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Letting others know your limitations is an important step in becoming a reformed people pleaser. Although the changes may take time, the rewards are plentiful.

Carol Selby, MS, NP, was looking forward to a relaxing vacation. After a busy day, she had just fallen asleep when her pager sounded.

Selby sighed when she recognized the phone number. It wasn't the hospital or a colleague paging her. The number belonged to an elderly patient whose frequent phone calls and increasing dependence on her were turning into an unwelcome source of stress in Selby's life.

Like many health care professionals, Selby's desire to help others sometimes ushers her into situations that stretch her patience. In cases like this one, she can't help but to question the wisdom of helping others when it comes at the expense of meeting her own needs.

Selby, a behavioral health nurse for the Eastern Colorado Health Care System in Colorado Springs, Colo., admits that learning to set clear boundaries with patients and colleagues has proved to be one of the steepest learning curves in her 11-year nursing career.

She clearly remembers the first time the elderly female patient set foot in her office. An intelligent woman with no family, the patient suffered from severe depression and was desperate to connect with someone.

"We were making great progress until I took a day off or went on vacation, and then she would fall apart," Selby said. "I made the mistake of giving her my pager number and telling her to use it only in an extreme emergency."

But the phone calls persisted on a regular basis and disrupted Selby's personal life. "She would call frequently in the middle of the night, crying," Selby said. "In the absence of family, she had literally adopted me, and I had gone way beyond the point I should have as her therapist."

Selby eventually sat down with the patient to discuss appropriate boundaries. She asked the patient to throw away her pager number and use the on-call service if she needed to call during off-hours. She also emphasized the need for the patient to use the stress relief strategies they had practiced together.

"I told her that I had allowed us to move into a friendship and that I couldn't be both her therapist and her friend," Selby said. "She respected that decision, and I truly think that setting appropriate boundaries has strengthened our professional relationship."

Selby was pleased when the patient immediately stopped making late-night calls. She also learned that being firm about her own limitations strengthened her professional relationship with the patient.

Just say no

Les Carter, Ph.D., a psychotherapist at Minirth Clinic in Richardson, Texas, has devoted much of his clinical practice to helping people pleasers like Selby change their ways. Carter counsels many health care professionals in his practice, and is the author of People Pleasers: Helping Others Without Hurting Yourself

"I help my patients who are people pleasers to recognize traits that lead them in the wrong direction, assess how they manage their life and work to develop healthy attitudes and behaviors," he said.

For some nurses, the challenge involves more than setting boundaries with patients. Denise Graham, RN, a gastroenterology nurse at Kaiser Permanente in Walnut Creek, knows she has a problem saying no when colleagues ask her for help.

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