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Patient Boundaries in Nursing
Terri Polick with patient, circa 1977.
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Terri Polick
Terri is a registered nurse and the proprietor of Nurse Ratched’s Place, a blog about psychiatric nursing. She is also a regular guest the popular podcast production, Insights in Nursing with Jamie Davis. Terri has been a nurse for over 30 years and is currently working as psychiatric bedside nurse. You can also follow Terri (AKA Motherjonesrn) on Twitter.
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Terri Polick | NursingLink
Do you recognize anyone in this picture? The one wearing the nurse’s cap is yours truly. The cute little gentleman was my patient. This picture appeared in my nursing school yearbook, circa 1977. (Did we all have bad hair like that back then?)
I remember loving my little geriatric patients. Yes, all patients need support and understanding, but nurses must know where to draw the line when it comes to delivering patient care. Professional boundaries are imperative! Crossing boundaries hurts patients and kills careers.
Nurses have recognized the need for boundaries since the very beginning of the nursing profession. Florence Nightingale was the first nurse to talk about professional boundaries, and Lystra Gretter, the author of the Florence Nightingale Pledge, addressed boundaries when she wrote the pledge in 1893. There’s a passage in the pledge that goes, “I will abstain from whatever is deleterious and mischievous … maintain and elevate the standard of my profession … will hold in confidence matters committed to my keeping…in the practice of my calling … and devote myself to the welfare of those committed to my care.” I suspect that Nurse Gretter wrote that because she saw some shaky boundaries during her own career.
What are boundaries? The best definition I’ve found comes from the National Council of State Boards of Nursing. It states that, “Professional boundaries are the spaces between the nurse’s power and the client’s vulnerability.”
Nurses Hold the Power
As caretakers, we’re with patients when they’re at their most vulnerable. A nurse’s power comes from access to knowledge about their patient’s private life. Boundary violations occur when there’s confusion between the needs of the nurse and those of the patient. Nurses violate patient boundaries when they disclose too much personal information about themselves, engage in secretive behavior with their patient, or when a role reversal forms between the patient and their nurse. Some nurses routinely cross the line and don’t even know it. Notorious nurses have been known to violate boundaries for personal gain.
I’ve seen more than a few violated boundaries during my own nursing career. In one case, a nurse unintentionally stumbled across boundaries, while another nurse had malicious intent from the very start.
The first nurse, who was a good friend, was assigned to a patient who had been in a serious car accident when Cupid’s arrow struck her heart. The patient was tall, dark, and handsome, a real charmer; my friend fell in love while she was caring for him during his long hospitalization. All the telltale signs were there: She didn’t want anyone else to take care of him, she was in his room all the time, and she came in to visit him on her days off from work. Obviously, our boss was not pleased.
rajkumarjonnala
over 1 year ago
100 comments
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ICU_RN
about 2 years ago
10 comments
As a sitter when I was in nursing school, I had the opportunity to spend an entire 8 hours straight with a variety of patients. On one occasion, I was sitting with a patient that had attempted suicide. The nurse assigned to the patient was a very religious Christian. When the nurse came in the room to assess his patient, he brought a bible with him and started preaching to the patient verses from the bible. He tried to convince the patient that what she did was wrong and if she wanted God to forgive her, she needed to pray and ask God for forgiveness. I am also Christian and I know that he meant well, but I think he was crossing the line with this patient in the way that he reached out his helping hand. I think it was inappropriate and if the patient happened to not be religious, the situation he created would not have ended well.