In nursing school I was always taught to maintain professional boundaries with patients, including never sharing any personal information like my address or contact information. No matter how many times faculty members said it, we never role played scenarios with that situation. I was unprepared for the moment, six months into my nursing career, when a kind, gentle, nonthreatening woman asked me for my address so she could send me a Christmas card.

Lisa Zajac, DNP, RN, ANP, BC, OCN®
Lisa Zajac, DNP, RN, ANP, BC, OCN®

I had to think on my feet. In that moment, in January 1998, my 22-year-old, novice nurse’s head couldn’t come up with a good reason to say no, other than saying my professors told me not to. This patient with esophageal cancer had a poor prognosis, and I knew it unlikely she would live to see Christmas. Plus, she was prepping for surgery the following morning and was quite anxious about the upcoming procedure. Her family had left for the day, and she was scared. I struggled to justify denying her, so I didn’t.

I still recall her smiling, grabbing a pen, and handing me the one bedside item patients use to document the most important information we provide them: a box of tissues. As I wrote my name and address on the back of that box, I felt as though I had broken the cardinal rule of nursing. I worried about that encounter for the next two days.

The patient's procedure went as planned, and she was discharged the following day. I was almost to the point of forgiving myself when I got the phone call from home the day after my patient was discharged. My mother told me about a mysterious floral delivery. I came home that night to a Minnie Mouse planter from the patient’s family. My first thought was, “What have I done?"

The patient died the next month. The following Christmas, and every year since, I’ve received a card from her daughter. She shares moments in the family’s life and, after many years, still thanks me for the exceptional care I gave her mother. As I write out my cards each Christmas, I always make sure to send her one as well, updating her on how I’m doing personally and professionally. Each year when I get her Christmas card, I think of that Sunday night when I first met her sweet mother. That Minnie Mouse planter still holds a place in my parents’ basement, reminding me that not every procedure or boundary with patients is set in stone.

Since then, I’ve only shared my personal information with less than 20 patients or families. Most times, I would give them my phone number or email, but a few times I did provide my address because I had developed relationships with patients or their families.

For some patient encounters, I did not tell them much about myself, but with others, I shared more. Each time I made the decision to break that professional boundary, the messages engrained from nursing school would flash across my mind. However, as I moved from a novice to expert nurse, I learned that following my heart and mind was sometimes more important.

This aspect of nursing, like all, is a delicate art, a muscle I developed over time. My heart, mind, and gut led me where I wanted to be with each patient I cared for.