Some of my oncology nurse colleagues give patients their personal cell phone numbers. Patients sometimes call or text them after hours, on weekends, and even on days off. In my opinion, as harmless as it may seem, the practice sets up barriers for the rest of the team because some patients will not call back; rather, they only respond when they see my colleagues’ personal number as the caller. Some of the conversations sound more like friends catching up and less like a professional discussion about an issue or concern. I know we all have to make our own professional choices, but sometimes I feel like I’m the odd one for not giving my number when patients ask if they can text me. Am I behind the times? — Name withheld on request
In some work settings, nurses use work cell phones provided by their employer; however, the scene described here clarified that the nurses are using their personal cell phones. This represents a big difference in expectations. When one is expected to use a work cell phone, he or she may take calls or even texts at that number during the day, in addition to taking calls from a desk phone. If one is using a work cell phone, expectations for terms, days, and hours of use should be clearly defined.
However, this situation sounds as though there are no employer provided phones, but rather, colleagues are choosing to use their own personal phones to communicate with patients and/or families. Do your colleagues freely give their cell phone numbers to all patients or only certain patients? Are you concerned that there is bias in terms of who your colleagues give their phone numbers to?
There may be potential ethical considerations, such as: professional boundaries (personal communication with only some patients outside of usual business hours), integrity (perhaps in the kinds of interactions that are taking place), moral questions and/or expectations (feeling pressured to question your own professional behavior when it differs from colleagues), and professional judgement (when behavior of someone on your team affects communication with the patient by anyone else on the team).
To answer your direct question, yes, times are changing; however, we still have professional and ethical responsibilities. We live in a world where people — not just patients — are used to having direct access to others at all times. Patients and/or families may have expectations that do not align with what’s possible in our work settings. Boundaries are necessary to set proper expectations of the professional relationship. Redirecting a patient or family member to the ways that they canreach you is acceptable.
Here are some suggestions for how to handle this conflict:
- Seek supervision, talk to a mentor or other trusted colleague. This person does not have to be on your team, but getting professional advice from someone familiar with your work setting can be helpful.
- Are there policies and procedures at your place of employment that address this behavior?
- The American Nurses Association Code of Ethics addresses these issues and others in various sections: Provision 1 Section 1.2: Relationships with Patients; Provision 2 Section 2.2: Conflicts of Interest for Nurses and Section 2.4: Professional Boundaries; Provision 4 Section 4.3: Responsibility for Nursing Judgments, Decisions, and Actions; and Provision 6 Section 6.2: The Environment and Ethical Obligation.
- Where there is concern about inappropriate patient interactions, you may need to address this with your colleague directly. If you’ve already done this and the behavior continues, it may be time to talk to a supervisor.
Your colleagues may still choose to give their personal numbers; however, their behavior doesn’t have to impact the boundaries you’ve set for your own practice.