How to Maintain Professional Boundaries in Nursing

It’s no secret that the nurse-patient dynamic is a unique one. Part of being a great nurse is having the ability to demonstrate empathy and compassion with patients without crossing the line of professionalism. To provide the best care, clinicians must protect the caregiver-to-patient relationship by establishing and maintaining strong professional boundaries in nursing. Here is a quick guide of these boundaries and how to respect them while interacting with patients.

Why Have Professional Boundaries in Nursing?

Professional boundaries in nursing exist in nursing for the safety of patients. While building rapport with a patient, it is very important to keep professional boundaries in mind so that both parties feel comfortable within the caregiver-patient dynamic. Healthcare workers are required to perform their duties according to the best interest of the patient at all times, and since patients meet nurses while they are in extremely vulnerable states, boundaries exist to protect them. To ensure patients’ safety, nurses are responsible for creating and upholding these professional boundaries during every encounter.

What are Professional Boundaries in Nursing?

According to the National Council of State Board of Nursing (NCSBN), “Professional boundaries are the spaces between the nurse’s power and the patient’s vulnerability.” When nurses cross professional boundaries — whether intentional or unintentional — it puts the nurses’ needs above those of the patient. Examples of crossing professional boundaries in nursing may include:

• Sharing personal or intimate information.
• Flirting or inappropriate touching.
• Keeping secrets with or for patients.
• Acting as if you are the only one who can care for or understand the patient, positioning yourself as the “super nurse.”
• Showing favoritism by spending more time with a patient than necessary, taking sides in disagreements among family members, or performing personal favors outside of your scope of work.
• Complaining, joking, or speaking negatively about your employer or colleagues to patients or family.
• Meeting with patients outside of work in areas where direct patient care is not being offered.
• Posting about a patient encounter on social media.
• Partaking in an act of omission or commission, which refers to any instance where the nurse fails to act in a manner that benefits the patient or threatens their well-being.

Violating Professional Boundaries in Nursing

Crossing the lines of professional boundaries can create severe consequences for the patient. A patient’s outlook on their care team can change dramatically after professional boundaries are crossed. Whether the boundary crossed was physical, mental, or emotional, a patient’s care and progress can be inhibited by the actions of their nurse. They may start to view their nurse as someone beyond the scope of the nurse’s duties, such as a therapist, confidante, friend, or even lover. While many nurses have big hearts, the sentimental bonds formed with patients should not extend beyond the purview of the healthcare facility. Inappropriate patient relationships can alter the patient’s view on sentimental bonds, emotional distances, moral obligations, or personal responsibilities. These altered expectations, which are not authentic and cannot be sustained, typically result in both mental and physical stress for the patient and can interfere with their current health condition.

In addition, inappropriate nurse-patient interactions can cause potential lasting trauma to the patient. When a vulnerable patient is subjected to unlawful actions by nurses including: inappropriate touch, battery, or HIPAA violations, it can cause or exacerbate medical trauma. Medical trauma is defined as a “set of psychological and physiological responses to pain, injury, serious illness, medical procedures and frightening treatment experiences.” Many patients who experience medical trauma avoid hospitals or resist receiving care due to their past negative experiences.

The consequences of crossing professional boundaries are also serious for nurses. According to the NCSBN, “Crossing professional boundaries and violating the nurse practice act can be the cause of professional discipline and termination of employment.” Further, more severe violations of crossing professional boundaries can result in loss of licensure, criminal charges, fines, and even jail time. The repercussions for violating professional boundaries can also go beyond professional chastisement and lead to nurse burnout and turnover, compassion fatigue, and negative mental health outcomes.

How to Uphold Professional Boundaries in Nursing

To keep professional boundaries securely intact, consider the following:

• Treat all patients with dignity and respect and consistently put their needs first.
• Dress, speak, and behave in a professional manner to reinforce that the nursing profession consists of specialized knowledge that is carried out within a specific scope of practice.
• Keep all patient and family information confidential, speaking to colleagues about patients only when necessary and seeking patient information on a “need to know” basis. Additionally, steer clear from sharing even veiled references of patients or clinical care on social media.
• Nurses who work with less supervision should take extra precautions to maintain professional boundaries, stepping back and evaluating personal behaviors more often if necessary.

Professional boundaries are supported by the values, principles, and standards of the codes of ethics for nurses. Examples of the national codes of ethics for nurses come from the American Nurses Association (ANA). Reviewing these codes can help you gain more clarity around your professional position and help you in maintaining professional boundaries in nursing.