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Warning signs

Do you know when you're crossing a boundary?

Alissa steps off the elevator and turns right, narrowly missing colliding with her colleague, Jim. “You’re not working today!” Jim says. "What are you doing here?” Feeling uncomfortable, Alissa is asking herself the same question. What is she doing here? She’s never done anything like this before.

When she offered to bring lunch for Claire, it didn’t seem like a big deal, even though it was her day off. Alissa was a little awed by Claire when she was first admitted to the rehab unit. Claire is a local celebrity and Alissa admired her success.

As the weeks passed, their conversations became more personal and they discovered they had similar interests. Alissa started spending part of her break in Claire’s room. The small favours—like picking up two coffees instead of one, dropping Claire’s mother off on her way home, or giving Claire her cellphone number—seemed harmless at the time. Now Alissa isn’t so sure.  

What are the warning signs of boundary crossing?

  • Showing favoritism
  • Having more physical contact than is required or appropriate
  • Spending breaks or time off with a client
  • Discussing personal or intimate issues with a client not related to their care or your nursing role
  • Providing personal information such as your email address or phone number
  • Hiding your relationship with a client from others
  • Receiving feedback from others that your behaviour is overly familiar or intrusive
  • Buying or accepting gifts from a client
  • Involvement with a client's family members outside the professional relationship

What are the risks?

Nurse-client relationships are therapeutic, focus on client needs and are defined by professional boundaries. 

Professional boundaries are the spaces between the nurse’s power and the client's vulnerability. Claire must trust that Alissa will act in her best interest at all times. If that trust is breached, it may be difficult or impossible to re-establish.

When Alissa puts her personal needs ahead of Claire’s, she is misusing her power and violating boundaries. Boundary violations can cause distress for a client, which he/she may not recognize or feel until harmful consequences occur. This might include a betrayal of trust, respect or intimacy between the nurse and the client, and may cause physical or emotional harm to the client.

Has Alissa crossed a boundary in her professional relationship with Claire?

Standing in the hallway, Alissa recognizes she has violated the boundaries of a therapeutic relationship with Claire. Her relationship and actions are no longer focused on meeting Claire’s health care needs; Alissa is meeting her own needs, too. She’s developed close professional relationships with other long-term clients before, but has always remained centred on meeting the client’s health care needs. This situation is different: she realizes she has to step back and re-examine her actions.

Alissa turns around and heads for the nursing station. She drops off the lunch for Claire and heads back to the elevator. Understanding that she needs to take steps to address this situation, she decides to talk with a colleague at the beginning of her shift tomorrow.

Re-establishing boundaries in a professional relationship

  • Reflect on your relationship with your client, examining your actions and intent
  • Talk about the situation with trusted colleagues and ask for feedback
  • Take steps to re-establish the appropriate boundaries with your client
    • Explain, in a client-focused manner, that your actions have allowed the focus of the relationship to shift away from meeting their health care needs. 
    • Clarify your role and appropriate boundaries going forward
  • Stop spending break or personal time with the client
  • If assigned to the client, be friendly, but focus on your client’s needs and plan of care
  • If your client brings up a topic unrelated to care, ask yourself whose needs you are meeting before you respond
  • If necessary, take steps to withdraw from or terminate the relationship, transferring care to another appropriate care provider

What does Alissa do?

The next morning, Alissa discusses the situation with Jim,  an experienced colleague. He reassures her that boundaries can get blurred, especially when nurses have long-term relationships with clients. He gives her some suggestions for how to re-establish boundaries and Alissa makes a plan, determined to carry it out as soon as possible. 

Alissa’s first step will be to explain the situation to Claire, and let her know that she’ll be acting differently from now on. Reflecting further on the situation over the next few days helps Alissa understand her behavior and feelings, and recognize the effect of her actions on her client, other clients and her team.

Have you ever had crossed a boundary with a client? How did you resolve it?

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