own. Patients get very attached to their caretakers. You feel very needed and wanted. And often, overly responsible. It is very important, if you provide hospice care, to take care of yourself.

If you work for a hospice that has staff support meetings and good supervision you are lucky. Many hospices just don't have the time and staff to provide this type of training and emotional support to their workers. CNAs are especially vulnerable to becoming over involved. They are the folks doing the hands-on work. They are bathing and cleaning and touching the patients. Many of whom are not touched by anyone else. Human contact is an important part of palliative care and most patients wait for and look forward to the arrival of their CNA. More than any of the other team members, the CNA has the most intimate and personal relationship with the patient. The doctor may see the patient weekly and the social worker may spend a significant amount of time with the family. But the CNA is there on a daily basis trying to attend to the every need of the dying individual. They form a bond like no other.

As a therapist I have worked with a number of hospice providers who have lost their boundaries. Their families and their own health suffer when they become too involved with their patients. They often give out their personal phone numbers and get called at all hours of the night. They begin to believe that they are the only ones who can give that special care to the patient who most needs them and so they are on call for them always. They work seven days week because they don't want to not be there if someone declines. As a result their own lives crumble. They do not see their families. They have not time to take care of their personal business. They forget to pay their bills and ignore their own health. It doesn't take long for them to burn out. They begin to feel drained and eventually angry and resentful. But never at the patients. Their angry focuses on their co-workers and family.

If you chose to devote yourself to working with this population it is important to not allow yourself to get caught up in the belief that you are the only one who can deliver the care your patient needs. Don't allow the demands of the job to take you away from your family and friends. Short staffed agencies will ask for as much time as they can get you to give. And the additional money may also be a lure. Hospice workers are not highly paid. Having a supportive mate and a loving family will help you to be in healthier frame of mind and you will do better work with your patients. Going to the doctor when you are not feeling well will insure that you can provide for others longer and better. It is easy to lose yourself when you give so much to others. Be mindful of your own needs, respect your own needs, and remember that you are a part of a team and don't have to do the job alone.