Practice Expectation Spotlight: Professional Boundaries

Are you at risk for committing a professional boundary violation? Answer the following survey question and read the case scenario below to assess your knowledge of risk factors and reflect on your responsibilities to maintain therapeutic nurse-client relationships.

Consider the following case scenario: Tom Brentsone RN is a registered nurse with 25 years’ experience in home care. His father recently passed away at home. Tom was the primary caregiver to his father and he takes solace in the fact that he helped fulfill his father’s wish to die at home. When Tom returns to work he feels an increased desire to support his clients to stay at home as long as possible. Tom reflects on his practice and decides to increase his knowledge of the community resources available to clients in his assigned territory. From his increased knowledge he creates a list of resources to hand out to clients.

While handing out the list of resources to Mr. Z, a client whom Tom has provided care to for many years, Mr. Z states that he needs more care than is provided by the home care program but can’t afford the resources on the list. In that moment, Mr. Z asks Tom to run an errand for him. Tom is aware that running the errand would be a personal favor and therefore would cross a professional boundary…but in the moment Mr. Z reminds Tom of his experience with his father so Tom decides to run the errand so that Mr. Z can benefit from the same supports his father had.

Mr. Z is very appreciative and praises Tom for his excellent care. Over the course of the next few weeks, Tom and Mr. Z’s relationship grows closer and Tom finds himself spending additional time with Mr. Z. Eventually Mr. Z asks Tom to stay for the entire afternoon. When Tom declines due to the need to see other patients Mr. Z becomes upset. After reflecting on this interaction, Tom comes to recognize the impact of the professional boundary violation on Mr. Z and decides to seek assistance from his manager to re-establish a therapeutic relationship.

Analysis: Tom is a dedicated professional who committed a boundary violation due to conspiring elements: working solo, vulnerability due to recent experience with his father, and rationalization that Mr. Z needed him to run the errand in order to receive the same supports Tom’s father had. When Tom realizes the impact of his actions, he demonstrates accountability by notifying his manager and taking action to address the boundary violation.

Case scenario question to consider: How could Tom and his manager address the boundary violation while keeping Mr. Z at the center of care?

Useful resources:

• Professional Boundaries for Therapeutic Relationships
• Canadian Nurses Association (2017) Code of Ethics for Registered Nurses

References:

• Catherine V. Caldicott. A Framework for Remediating Professional Ethical Lapses, Journal of Nursing Regulation,Volume 10, Issue 2,2019,Pages 11-20,ISSN 2155-8256, https://doi.org/10.1016/S2155-8256(19)30111-5.