In a prior post, we suggested a Correctional Nurse Manifesto with seven propositions. We are in the midst of discussing Proposition Four:

Correctional nurses hold themselves and their peers to the professional boundaries of practice

Our last post discussed why we need boundaries and signs that boundaries are being crossed. This post talks about the broken fences of boundary violation and what to do to avoid boundary crossing or violations in your own practice or that of your peers.

Broken Fences – Boundary Violations

Unfortunately, we see it again and again – correctional nurses crossing the boundary into sexual relationships, providing contraband, or drugs to an incarcerated patient. How does it happen? Boundaries are violated when a professional relationship moves to a social relationship. In a professional relationship the nurse provides care and service based on using expert knowledge. The relationship is therapeutic and focused on the needs of the patient. A social relationship shifts this focus to personal needs and desires, thus distorting goals and intentions of communication and actions. At a minimum this can be confusing to the patient and undermines therapeutic efforts. At worst, this can be exploitative and personally dangerous.

Boundary crossings, described in Part I, lead to boundary violations. The line between a boundary crossing and a boundary violation can be blurred. Boundary crossings are single events in a nurse-patient relationship that may be by error or lack of awareness. A boundary violation, however, is a persistent relationship characterized by indulging in actions of a personal nature. In the correctional setting, this often involves affectionate communication – both verbal and written (love letters); sexual interaction; or providing contraband – drugs, cell phones, alcohol.

Identifying Inappropriate Professional Behavior

We serve ourselves, our colleagues, and our patients by being alert for and responding to any indication of professional boundary crossing or violation. The College of Registered Nurses of Nova Scotia provides a decision-making framework with 5 quick questions to ask to determine if a behavior you are considering or one you observe in a colleague is within professional nursing boundaries. These questions have been modified to reflect American correctional nursing practice:

• Is the behavior consistent with the Nursing Code of Ethics?
• Is the behavior consistent with the Correctional Nursing: Scope and Standards of Practice?
• Is the behavior consistent with your duty to always act in the best interest of your patient?
• Does the behavior promote patient autonomy and self-determination?
• Is this a behavior you would want other people to know you have engaged in with a patient?

If the answer to any of these questions is ‘No’ – DON’T DO IT!!!

Mending Fences

Even if there have not been any boundary crossings or violations, good fence upkeep is in order. We all need to keep our professional fences in good repair and encourage our peers to do the same. Here are some recommendations from a nursing journal article on the subject:

• Openly discuss the challenge of professional boundaries with correctional nursing peers
• Make a pact with your peers to ‘watch their back’ when it comes to observed boundary crossing. Look out for each other
• Be particularly sensitive to stressful times in your personal life as this increases vulnerability to boundary violations in practice
• Do not discuss intimate or personal issues with a patient
• Do not keep secrets for or with patients
• Treat all patients with dignity and respect (See Manifesto Proposition One)
• Speak, act, and dress professionally to inspire professional conduct in yourself and others
• Be firm, fair, and consistent with all patients
• Do not engage in behavior that can be misinterpreted as flirting, like touching or giving personal compliments

Have you seen indications of professional boundary violations in your correctional nursing practice or the practice of your peers? What did you do about it? Share your thoughts in the comments section of this post.