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Blurred Lines: Proper Nurse and Patient Boundaries
Date Posted: 10/Aug/2014
Most nurses join the healthcare profession because they genuinely care about other people and have compassionate hearts. Really, nurse’s ability to provide assistance and comfort is a virtue. Sometimes, however, what one considers innocent-support is not seen as professional. It may cause the nurse to cross over the invisible nurse and patient boundary line. Occasionally, due to the sensitive nature of certain situations, some are more susceptible to offering support that could be misconstrued. 
So how does a nurse keep a balanced level between supportive care without getting TOO involved? The line between therapeutic and improper is a line that varies depending on the particular situation. Nurses, especially travel nurses who may try to form friendships with patients because of them not knowing locals as well, can find themselves accidentally acting in a way that is not proper. However, the rules are confusing, let’s be honest!
The American Nurses Association’s (ANA) code of ethics states, “The nurse acts to safeguard the patient when his care and safety are affected by the incompetent, unethical, and illegal conduct of any person.” 
The best thing you can do to understand proper etqieuette between relationships with someone you’re treating, you’ve got to get schooled. In order to ensure your patient feels safe and that you do not accidentally jeopardize your career, its crucial to get yourself educated on what is appropriate and what is not. Read up on the literature out there and maybe even find a seasoned nurse that can help mentor you so that you never run into any issues. At the same time, if you see a new nurse that may not know proper boundary protocol, try taking them under your wing and teaching them!
The American Nurses Association’s (ANA) code of ethics states, “The nurse acts to safeguard the patient when his care and safety are affected by the incompetent, unethical, and illegal conduct of any person.
What is the definition of “professional boundaries?”
The National Council of State Boards of Nursing (NCSBN), says professional boundaries are “the spaces between the nurse’s power and the client’s vulnerability.” So what exactly does that mean? Well basically, it means that because you are the one in the position of the professional and they are in the position where they depend on your care, its important to conduct yourself in a way that makes your patient’s needs met safely. 
Different Levels of Boundary Crossing
Not all boundary crossing in created equal. It ranges from slight or accidental done as to help the needs of a patient to the other end of spectrum–wildly inappropriate behavior from nurse to a patient.
. Boundary Crossing-
These might be accidental or done with the best interest of the patient in mind. This is the most common form of boundary crossing that occurs between patient and healthcare professionals. Some examples of this would be a nurse disclosing/over-sharing too much personal information to someone they were treating.  This usually happens as a way to reassure or relate to the patient. But, despite the good intentions of doing so, it can interpreted as unprofessional or make the patient feel uncomfortable. Accepting gifts from a patient also is not okay. It may seem like a nice gesture, but it can become inappropriate. Also, giving excessive attention to a patient where it is not necessary is boundary-crossing. (However providing too little attention is also a big no no.)However, these mild behavioral slips usually do not lead to punishment or go unnoticed.
. Boundary Violation-
A common boundary violation is when nurses break the privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) by discussing or disclosing a patient’s personal information outside of for treatment purposes. Do not share intimate feelings or personal problems (and absolutely never talk about anything of a sexual nature–that crosses into the next level, sexual misconduct.)
. Sexual Misconduct-
This is absolutely the worst level on the totem pole of boundary-crossing in nursing. ANYTHING between a nurse and patient that can be interpreted as sexual in nature falls under sexual misconduct. You can’t hint around about kissing (or heaven forbid worse actions) to any patient or relatives/family of the one you are treating. You also cannot solicit dates from any of these people. A sexual relationship with a patient, even if it is started by the patient or they offer consent, still is sexual misconduct.
Stepping the line of personal boundaries in the nursing profession is a slippery slope. In order to make sure that nothing you do ends up escalating negatively or so that your innocent actions don’t get interpreted the wrong way, be mindful of some practices you should shun in your practice. Some examples of  things to avoid while in the professional setting include:
. Speaking of your own/your co-workers inabilities in the profession
. Discussing topics with patients/their families that are outside of what is related to the practice
. Singling out certain people–giving them excessive attention compared to other patients (or providing less attention)
. Sharing secrets with guests
. Feeling that you understand the patient more than other hospital staff
. Making rude comments
. Doing outside favors like getting groceries for patients
. Flirting (obviously! Just don’t do it.)


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