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Professional boundaries
In the nurse-patient relationship, nurses hold a position of power by virtue of having:
- professional knowledge and skills patients rely on for their well-being
- access to patients' bodies while performing intimate physical exams
- access to patient’s personal health information
- a position of authority
Maintaining professional boundaries is always the nurse’s responsibility. This includes physical boundaries. Because of the power imbalance that exists between the patient and the nurse, any sexual or romantic relationship a nurse has with a patient is abuse and professional misconduct.
A nurse is also not allowed to engage in a sexual or romantic relationship with a patient for one year after the end of the professional relationship with the patient. This means, if a nurse begins a romantic relationship with an individual to whom they provided care to six months ago, the nurse’s conduct would be sexual abuse
There are serious consequences by engaging in sexual acts with a patient, including the nurse losing their ability to practice nursing in Ontario.
Trust, respect, professional intimacy, empathy and power are the five components inherent to the nurse-patient relationship. When a nurse suspects that she or he is involved in a situation that crosses the boundaries of the therapeutic nurse-client relationship, the nurse needs to take action to maintain or restore the professional boundaries. The primary concern is always for the safety and well-being of the patient.
Nurses manage the boundaries of the therapeutic relationship through:
- self-reflection
- establishing and following a comprehensive plan of care
- meeting personal needs (for example, social support, companionship, approval) outside of the therapeutic nurse-patient relationship
- explaining and discussing the meaning of confidentiality with the patient
- being sensitive to the context in which care is provided (for example, in a patient’s home, outside a traditional environment)
- achieving a clear understanding with the patient about the duration and termination of the relationship.
Nurses are also responsible for helping clients understand when their requests are beyond the limits of that relationship.
Myths about professional boundaries
