PROFESSIONAL BOUNDARIES

Professional boundaries are the appropriate limits that should be established by the nurse in the nurse/client relationship due to the nurse’s power and the patient’s vulnerability. Working within professional boundaries refers to the provision of nursing services within the limits of the nurse/client relationship. However, nurses who display one or more of the following behaviors should examine their patient relationships for possible boundary crossings or violations:

• Excessive self-disclosure. The nurse discusses personal problems, feelings of sexual attraction, or aspects of his or her intimate life with the patient.
• Secretive behavior. The nurse keeps secrets with the patient and/or becomes guarded or defensive when someone questions their interaction.
• “Super nurse” behavior. The nurse believes that they are immune from fostering a nontherapeutic relationship and that only they understand and can meet the patient’s needs.
• Singled-out patient treatment or patient attention to the nurse. The nurse spends inappropriate amounts of time with a particular patient, visits the patient when off-duty, or trades assignments to be with the patient. This form of treatment may also be reversed, with the patient paying special attention to the nurse, e.g., giving gifts to the nurse. If a nurse is receiving this type of attention from a patient, it is advisable for the nurse to seek the guidance of the supervisor.
• Selective communication. The nurse fails to explain actions and aspects of care, reports only some aspects of the patient’s behavior, or gives double messages. In the reverse, the patient returns repeatedly to the nurse because other staff members are too busy.
• Flirtations. The nurse communicates in a flirtatious manner, perhaps employing sexual innuendo, “off-color” jokes, or offensive language.
• “You and me against the world” behavior. The nurse views the patient in a protective manner, tends not to accept the patient as merely a patient, or sides with the patient’s position regardless of the situation.
• Failure to protect the patient. The nurse fails to recognize feelings of sexual attraction to the patient, consult with a supervisor or colleague, or transfer care of the patient when needed to support boundaries.
  (NCSBN, 2014; TX BON, 2017)