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.
Remember, any boundary violation is considered a violation of the Nurse Practice Act and could be a concern for your license.