Boundary crossings and violations
Scenario 1 - Personal needs and interests
Nancy, a registered nurse, is caring for Dan. Nancy discovers they have a lot in common and finds a certain connection with Dan. Nancy finds she cannot stop thinking about Dan, and eventually emails him. They begin to chat over email and, after a month or so, she asks Dan to go to dinner with her. Dan agrees.
Questions for discussion
- Was it appropriate for Nancy to email Dan?
- When is it appropriate for a nurse to email a patient?
- What factors need to be considered to determine whether a boundary has been crossed or violated?
- Was it okay to ask Dan out, seeing as he agreed?
- If it was Dan who couldn’t stop thinking of Nancy and she agreed to dinner with him, would that change your interpretation of the case?
- If Nancy approached you as a peer seeking guidance or advice, what would you say to Nancy?
- Dan accepted Nancy’s invitation - does that make it ok?
- Has Nancy violated a professional boundary? If so, which, and in what way? Why?
Key concepts this scenario illustrates:
- Transference/Countertransference
- Boundary crossing led to boundary violation = slippery slope and risk management
In this case, Nancy emails Dan after she feels a certain connection with him. The reason for emailing does not appear to be connected to a therapeutic need. Instead it appears to be connected to Nancy’s personal needs or interests; therefore, her emailing Dan or contacting Dan in any way for this purpose is not appropriate.
It is not acceptable for Nancy to ask Dan out as Dan is a patient, and they have a current therapeutic relationship. Dan’s accepting does not change this. Nancy has professional obligations to maintain boundaries. Nancy’s inviting a patient out to dinner crosses the line between professional and personal relationships. Emailing with a patient for personal reasons and going to dinner with a patient in a personal capacity are both boundary violations.
The analysis doesn’t change even if it was Dan who asked Nancy to dinner. In that scenario, Nancy is responsible to re-establish appropriate boundaries with Dan by explaining that joining a patient for dinner in a social or personal capacity is not appropriate and she must maintain a professional relationship. This ensures her ability to provide high quality patient care isn’t compromised by personal or social relationships with her patients.
If you were Nancy’s peer, and she approached you for advice in this situation, you would be expected to reaffirm the need to maintain appropriate boundaries with patients so patient care is not compromised. You also could coach Nancy on how to re-establish boundaries with Dan.
Nurses who have engaged in boundary violations of this nature are found to have engaged in professional misconduct.
