As a nurse or other health care professional, we have a special relationship with our patients. People expect a nurse to act in the patient’s best interest and to respect their dignity.
It is extremely important for a health care professional to maintain a therapeutic relationship with the patient. A therapeutic relationship is one where the nurse can apply her professional knowledge, skills, abilities and experiences to meet the patient’s health care needs.
When patients need health care, they are in a vulnerable position and are required to give confidential information. As a health care professional, this position allows access to this sensitive information creating an imbalance between health care provider and the patient. Therefore, the health care provider is in a powerful position, one that should not be exploited.
There are several different boundary issues. The first can be characterized by excessive personal disclosure by the nurse, secrecy or even reversal of roles. This can cause distress for the patient.
Another example of a boundary issue is social media. Once there is a therapeutic relationship, the health care professional should not have personal contact with the patient outside of the health care environment. This means no patient friends on facebook!
Of course, in small communities, you’re going to know them, see them and be polite to them. Beyond that, do not have a personal relationship with a current or former patient!
Some examples of professional boundaries outlined by the National Council of State Board of Nurses (click here) are the following:
The nurse’s responsibility is to delineate and maintain boundaries. The nurse should work within the therapeutic relationship. The nurse should not:
- Discuss intimate or personal issues with a patient;
- Engage in behaviors that reasonably could be interpreted as flirting;
- Keep secrets with a patient or for a patient believing that you are the only one who truly understands or can help that patient;
- Spend more time than necessary with a particular patient;
- Speak poorly about colleagues or your employment;
- Shout at the patient and/or patient’s family;
- Show favoritism;
- Leave a patient in settings besides those used to provide direct patient care or when you’re not at work.
For more resources on professional boundaries, go to https://professionalboundaries.com or search for information on the National Council of State Boards of Nursing http://www.ncsbn.org.
Remember, any boundary violation is considered a violation of the Nurse Practice Act and could be a concern for your license.
Beth Boynton says
Great list of don’ts Lorie and one that every nurse should know. As you suggest, remembering the goal of the therapeutic relationship, i.e. “…to meet the patient’s health care needs” is a great thing to keep in mind when questioning appropriate communication and boundaries. I also like to remind nurses that their needs and concerns are important and finding other resources to get their needs met a healthy alternative to secondary gains from poor boundaries. I’d love to hear your thoughts on that.
Donna Carol Maheady says
Lorie,
Great reminders for all of us!
I would also add the need for nursing educators to recognizer boundaries when working with students. The same issues apply to student/faculty relationships.
Dr. Rachel Silva, DNP says
Thanks for discussing such an important topic that unfortunately is not given much thought, until it could be too late. Excessive personal disclosure, secrecy, reversal of patient and nurse roles, and unprofessional social media posts are all circumstances we need to prevent not only for ourselves, but to ensure the patient’s health needs and outcomes are the priority. Thanks for sharing the link to the National Council of State Board of Nurses as a resource with additional helpful information.
Nicole Graves RN says
I especially agree to never engage patients or their families on social media. As nurses, we need that clean break!
Elizabeth Scala says
I am glad you also mentioned social media in this article. Boundaries are growing online as well as offline. It’s a great teaching point to practice what we do in person on the computer as well. Great post, thanks for sharing.
Greg Mercer says
Thanks for the useful advice: this is an important and difficult topic for many nurses. I work in psycch, and have long found that it’s crucially important to find ways to maintain boundaries without damaging rapport or motivating patients to hold back important information. It’s not easy in such an asymetric relationship!