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Professional

Boundaries

BCCNM LEARNING MODULE — WORKBOOK

In Nursing Practice

Introduction

ThisworkbookoffersactivitiesthatallowyoutoapplyideaspresentedintheModule.Itisorganized

inthreesections.

• Part 1 includesWorkbook Activities thatarerelatedtovarioustopicareas.Asyouworkthrough

themodule,youwillbedirectedtocompleteaspecicWorkbookActivity.Thissectionalso

includespagesforyoutorecordyourreectivethoughtsandinsightsrelatedtoyourexploration

inthismodule.

• Part 2, “Applying My Learning”,includesacasescenarioandassociatedquestions.Completingthis

activityprovidesanopportunityforyoutoapplyalloftheinformationthathasbeenofferedinthe

moduleinthecontextofthispractice-basedscenario.Whenyouhavecompletedthiscase,youmay

wishtocompareyourresponseswiththoseprovidedinthe“ApplyingmyLearning:Perspectives”

locatedinPart3.

• Part 3 presentssample responses toWorkbookactivitiesandthecasescenarioinPart2.These

responsesprovidetheperspectivesofthecoursewriterandothersonthecasescenario.

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Part 1:

Workbook Activities

WorkbookActivity#1

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Considerthefollowingquestions.Recordyourresponsesinthespacesbelow.Thesethoughts,ideas,and

responseswillhelpyoudecidewhatyouwouldliketofocusoninthismodule.Theymayalsoformpartofthe

basisforyourprofessionaldevelopmentplanningaspartofyourqualityassurancerequirements.

• Whataremystrengthsinrelationtotherapeuticrelationshipsandprofessionalboundaries?

• WhataspectsoftherapeuticrelationshipsandprofessionalboundarieswouldIliketoknowmoreabout?

• AmIawareoftheresourcesavailablethatcansupportmypracticeinrelationtotherapeuticrelationshipsand

professionalboundaries?

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WorkbookActivity#2

1. Thinkbacktothecasescenario,andpretendyouareSaira.Wouldyoudothesamethingshedid(purchasing

atoyforAnnie)?Whyorwhynot?Ifnot,whatwouldyoudo?Whatcontextualfactorsfromthescenarioare

inuencingyourchoicesanddecisions?Writeyourthoughtsinthespaceprovided.Youmaywishtocompare

youranswerswiththediscussioninPart #3, Perspectivesattheendofthismodule.

2. Reection Point

Thinkofatimeinyourownpracticewhereyoumadeadecisioninrelationtoprofessionalboundaries.Itcould

beanything….youmayhavedecidedtotakeextratimewithaclient,decidedtogiveaclientorfamilymember

ahug;youmayhavehadaFacebookfriendrequestfromaclientorfamilymemberoryoumayhaveconsidered

doingapersonalfavourtohelpaclient,etc.Onceyouhavethoughtofscenario,thinkaboutthecontextual

factorsthatinuencedyourthoughts,decisions,andactions.Wouldyouhavemadedifferentdecisions,ordone

thingsdifferentlyifcircumstances,orthecontext,weredifferent?Howdidthecontextinuenceyou?Record

yourthoughtsonthe“ThoughtsfromReectionPoints”pageofthisworkbook.Atthecompletionofthe

module,youwillhaveanopportunitytousetheinsightsandafrmationsgainedinvariouslearningactivities,

aspartofyourplanningforfutureprofessionalgrowthanddevelopment.

page 6

WorkbookActivity#3

Inthisactivityyouwillexplorethedirectionprovidedwithinyourprofessionalregulatorybody’swebsite

resourcesforestablishingandmaintainingprofessionalboundariesinnursingpractice.Thedocumentsand

resourcescanbeaccessedfromtherelevantlinksbelow.

1. ReviewtheProfessionalStandardsforyourprofessionalgroup,forexample,RegisteredNursesandNurse

Practitioners.Asyoureviewthestandardsandassociatedindicators,considerhowtheyrelatetoyouruseof

professionalboundariesintherapeuticrelationships.

Inwhatwaysdothestandardsandindicatorsprovidedirectionforcompetencyrelatedtoprofessionalboundary

maintenanceinnursingpractice?WriteyouranswersdowninyourWorkbook.

2. Theprofessionalregulatorybodywebsiteshavemanydifferentresourcesavailableregardingprofessional

boundariesinnursingpractice.TakesometimetoexplorethewebsiteofyourCollegeandndwhatother

resourcesthewebsiteprovides.ListtheseresourcesinyourWorkbook.Youmaywishtoexploretheseresources

inmoredetaileitherinthefuture,orrightnow.

3. TheCanadianNursesAssociationprovidessomedirectionforprofessionalboundariesintheCodeofEthics

forNurses.Pleasetakesometimetoinvestigatewhatdirectionthisresourceprovidesforyouintermsof

professionalboundaries.Youmaywishtojotdownsomethoughtsandideasthisresourceprovidesforyou.

Alinktothiswebsiteandmanyotherrelevantresourcesmaybefoundbyclickingonthelinktothemodule

ResourceSectionbelow.

BC College of Nurses & Midwives Web Site: https://www.bccnm.ca/Pages/Default.aspx

Module Resource Section pdf: https://www.bccnm.ca/Documents/learning/modules/PBlearningresources.pdf

professional boundaries in nursing practice workbook

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WorkbookActivity#4

GotothewebsiteforyourRegulatoryBodyandreviewtheBoundariesintheNurse-ClientRelationship

PracticeStandard.Alinktoapdfofthisdocumentisalsoavailablebelow.Answerthefollowingquestionsin

yourworkbook.Remember,youdonotneedtoshareyouranswerswithanyone.Thisexerciseisintendedto

assistyoutobecomeawareofhowyouutilizethePracticeStandardPrinciplesforboundariesinthenurse-client

relationshipinyourpractice,andidentifyanyareasforfurtherlearningandgrowthinyourpractice.

https://www.bccnm.ca/RN/PracticeStandards/Lists/GeneralResources/RN_PS_Boundaries.pdf

1. HowfamiliaramIwiththePracticeStandardPrinciplesforBoundariesintheNurse-ClientRelationship?DoI

regularlyindependentlyapplytheprinciplestomypractice?How?Ifnot,whynot?Writethesethoughtsdownin

thespacebelow

2. Dotheseprinciplesofferinsightsorsolutionsforareasofprofessionalboundariesthatyouareunsureofornd

challenging?How?

3. WhatisbestpracticeifaclientasksifI’veeverhadthesametypeofmedicaltreatmentheorsheisaboutto

receive?

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WorkbookActivity#4(continued)

4. Doesmyagencyhaveapolicyaboutreceivinggiftsfromclients?WherecanIndthispolicy?

AmIfamiliarwithit?

5. WhatshouldIdoifmychild’sfriendbecomesmyclient?

6. MyclienthasaskedifIwillcareforhim/herprivately,outsidemyagency’ssetting.Whatdirectiondoesthe

practicestandardprovideinmakingthisdecision?

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WorkbookActivity#5

Eachagencyandemployermayhavedifferentpoliciesregardingnurses’practiceinrelationtoprofessional

boundariesinnurse-clientrelationships.Thisactivitywilldirectyoutofamiliarizeyourselfwiththespecic

employerpolicieswithinyourpracticesettingandhowtheseguide/restrictyourpracticeinrelationto

professionalboundaries.Recordthesebelow.

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WorkbookActivity#6

Reectonyourownpracticeintermsofrecognizing,establishing,andmaintainingboundariesinnurse-client

relationships.Hereyouareconsideringtheindividualnurselevelofcontrolonpractice.Whatknowledge,skills,

judgement,andattitudesdoyouholdthatmayaffectyourpracticeinthisrealm?Writetheseideasdown.

Consider:WhatdoIneedtondout,ordo,inordertoaddressanygaps?Thinkbroadlywhileyoudothis,and

remember,youdonotneedtosharethiswithanybody!Thislearningactivitywillformpartofyourongoing

professionaldevelopmentplan

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WorkbookActivity#7

Mostnurseswhoviolateprofessionalboundariesdonotintendtodoso,butendupinasituationwhere

theirviolationpotentialishigh,andtheyenduptravellingdowntheSlipperySlope.ConsiderLesley’s story

andanswerthefollowingquestions.YoumaywishtocompareyouranswerswiththediscussioninPart #3,

Perspectives at the end of this Workbook.

1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,risk

factors,andcontextinyouranswer.

2. LookingbackatLesley’sstoryagain,traceherpathdowntheslopetoboundaryviolation.Atwhatpointsdidshe

engageinboundarydrift,boundarycrossing,andboundaryviolation?

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WorkbookActivity#8

Ifyouareworkingwithacolleaguewhomyoubelieveiscrossingorviolatingaprofessionalboundaryyouhave

aresponsibilitytotakeaction.ConsiderSimone’s situationandanswerthefollowingquestions.Youmaywishto

compareyouranswerswiththediscussioninPart #3, Perspectives at the end of this Workbook.

1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandardandapplythePrinciplesto

Simone’ssituation.WhatguidancedoesthePracticeStandardgiveforSimone?

https://www.bccnm.ca/RN/PracticeStandards/Lists/GeneralResources/RN_PS_Boundaries.pdf

2. ListtheactionsSimoneshouldtakeinthesituation.

3. Findouttheprocedureinyouragencyfordealingwithaboundaryviolationbyacolleague.Ifthereisnowritten

policy,youmayneedtohaveaconversationwithyourmanagerinordertondoutyour’agency’sapproach.

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WorkbookActivity#9

Case One:

DoyourememberDaniel’s story fromearlierinthelearningmodule?Refreshyourselfonhissituationand

thenusethethinkingtooltohelphimdecidewhattodobyansweringthefollowingquestions.Onceyouare

done,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of this

Workbook.

Daniel is the charge nurse of the emergency room in a small rural community. He is also well-known in

the community as he coaches his children’s sports teams and through other community events. Daniel

also plays recreational hockey on a local team. During one shift, one of Daniel’s hockey teammates, who

also happens to be one of Daniel’s son’s high school teachers, arrives in the ER with a small laceration that

requires sutures. Daniel’s son has applied for a big scholarship, and this teacher is on the application review

committee. The ER is extremely busy and the teammate will need to wait a long time to have this done. The

teammate asks for his friend, Daniel, to fast track him so that he can get his injury attended to faster.

1. Ask,“WHOwillbenetfromthisaction”?IfDanielfast-trackshisteammateandson’shighschoolteacher,who

benets?

Ask,“WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclients

bemet?

2. Ask,“WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshis

teammate,willthishelporhinderthenurse-clientrelationship?How?

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesit

includethisaspect?

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith

theclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?

5. IfyouwereDaniel,whatisyourdecision?Why?

page 14professional boundaries in nursing practice workbook

WorkbookActivity#9(continued)

Case Two:

Let’stryanothercasescenario.HereyouwillmeetScott,anursewhoworksinarehabilitationcentre.

Again,youmaywishtocompareyouranswerswiththediscussioninPart #3, Perspectives at the end of

this Workbook.

Scott works in a spine rehabilitation centre with clients who have sustained serious spinal cord injuries. Most

of Scott’s clients are in the rehabilitation centre for at least several weeks, and Scott and his colleagues often

get to know the clients well. Scott is caring for Grant, a young lawyer who sustained a thoracic spinal injury

in a snowboarding accident. Grant has always been a very athletic man, and has had a difcult time adjusting

to his new disabilities. He is also an ardent hockey fan. Scott has many similar interests as Grant, and the

two men have established a very effective rapport. Grant trusts Scott and responds well to his treatment

and intervention regime with Scott as his caregiver. In conversation one day close to Grant’s discharge

from the rehabilitation centre, Grant and Scott discover they are both fans of the same local hockey team.

Scott expresses regret about being unable to attend any of the team’s playoff games due to other nancial

priorities. At discharge, Grant gives Scott an envelope addressed to him. Inside is a handwritten thank you

note and a pair of hockey tickets to the local team’s playoff games.

1. Ask,“WHOwillbenetfromthisaction”?IfScottacceptsGrant’sgift,whobenets?

Ask,“WHOSEneedswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?

2. Ask,“WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,

willthishelporhinderthenurse-clientrelationship?How?

3. Ask,“WHAT?Isthisactionconsistentwiththenursingcareplan?”WhatisthecareplanforGrant?

4. Ask,“HOW? IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith

theclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensive

hockeyticketsbyaclient?

5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScott

theticketsduringhishospitalization?Why?

page 15professional boundaries in nursing practice workbook

WorkbookActivity#10

Gothroughtheworkbookthatyouhavecompleted.Noticeareaswhereyouhavefurtherquestions,further

interest,orneedfurtherdevelopment.Noticeareaswhereyouhavestrengthsinrelationtoprofessional

boundarymaintenancetoo.Pickoneareathatyouwouldliketodevelopfurtherandcreatealearningplan

foryoutomeetyourownlearningneeds.Youmayndthefollowingframeworkhelpfulforyoutostructure

yourlearningplan.AProfessionalDevelopmentPortfoliothatcanbecompletedelectronicallyisalso

availableontheBCCNMQAWebpage.Alinktoapdfofthisdocumentisbelowandmakesurethatyou

saveittoyourcomputertocompleteit

https://www.bccnm.ca/Documents/quality_assurance/PD_plan_template.pdf

page 16professional boundaries in nursing practice workbook

MyPlanforGrowth

Goals

Action Plan

PeopleorplacesthatIcaninvestigateforlearningstrategiestohelpmemeetmygoalsforgrowthare:

page 17professional boundaries in nursing practice workbook

MyPlanforGrowth

Strategy Resources I need to

implement this strategy

Target completion date Other thoughts

NotesfromReectionPoints

page 18professional boundaries in nursing practice workbook

ProfessionalBoundariesinmy

NursingPractice:AfrmationsandInsights

page 19professional boundaries in nursing practice workbook

Part 2: Applying

My Learning

page 21professional boundaries in nursing practice workbook

ApplyingMyLearning

Doyouwantmore?Inthissection,ApplyingMyLearning,thereisamorecomplexcasescenarioforyouto

workthroughinordertofurtherintegrateandapplytheunderstandingyouhavebuiltthroughoutthemodule.

Thissectionisoptionalforthosewhowantmorepracticeapplyingwhatyouhavelearnedtonursingpractice.

Case Study

PleasereadthefollowingcasescenarioaboutJanice,aRegisteredNursewhoworksinabonemarrowtransplant

unit.Whenyouhavenished,analyzethescenariousingtheinformationyouhavelearnedaboutinthismodule,

andmakeadecisionaboutwhatJaniceshoulddo.Whenyouhavecompletedthisactivity,youmaywishto

compareyourresponseswiththoseprovidedinthe“Perspectives”sectionattheendofthisWorkbook.

Be sure to consider:

• thetherapeuticnurse-clientrelationship

• thedirectivesforpracticeinrelationtoprofessionalboundaries

• theslopeofboundaryviolations

• violationpotential

• thethinkingtoolforprofessionalboundaries

page 22professional boundaries in nursing practice workbook

ApplyingMyLearning

Janice cared for Mrs. Black, who was hospitalized on the bone marrow transplant unit following a transplant

for her acute leukemia. Janice, who graduated from her nursing program 18 months ago, really enjoys

working on the unit. She enjoys the acuity of care, but she particularly likes getting to know her clients and

their families. She nds the work both challenging and rewarding.

Mrs. Black was a client on the unit for several weeks, and had experienced many downturns in her condition.

In the periods of time when Mrs. Black’s condition stabilized, she talked frequently with Janice about

wishing she would live long enough to see grandchildren born. Mrs. Black reminded Janice of her favorite

aunt, Bonnie, and Janice developed a close, friendly relationship with her.

The frequent relapses in Mrs. Black’s condition made for a very tumultuous time for her close-knit family.

Janice got to know all the family members quite well, including Mrs. Black’s 32 year old son, Hugh, who

visited daily. Janice liked Hugh as he had a great sense of humor and Janice had an easy rapport with him.

Hugh requested to be Facebook friends with Janice, and she accepted. Hugh would send websites and jokes he

thought Janice would enjoy and Janice would occasionally do the same.

Eventually, Mrs. Black’s condition inevitably deteriorated and she ultimately passed away in the bone

marrow transplant unit. Janice and two other nurses from the unit attended Mrs. Black’s funeral. Janice felt

badly for the family members who had always been so hopeful about Mrs. Black’s condition. She let them

know at the end of the funeral that she would be available to support them if they needed her.

A few weeks after the funeral Hugh contacts Janice and asks if she could meet him for coffee. Janice agrees,

and she and Hugh have a nice conversation reminiscing about Hugh’s mother and generally catching up with

each other. As Janice stands up to go, Hugh asks if he can have her telephone number; he’d like to ask her

out for a date sometime, saying “Even my mom wanted me to ask you out!”. Janice blushes as her heart rate

increases slightly….Hugh is very attractive, and she really enjoys his company.

Part 3: Workbook

Activities and Case

Perspectives

page 24professional boundaries in nursing practice workbook

WorkbookActivity#2

ThereareanumberofcontextualfactorsthatareinuencingSaira’sdecisioninthiscase.Herearesometo

considerwhenyouanswerthisquestion.Youmayhaveotherideasaswell.

Context:

• Whataretherules,regulations,policies,standards,andguidelinesthatgovernmypracticeinrelationto

professionalboundaries?What,ifany,aretheexceptionstothese?

• Whatismyunit’spolicyongifts?Whatismyunit’spolicyonclients’birthdays?

• Howdoesthistwiththeclientcareplan?

• WouldIhavemymanager’ssupportforthedecisionImake?

• ArethereothercolleaguesorpeopleIshouldinvolveinthisdecision?

• Howwouldtheclientfeelaboutmyaction?Howwouldherfamilyfeelaboutit?

• WouldIdothisforalltheunitclients?

• HowcomfortableamIwiththevariousoptions?Whataremybeliefsabouteach?

page 25professional boundaries in nursing practice workbook

WorkbookActivity#7

ConsiderLesley’s storyandanswerthefollowingquestions

1. IdentifythefactorsthatcontributedtoLesley’sViolationPotentialinthissituation.Considervulnerability,risk

factors,andcontextinyouranswer.

FactorsthatcontributedtoLesley’sViolationPotentialinthissituationinclude:

• Vulnerability:Lesley’sclient’shusbandisinavulnerablepositionasheiscopingwithhiswife’sillnessas

wellashischildren,job,andotherresponsibilities

• Context:Lesleyhasworkedwiththeclientandclient’shusbandoveralongperiodoftimeandhascome

toknowthemwellviaacontinuouscaringrelationship.

• Catalyst:Lesleyexperiencesadivorce,whichincreaseshervulnerability.

2. LookingbackatLesley’sstoryagain,traceherpathdowntheSlipperySlopetoboundaryviolation.Atwhat

pointsdidsheengageinboundarydrift,boundarycrossing,boundaryviolation?

Boundarydriftandcrossings:

• Developingafriendshipovertime

• Havingcoffeetogether,sharingphotosofkids,talkingaboutoutsidelifeandotherthings

Theseactivitieswerecrossingfromtheprofessionalrealmintothepersonalrealm.Theseactivitieswouldnot

beapartoftheprofessionalnurse’srole,theclient’scareplan,and/orthenurse’sworktime.Lesleyshouldhave

rotatedclientassignmentswhenshefoundherselfwantingtospendmoretimewithLuke.

• Unableto“copewithalltheemotionandstress”onherown,andprogressingtoseeingtheclient’s

husbandromantically.Thisisaclearboundaryviolation.

Lesleyneedstoseekoutanddeveloppersonalsupportnetworks.Shemayconsideremployeeassistance

programsofferedbyheremployer.

page 26professional boundaries in nursing practice workbook

WorkbookActivity#8

ConsiderSimone’ssituationandanswerthefollowingquestions

1. ReferbacktotheBoundariesintheNurse-ClientRelationshipPracticeStandard,andapplythePrinciplesto

Simone’ssituation.WhatguidancedoesthePracticeStandardgiveforSimone?

Guidance from the Practice Standard includes:

• Thenurse-clientrelationshipisconductedwithinboundariesthatseparateprofessionaltherapeuticbehaviour

fromnon-professionalandnon-therapeuticbehaviour.

Simoneiswitnessingbehaviourthatmakesherfeeluncomfortable,becauseshebelievesitisnon-therapeutic.

• Thenurse,nottheclient,isalwaysresponsibleforestablishingandmaintainingboundaries.

Geoffisresponsiblefortheestablishmentandmaintenanceofprofessionalboundarieswiththeclient.

• Nursesdonotenterintoafriendshipwithclients

Simoneiswitnessingbehaviourthatisexpectedwithinnon-professional,friendlyrelationships,butnotinthe

contextofaprofessionalrelationship.

• Nurseshelpcolleaguestomaintainprofessionalboundariesandreportevidenceofboundaryviolationstothe

appropriateperson.

SimonemusthelpGeofftore-establishprofessionalboundaries;thismayincludejustashort,factual

conversationwithGeoffregardingthePracticeStandard,and/oritmayincludereportinghisbehaviourtotheir

manager.

• Employersthatprovideeducation,supervision,andsupportrelatedboundaryissueswillhelpstaffrecognize

andresolveproblemsintheearlystagesSimonemayinvolvehermanagertohelpresolvetheissuebeforeit

becomesabiggerproblem.

• Considerifaspectsforthenurse’srelationshipwiththeclientarehiddenfromothers,thenursedoesnotwant

othernursestohavethesamerelationshipwiththeclient,thenurseisgivingpreferentialcareortimetothe

client.

Geoffisgivingpreferentialcareandtimetothisclient

2. ListtheactionsSimoneshouldtakeinthesituation.

TheRegulatoryBody’swebsitesprovidespecificguidanceandresourceswhichcanhelpSimoneinthis

situation.AnexampleisawebmoduleontheBCCNMwebsiteentitles“TakingActiononConcernsAbout

Practice”.https://www.bccnm.ca/Lists/Learning_modules/taking_action/player.html

SimonecanalsotalktoamanageroraccessthepracticeconsultationandadvisingserviceofherRegulatory

Bodytohelpguideheractions.

page 27professional boundaries in nursing practice workbook

WorkbookActivity#9

Case One: Daniel’s Story

1. Ask,“WHOwillbenetfromthisaction”?IfDanielfast-trackshisteammateandson’shighschoolteacher,who

benets?

• IfDaniel’sfast-trackshisteammate/son’shighschoolteacher,theteacherwillbenet.However,Danieland

hissonmayalsopotentiallybenetfrompossiblepreferentialtreatmentofhisson’sscholarshipapplication.

Ask,“WHOSEneedswillbemet?”Willtheclient’sneedsbemet?WillDaniel’s?Willtheneedsofotherclientsbe

met?

• Theclient’sneedswillbemet,andDaniel’spersonal(notprofessional)needsmaybemet.However,thiswill

occurattheexpenseofotherclients’needs,sinceDanielwillnotbefollowingstandardizestriageassessment

protocols.

2. Ask,“WHY?Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfDanielfasttrackshis

teammate,willthishelporhinderthenurse-clientrelationship?How?

• IfDanielfast-tracksthisclient,hewillalsobeviolatingaboundaryintermsofbehaviourrelatedto

favoritism.Thiswillhinderthenurse-clientrelationship.

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”Whatisthecareplanfortheclient?Doesit

includethisaspect?

• Thisactionisnotconsistentwiththisclient’scareplan,sincehedoesnotrequirefast-trackingaccordingto

triageprotocols.Thisactionisalsonotconsistentwithotherclients’careplans.

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith

theclient?”WouldDanielbecomfortablewithotherpeopleorcolleaguesknowinghefasttrackedtheclient?

• Danielwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeople

andcolleaguesknewyouhadfasttrackedthisclient(ifyouwereDaniel)?

5. IfyouwereDaniel,whatisyourdecision?Why?

• Danielshouldideallytransferthecareofhisfriendtoanothernurse(Principle#8BoundariesinNurse-

ClientRelationshipPracticeStandard).Ifthisisnotpossible,Danielneedstoclarifythatheisactingina

professionalcapacityandnotapersonalcapacitywithhisfriend(Principles#9and#10BoundariesinNurse-

ClientRelationshipPracticeStandard).Danielmayneedtoinvolvehismanager.

page 28professional boundaries in nursing practice workbook

WorkbookActivity#9(continued)

Case Two: Scott’s Story

1. Ask,“WHOwillbenetfromthisaction”?IfScottacceptsGrant’sgift,whobenets?

• Scottwilldirectlybenetfromthisaction.

Ask,“WHOSE needswillbemet?”WillGrant’sneedsbemet?WillScott’sneedsbemet?

• Scott’sneedswillbemet.

2. Ask,“WHY? Willthisactioncontributetothetherapeuticnurse-clientrelationship?”IfScottacceptsthetickets,

willthishelporhinderthenurse-clientrelationship?How?

• Acceptingtheticketswillnotcontributetothetherapeuticnurse-clientrelationship.

3. Ask,“WHAT?Isthisactionconsistentwiththeclientcareplan?”WhatisthecareplanforGrant?

• Grantisbeingdischarged,however,acceptingtheticketswouldnotbeapartofthe

planofcareforGrant.

4. Ask,“HOW?IsthisactionsomethingIwouldbecomfortablewithotherpeopleknowingIhadengagedinwith

theclient?”WouldScottbecomfortablewithotherpeopleorcolleaguesknowinghehadbeengivenexpensive

hockeyticketsbyaclient?

• Scottwouldneedtoanswerthisquestionforhimself,however,wouldyoufeelcomfortableifotherpeople

andcolleaguesknewyouhadacceptedthesetickets(ifyouwereScott)?

5. IfyouwereScott,whatisyourdecision?Why?WouldyourdecisionhavebeendifferentifGranthadgivenScott

theticketsduringhishospitalization?Why?

• ScottneedstoexplaintoGrantthatheisunabletoacceptthesignicantgift,althoughhetrulyappreciates

thegesture.Hecannotacceptthem,butifGrantisinsistent,ScottcouldsuggestthatGrantspeakto

themanageraboutit.Theremaybespecicagencypolicyinplaceregardingsubstantialgifts;forexample,

agencypolicymayallowforsomethinglikeastaffdraw(Principle#17BoundariesinNurse-Client

RelationshipPracticeStandard).

• ThedecisionwouldnotbedifferentiftheticketswereofferedduringGrant’shospitalization.Scott

coulddiscusstheissuewithhismanagerandcolleaguestoensurethatthereisaconsistentunderstandingof

professionalresponsibilitiesandagencypolicy:Giventhecontextofrehabilitation,andthelongtermnature

ofthenurse-clientrelationships,itmaybeanticipatedthatthistypeofsituationmayariseagain.

page 29professional boundaries in nursing practice workbook

CasePerspectives

Trust: Trustiscriticalinthenurse-clientrelationshipbecausetheclientisinavulnerableposition.Hughtrusted

Janicetocareprofessionally,ethically,andcompetentlyforhismother.Hismotherwasinavulnerableposition,

andHughistoo.DatingHughwouldtakeadvantageofthisvulnerability.

Respect: Respectistherecognitionoftheinherentworth,dignity,anduniquenessofeachindividual.Atthis

point,respectseemstobeintactwithinthisnurse-clientrelationship.

Professional intimacy: Professionalintimacyincludesphysicalactivitiesthatcreatecloseness(forexample,

bathing,andalsopsychological,spiritual,andsocialaspectsofcare.Janice’srelationshipwithHughhasasense

ofintimacyfromaprofessionalstandpointbecauseoftheintimatecareshehasprovidedtohismotheraswellas

thepsychosocialnursingcareshehasprovidedtoHugh.DatingHughwouldviolatetheprofessionalnatureof

thisintimacy.

Empathy:Empathyallowsthenursetoprovidecompassionateandethicalcaretoclientsandfamilies.Empathy,

however,alsoincludeappropriateemotionaldistancefromtheclienttoensureobjectivityandanappropriate

professionalresponse.ThisemotionaldistancewillbenegatedifJanicedatesHugh.

Power: Thenursehasmorepowerthantheclientinthenurse-clientrelationship.JaniceandHugharenoton

equalfooting.

Levels of Control on Practice:

TheBoundariesintheNurse-ClientRelationshipPracticeStandardprovidesdirectionforJanice’spractice.

Principles#1,#3,#5,#6applyhere.

RN: https://www.bccnm.ca/RN/PracticeStandards/Pages/boundaries.aspx

NP: https://www.bccnm.ca/NP/PracticeStandards/Pages/boundaries.aspx

Violation Potential:

Janice’sviolationpotentialwasmostlyimpactedbythecontextofcaringforaclientoveraperiodoftime,in

emotionallychargedcircumstances.ThecatalystherewasMrs.Black’sdeath.

Slippery Slope:

Janicestarteddowntheslipperyslopewithoutmeaningto.Boundarycrossingsoftenstartoffasinnocuous.

Janicebegantocrossboundarieswhenshe:

- beganthinkingofMrs.Blackasheraunt

- developedaclose,friendlyrelationshipwithher

- acceptedFacebookfriendshipwithHugh

- sharedjokesandwebsiteswithHugh

- offeredtobeavailabletosupportthemiftheyneededher

page 30professional boundaries in nursing practice workbook

CasePerspectives

Thinking Tool

Who? IfJanicegoesoutwithHugh,Janicebenets.

Whoseneedsarebeingmet?Janice’ssocialneedsarebeingmetifshedatesHugh.

Why? Doesthishelporhinderthetherapeuticnurse-clientrelationship?Asnotedinthediscussionearlier,

Janicerisksalteringthetherapeuticnurse-clientrelationshipsothattheclient’sneeds(Hugh’sneedsareno

longerinthecentreofsafe,appropriate,competentandethicalclientcare.

What? JanicedatingHughisnotconsistentwiththeclientorfamilycareplan.

How?WouldJanicebecomfortablewithcolleaguesandothersknowingshewasdatingHugh?

JaniceneedstorespectfullydeclineHugh’sinvitation,andre-establishaprofessionalrelationship.Janice

maywishtoinvestigateBCCNMresourcestohelpherwiththisaction,orpossiblydiscussthesituation

withhermanager.Thismaybeanopportunitytoinitiatesomediscussionandsharedlearningwith

colleaguesaboutprofessionalboundaries.

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