REGISTERED NURSES PROFESSIONAL BOUNDARIES

Registered Nurses Professional Boundaries

Registered Nurses Professional Boundaries

Introduction

  Professional boundaries separate therapeutic behaviour of the registered nurse from any behaviour which, well intentioned or not, could lessen the benefit of care to clients, families and communities. These guidelines outline the professional boundaries of therapeutic relationships between registered nurses and clients who place trust in their care. The ethical limits of relations between registered nurses giving care and those persons who receive nursing care are defined, and boundary violations are described. Information on resources to help registered nurses and others with questions about professional boundaries is also provided. Professional boundary issues also arise for registered nurses outside of therapeutic relationships with clients. There are registered nurses in teaching relationships with students, working with research participants, managing staff, and in working relationships with co-workers or in other roles. These relationships are not therapeutic ones, but they also require trust. Registered nurses in any role can ensure that professional boundaries are respected by applying the following guidelines to their nursing practice as appropriate for their role. Guidance for appropriate conduct should also be sought in policies for faculty conduct in educational institutions, in research guidelines for researchers, and in personnel policies, labour law and collective agreements for managers and staff(Chadda, 1998).

Discussion

It is possible to be under-involved or over-involved in a nurse-client relationship, rather than helpfully involved. Healthy boundaries keep the nurse-client relationship a safe one where the client and registered nurse are both respected. The client's human dignity, autonomy and privacy are safeguarded, and the registered nurse is recognized as a professional with certain obligations and rights. In fact, a critical element for resolving boundary issues is to set limits that respect both the client as a person who needs care and the registered nurse as a person providing professional care.

Health professionals should never forget that clients frequently let us into their “homes and their hearts” (personal communication from a member of the public to the AARN Practice Review Committee). We protect the trust of clients and their families by careful attention to the professional boundaries of our relationships with them. It is understandable for clients and families to feel that health professionals exercise power over their well-being. The registered nurse needs to respect how people's health-care experiences affect their feelings of personal power in their situation. Relationships with clients have both the power to heal and the power to harm.

Healthy professional boundaries are flexible within the bounds of relevant law and sound professional judgement. It takes risk to get help and to give it. A registered nurse or client may intentionally cross a professional boundary for a period of time to establish or maintain a therapeutic relationship. The key is to recognize what is a helpful crossing, and what is not. For instance, in a long standing relationship, a registered nurse who knows that a client finds a hug comforting shows compassion and support through such touch. On the other hand, repeated touching of clients in very personal ways ...