18 October 2021
Article from October 2021 edition of INPractice
Do you know your professional boundaries?
All health practitioners are expected to maintain professional boundaries between themselves and patients they provide care to, especially registered and enrolled nurses who are registered health practitioners with the Australian Health Practitioner Regulation Agency (AHPRA) and pursuant to the Health Practitioner Regulation National Law (South Australia) Act 2010 (National Law).
This probably sounds like an obvious statement and is something that all nurses learn in the early stages of their studies and training. It is probably not something that is actively thought about until someone crosses the line or blurs the professional boundary and is called into question. Despite what seems like an obvious and paramount obligation of all nurses, we still continue to see violations of professional boundaries and this is a timely reminder to take the time to consider your obligations to always act within the parameters of your professional boundaries as nurses.
What are professional boundaries in nursing?
The Nursing and Midwifery Board of Australia (NMBA) defines professional boundaries as:
“limits which protect the space between the professional’s power and the client’s vulnerability; that is they are the boarders that mark the edges between a professional, therapeutic relationship and a non-professional or personal relationship between a nurse and a person in their care”. (NMBA A Nurses Guide to professional Boundaries February 2010)
The power of a nurse comes from their professional position and their access to personal and private information about the patient. Establishing professional boundaries allows a nurse to manage the power imbalance whilst acting in the interests and needs of the patient.
What constitutes a breach of the professional boundary?
Breaches of professional boundaries can vary from very subtle and less obvious behaviour to extreme violations. Less obvious boundary crossings can, without identifying the early warning signs, continue over extended periods of time and still lead to significant harm to a patient and consequences for the nurse. For example, lending a patient money or buying them gifts can still constitute a boundary crossing much the same as offering help or support to a patient outside of the scope of the professional nursing relationship. Breaching professional boundaries is often a result of good intentions and can result in nurses confusing their own interests with the interest of their patients.
At the other end of the spectrum, extreme violations include sexual and personal relationships with patients (including former patients) which is inappropriate in any circumstances. It generally does not matter whether the patient makes the first move or asks for the nurse’s phone number or whether the catch-ups started as friendly chats at a local café or a walk in the park, as the case generally is.
Below are some examples that would constitute a breach of the professional boundary between a nurse and a patient, regardless of whether the conduct is with good intention or not:
Having a dual relationship with a patient;
Inappropriately socialising with a patient outside of the scope of the professional relationship, including on social media;
Helping or supporting patients outside of the scope of the professional relationship, including interacting with a patient in your personal time or using your personal money;
Accessing confidential patient information outside of the scope of the professional relationship;
Disclosing confidential patient information to others;
Disclosing personal information about yourself to a patient; and
Receiving and giving gifts to patients.
Penalties for breaching professional boundaries
The NMBA can take action against nurses for breaches of professional boundaries, such as imposing a caution, imposing conditions on a nurses’ registration or, in the more serious cases, referring the matter to the responsible Tribunal for determination.
If a Tribunal finds a nurse has engaged in unprofessional conduct or professional misconduct, it can impose a fine, a reprimand, impose conditions on a nurse’s registration, cancel a nurse’s registration, disqualify a nurse from being eligible for registration. The Tribunal can also prohibit a nurse from providing any other health service if the nurse is considered to pose a risk.
A recent interstate case involved a mental health nurse who was found to have engaged in professional misconduct by accessing patient information on four occasions without authority and entering into two separate personal and sexual relationships with two patients she had provided care to.
The 33-year-old nurse was employed at a health service where she provided nursing care to patients who suffered from mental health illnesses, both in an inpatient and outpatient setting. The nurse admitted to entering into a personal and sexual relationship with the first patient and accessing their records without authority on four occasions, prior to entering into a second personal and sexual relationship with another patient.
The Tribunal found the nurse had engaged in professional misconduct. The nurse was reprimanded and had her registration cancelled and was disqualified from applying for registration for 12 months, taking into account the prior three-year period she was suspended by the NMBA. When the nurse applies for registration after the disqualification period, she will need to demonstrate to the NMBA that she is a fit and proper person to hold registration as a nurse.
The message here is, don’t have sex with your patients!
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Click here to read the October 2021 edition of INPractice