The nurse-client relationship should always remain professional and therapeutic, with the client’s needs as the primary focus.
Nurses are responsible for establishing and maintaining boundaries that protect the integrity of this relationship. When boundaries are not respected the client’s well-being and quality of care may be compromised.
Self-reflection is essential for recognizing when boundaries may be at risk. By reflecting on your actions and feelings, and seeking feedback from a supervisor or trusted colleague, you can identify potential issues early on and take steps to restore appropriate limits.
It is important to be aware that some boundaries should never be crossed, while others require you to carefully consider the context. Thoughtful consideration is key to ensuring that any behaviour is in the client’s best interests.
Over-involvement can blur professional boundaries. Behaviours may include:
- Frequently thinking about a client outside of work
- Providing preferential care or attention to one client over others
- Feeling personally responsible for a client’s progress or frustrated by delays
- Engaging in unnecessary or inappropriate physical contact
- Spending personal time with a client or sharing personal contact information
- Participating in personal conversations, flirtations or inappropriate jokes
- Experiencing romantic or sexual thoughts about a client
- Hiding aspects of your relationship with a client from colleagues
- Sharing or keeping secrets with a client
- Ignoring feedback from colleagues that your behaviour may be overly familiar
- Refusing to transfer care when therapeutically appropriate
Under-involvement may result in neglect or harm. Behaviours may include:
- Delaying care or treatment unnecessarily (for example, ignoring call bells or postponing medication)
- Skipping essential care tasks (for example, hygiene or dressing changes)
- Blaming the client for a lack of progress
- Being rough or careless during care
- Using disrespectful, demeaning, or humiliating language or tone
- Failing to properly drape a client during procedures
- Avoiding a client to the point that care needs are unmet
- Withholding information needed for informed decision-making
It is important to remember that you are accountable for your actions. If you determine a professional boundary has been crossed, you should pause and consult with your supervisor and take immediate steps to resolve the situation. Timely intervention helps preserve the trust and integrity of the nurse-client relationship and ensures that care remains focused, respectful and therapeutic.
CNO thanks BCCNM for permission to adapt content from their Understanding boundaries web page