One of the crucial lessons that nurses begin to recognize early in their education is that professional boundaries in nursing describe a different and more complex type of relationship that we're priviledged to share with patients. This affiliation is much broader than professional relationships experienced by those in other careers. By virtue of our profession, there are many situations in which our designated boundaries allow for intimate entry into another person's life experiences.
Those of us in nursing who explore the meaning of professional boundaries find that such boundaries are critical and provide the guidelines essential to professional effectiveness. Let's take a closer look.
How to stay in the zone
According to the National Council of State Boards of Nursing, the “zone of helpfulness” constitutes the center of the continuum of recommended professional behaviors (see Get in the zone). Professional boundaries define the relationship that supports a therapeutic connection between the nurse and patient.
Follow these guidelines for implementing care within the zone of helpfulness:
* It's critical to treat all patients, at all times, with dignity and respect.
* Inspire confidence in all patients by speaking, acting, and dressing professionally.
* Through your example, motivate those you work with to talk about and treat patients and their families respectfully.
* Be fair and consistent with each patient to inspire trust, amplify your professionalism, and enhance your credibility.
Behaviors to avoid when planning and implementing patient care include:
* discussing your intimate or personal issues with a patient
* keeping secrets with a patient or for a patient
* believing that you're a “supernurse” or the only one who truly understands or can help a patient
* spending more time with a patient or revisiting that patient when you're off duty or out of uniform
* engaging in any behavior that may be misinterpreted as flirting (Nurses understand the difference between a sincere compliment that enhances the patient's self-esteem and one that may be interpreted as flirtatious.)
* taking a patient's side when there's a disagreement between the patient and his or her spouse or the patient and his or her family members.
Out of bounds
Some nurses may perceive boundary issues as threatening and, as a result, move toward underinvolvement with patients. This may be demonstrated by distancing oneself from the assigned patient or showing disinterest in the patient. In such cases, it's important to be aware that boundaries may be violated by any act of omission (failure to act in a manner that's beneficial to the patient) or commission (performing any act that presents a threat to the patient's well being) that negatively impacts the limits of a professional relationship.
When you begin to feel a bit detached, stand back and evaluate your interactions. If you sense that boundaries are becoming blurred in any patient care situation, seek guidance from your nursing supervisor. A sentinel question to ask yourself is: “Will this intervention be of overall benefit to the patient or does it satisfy some need in myself?”
Nurses who work with more independence and less supervision must be especially careful to safeguard professional relationships. Examples of more fluid work settings in which boundaries may be at risk for becoming blurred include home health or hospice. One way in which these settings pose unique challenges is that there's often less access to the professional supports that are available in more traditional healthcare settings.
As professionals, we know that we must keep all patient and family information confidential. This directive also includes making any kind of clinical or patient care references, no matter how veiled, through any social media site (such as Facebook or Twitter). Emotions are personal and a normal part of who we are as individuals. Boundaries are professional and dictate how to protect and best work with patients, assisting them to meet their healthcare goals.
Know your boundaries
The American Nurses Association's Code of Ethics states, “When acting within one's role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships.” It's every nurse's responsibility to become knowledgeable regarding the prescribed professional boundary guidelines. Understanding of, and compliance with, these boundaries allows us to best serve the public during all professional nursing interactions.
Learn more about it
Holder KV, Schenthal SJ. Watch your step: nursing and professional boundaries. Nurs Manage. 2007;38(2):24–29.
National Council of State Boards of Nursing. Professional Boundaries: A Nurse's Guide to the Importance of Appropriate Professional Boundaries. Chicago, IL: NCSBN; 1996.
Wright LD. Violating professional boundaries. Nursing. 2006;36(3):52–54.