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Patient Boundaries in Nursing

Patient Boundaries in Nursing

Terri Polick with patient, circa 1977.

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.

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