In the therapeutic nurse-client 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.

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,  and empathy are the three components inherent to the therapeutic nurse-client relationship. When a nurse suspects that they are 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 client.

Nurses manage the boundaries of the therapeutic nurse-client 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-client relationship
• explaining and discussing the meaning of confidentiality with the client
• being sensitive to the context in which care is provided (for example, in a client’s home, outside a traditional environment)
• achieving a clear understanding with the client 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.