It’s no secret that the nurse-patient dynamic is unique, and involves a therapeutic relationship with a focus on meeting the health needs of our patients—not ourselves. As nurses, we perform our work by applying our knowledge, skills, experiences, and abilities. To provide the best care, we protect the nurse to patient relationship by establishing and maintaining strong professional boundaries.
Why Have Professional Boundaries?
Professional boundaries exist in nursing for the safety of patients. Nurses are to perform duties in the best interest of the patient at all times. This is not just because of our kind-hearted or good-natured personality. This professional position allows nurses to hold a certain level of authority and influence that impacts every patient in our care. When combined with access to personal information, this specialized knowledge gives nurses an advantage while also presenting a vulnerability for the patient. To ensure patients’ protection and safety, nurses are responsible for creating and upholding professional boundaries during every encounter.
What are Professional Boundaries?
According to the National Council of State Board of Nursing (NCSBN), “Professional boundaries are the spaces between the nurse’s power and the patient’s vulnerability.” When nurses cross professional boundaries — whether intentional or unintentional — it puts the nurses’ needs above those of the patient. Examples of crossing professional boundaries may include:
- Sharing personal or intimate information
- Flirting or indiscriminate touching
- Keeping secrets with or for patients
- Acting as if you are the only one who can care for or understand the patient, positioning yourself as the “super nurse”
- Showing favoritism by spending more time with a patient than necessary, taking sides in disagreements among family members, or performing personal favors outside of your scope of work
- Complaining, joking, or speaking negatively about your employer or colleagues to patients or family
- Meeting with patients outside of work in areas where direct patient care is not being offered
- Posting about a patient encounter on social media via photo or comment
- Encouraging a role reversal, such as creating a situation where patients or families feel the need to provide the nurse with emotional support during times of distress
- Partaking in an act of omission or commission, which refers to any instance where the nurse fails to act in a manner that benefits the patient or threatens their well-being.
Violating Professional Boundaries
The cost to the patient:
Professional boundaries help protect patients in their vulnerable states. When professional boundaries are crossed, the possibility of harm to patients is often not immediately recognized by us or the patient. However, the potential for negative consequences has been formed.
When professional boundaries are violated, the potential for patients to misinterpret our behavior escalates. Patient expectations can change, which may disrupt their outlook regarding sentimental bonds, emotional distances, moral obligations, or personal responsibilities. These altered expectations, which are not authentic and cannot be sustained, typically result in both mental and physical stress for the patient and can interfere with their current health condition.
The cost to the nurse:
According to the NCSBN, “Crossing professional boundaries or engaging in improper use of social media are violations of the nurse practice act and can be the cause of professional discipline and termination of employment.” The repercussions for violating professional boundaries can also go beyond professional chastisement and lead to nurse burnout and turnover, compassion fatigue, moral distress, and negative mental health outcomes.
Tips to Stay Within the Perimeters of Professional Boundaries
To keep professional boundaries securely intact, consider the following:
- Treat all patients with dignity and respect and consistently put their needs first.
- Dress, speak, and behave in a professional manner to reinforce that the nursing profession consists of specialized knowledge that is carried out within a specific scope of practice.
- Keep all patient and family information confidential, speaking to colleagues about patients only when necessary and seeking patient information on a “need to know” basis. Additionally, steer clear from sharing even veiled references of patients or clinical care on social media.
- Nurses who work with less supervision should take extra precautions to maintain professional boundaries, stepping back and evaluating personal behaviors more often if necessary.
Professional boundaries are supported by the values, principles, and standards of the codes of ethics for nurses. Examples of the national codes of ethics for nurses come from the American Nurses Association (ANA) and the Canadian Nurse Association (CAN). Reviewing these codes can help you gain more clarity around your professional position. It clearly outlines both what the professional position role is and what it is not. According to the American Nurses Association’s code of ethics, “When acting within one’s role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships.”