Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
Sheila is an intake nurse in a local jail in her community. About a month ago she processed the intake for a former high school friend who, along with several other men, was charged with assault during a barroom brawl that ended with emergency response and several patrons taken to the hospital for stitches. Jim and Sheila talked briefly during the intake process and he was in the jail 48 hours. She saw him again a couple weeks later in line at the coffee shop in town. They got seats and spent an hour catching up on their time since high school. As Sheila got ready to leave to finish her errands, Jim asked if they could catch a movie together this coming weekend.
Professional or Personal?
The 2.4 Interpretive Statement included with Provision 2 of the Code of Ethics for Nurses describes ethical considerations in our relationships with patients and colleagues. Maintaining a professional relationship keeps the focus therapeutic and committed to the health and wellness needs of the patient. When boundaries are crossed into a personal relationship, the focus is clouded and can easily shift to meeting the nurse’s personal needs.
When has a professional relationship changed to a personal one? This shift can be subtle and easily missed. Here are some common ways to evaluate if a patient relationship is moving outside the therapeutic zone.
- Discussing personal issues with a patient
- Conversation that would be interpreted by others as flirting
- Spending more time than necessary with the patient
- Showing favoritism toward the patient
According to the Code of Ethics for Nurses “dating and sexually intimate relationships with patients are always prohibited” (pg. 7)
Gift or Bribe?
In another post, I discuss gifts and favors often offered to nurses. In correctional nursing practice, a gift can easily turn into a bribe or blackmail. This section of the Code of Ethics directs us to follow facility policy about gifts from patients and that generally gifts should be accepted for the entire nursing staff and not for one specific nurse. Almost universally, correctional facility policy is to accept no gifts from patients as they can be part of a manipulation ploy.
Boundaries with Team Members
While most professional boundary discussions are directed toward the nurse-patient relationship, the new Code reminds us that “boundary violations can also occur in professional colleague relationships” and that “in all communications and actions, nurses are responsible for maintaining professional boundaries”. In our highly charged atmosphere of sexual harassment and coercion, the Code prompts us to keep it professional in the workplace.
Boundaries with Patients
Boundaries in the nurse-patient relationship separate professional therapeutic behavior from non-professional non-therapeutic behavior. Along a continuum of relationship, it is a balance between being over- or under-involved in the patient’s care.
A more extensive treatment of this subject can be found in these posts and podcasts.
Is this a Patient Relationship?
The Nurse’s Guide to Professional Boundaries provides some helpful information for Sheila as she considers Jim’s movie offer. For example, they suggest the following considerations.
- Is the nurse-patient relationship current or former?
- How extensive was the nursing care provided? Short or long-term?
- Will the patient need nursing care in the future?
- What is the risk to the patient in this situation?
The guide particularly addresses the concerns of nurses working in small communities where personal and patient relationships may go on during different time periods over a lifetime. The Guide suggests that, in this case, the nurse must clearly acknowledge the duel relationship and communicate when they are performing in a professional capacity in a situation.
So, what do you think? Should Sheila go to the movies with Jim?
Read other posts about the Code of Ethics here.