Nursing in its own rights is considered a ‘caring’ profession and this can result in the nurse-patient relationship, or even nurse-carer relationship, sliding into that grey area that becomes over familiar and unprofessional. Part of our jobs is to get to know the ins and outs of every aspect of our patient’s lives, building a trusting relationship and looking at everything holistically.
One of the first sentences in the NMC Code of Conduct is “make their care and safety your main priority” and because most nurses put their heart and soul into their job, they can become overinvested in a patient’s care. However, the Code also states that nurses must maintain a professional relationship with everyone in their care, ensuring they stay objective and within their role.
Location, location, location
Now, maintaining that professional barrier is not always difficult, but does vary depending on where you work. If you’re based in a recovery unit where patients are only with you for a short period of time, this is slightly easier to do. However, those nurses in the community, or with long term patients in hospitals, get to know their patients for a longer period of time, even years. When you know someone this long its impossible to not get to know them and this works in the other direction as well, with the patient knowing more about the nurse’s personal life. While there’s no problem with a patient or nurse knowing some things, in excess it can move the relationship away from being person-centred, leading one or both parties to become overinvolved in a given situation.
The real problem is ‘boundaries’ are not something that’s easy to define. There are clear examples, such as starting a romantic relationship or taking a patient’s money, but some things are very subjective. Should nurses hug their patients? Some nurses won’t like this, either because they’re not huggy people, while some feel that this is unprofessional; I’ll admit, most nurses I’ve spoken to would hug a patient and I myself have done it, but only with consent from the patient and at an appropriate time. Professional boundaries can also be perceived differently by different people, for instance, while the nurse and patient may feel its appropriate to hug, a visitor of another patient may feel that this is unprofessional. The crossing of any boundary in a professional relationship should be in the patient’s best interests and have some sort of therapeutic benefit.
Nurses can also fall into the trap of providing services above and beyond their job role, especially if they are friendly with their patients or there is a crisis. This is particularly prominent in the community where 24 hour care is only for emergencies and there is no one to hand over the care of a patient too; nurses can spend extra hours of their day, unpaid, working to fix issues.
There is also the issue to ensuring you don’t underinvest in a patient in an effort to create a professional boundary. If a nurse is unable to build a viable relationship with their patients then its very difficult to develop a trusting relationship.
If you’re concerned?
As a general rule, nurses should avoid sharing or discussing their personal lives with patients, keeping secrets with them, visiting them outside their normal work hours or expressing favouritism towards them. When concerned always ask a colleague, find out how they would have behaved in the situation or what they would have done differently. Your mentor or tutor will also be able to give advice.
National Council of State Boards of Nursing (2018) A Nurse’s Guide to Professional Boundaries. Available at: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf (Accessed: 25 October 2018).
NMC (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at: http://www.nmc.org.uk/code (Accessed: 10 October 2018).