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Ooof, boundaries. You know that setting healthy limits is good for you when working as a nurse, yet it’s sometimes challenging to draw the line—yep, especially for people pleasers.
Nursing is one of the most trusted professions. Every day, nurses show up at patients' bedsides to provide professional care. However, a nurse is never limited to providing just clinical support.
The nurse-patient relationship is based on trust and compassionate care; nurses comfort, explain, and often create bonds with patients that go far beyond administering treatment.
Yet, where do you draw the line without losing the beautiful humanity that characterizes nurses' care for their patients?
Here’s the deal: Setting boundaries with patients is crucial to maintaining a healthy work ethic. In fact, to stay ethical within your job scope, you need to be familiar with how to set these limits.
If you want to learn how to maintain professional boundaries as a nurse at work, here’s how to do just that (and stick with it).
Professional boundaries definition: It’s all in the balance
Professional boundaries set the line that separates your professional responsibilities as a nurse from your personal involvement with a patient.
Does this sound a bit ambiguous? Not to worry; here are a couple of other definitions of professional boundaries:
- According to the National Council of State Boards of Nursing, Inc. (NCSBN®), “Professional boundaries are the spaces between the nurse’s power and the patient’s vulnerability.”
- Professional boundaries, according to the American Nurses Association’s Nursing Code of Ethics, Provision 2.3, are to “protect the patient and to mitigate power imbalances with recipients of care. Nurses examine their behaviors and actions to ensure they are functioning within their professional role.”
Essentially, professional boundaries in healthcare will maintain a healthy therapeutic relationship between a nurse and their patient. While it sounds simple, we are just scratching the surface.
Why is it so important to establish these boundaries?
Why are professional boundaries important for nurses? Boundaries are crucial to avoid burnout, emotional entanglement (with patients), and enmeshment between your professional and personal life.
Nurse burnout is on the rise in the nursing profession. This reflects how much nurses give yet forget to care for themselves. Avoiding emotional enmeshment within a nurse-patient relationship is, therefore, essential for maintaining overall wellbeing.
As a nurse, you also need to be aware of how not setting healthy boundaries could lead to legal repercussions.
In worst-case scenarios, if you violate guidelines clearly stated in the Code of Ethics for Nurses or regulations outlined in the NCSBN, you could face disciplinary action. These actions could include fines or even termination of employment.
What are examples of professional boundaries in nursing?
There are many ways that a nurse and client relationship can be functional, empathetic, and appropriate. First, you should understand how boundaries in nursing are categorized and how to follow them.
Below are some examples of professional boundaries in nursing.
Physical boundaries
Nurses must abstain from any inappropriate physical display or contact beyond clinical care.
- Example situation: A patient asking for a hug or other physical display of affection that seems too intimate
Emotional boundaries
Nurses must refrain from excessive personal disclosure or emotional dependence.
- Example situation: A nurse venting to a patient about a recent breakup
Social boundaries
Nurses should not accept invitations, social encounters, or relationships outside the clinical care setting.
- Example situation: A nurse giving special treatment to a patient, such as visiting them more often than other patients, giving them gifts or running errands for them because of personal or romantic interests
Digital boundaries
Nurses should refrain from exchanging information outside of clinical communication and avoid connecting with patients on social media channels.
- Example situation: A patient trying to send a nurse a personal message on social media channels, such as Facebook or Instagram
Long story short, you can still remain empathetic and compassionate with your patients without going over the line as a nurse. Keeping these examples in mind will help you stay on track.
Wait, but can nurses become friends with patients?
The short answer? Yes, a nurse can certainly become friends with a patient, as long as the relationship stays within an appropriate scope of connection.
Imagine this: You are caring for a patient who has recently come out of a major surgery, and you are in charge of overseeing their post-surgical care, which is expected to include an extended hospital stay. Over the course of several days, you begin to interact with your patient as they become more coherent and share details about their home life.
They tell you stories about their children and grandchildren and how they are anxious to get back to them. The conversation stays neutral and casual, and you notice that the chats help keep your patient motivated to heal.
This example falls within the realm of an appropriate therapeutic nurse-client relationship.
The bottom line is that nurses can absolutely connect with their patients and form friendships over time. However, these relationships should stay within professional limitations that don’t risk a nurse’s job or a patient’s wellbeing.
Can a nurse date a patient?
It is generally not a good idea to date a patient under your direct care. Even if a patient has recently been discharged, nurses should abstain from dating them.
In the United States, no rules or explicit federal laws prohibit a nurse from dating a former patient. However, you should always carefully review your state’s board of nursing regulations and the ANA code of ethics, which address appropriate relationship dynamics between patient and nurse.
How do I maintain a healthy professional nurse-patient relationship?
Maintaining a healthy therapeutic relationship in nursing is not always easy, but it is necessary. Here’s how to set professional boundaries as a nurse:
- Avoid unnecessary physical contact: Make sure physical contact is always clinical in nature.
- Be kind but firm: Provide care and emotional support without falling into a friendship that blurs the lines between therapeutic care and emotional dependence.
- Be ethical and professional: Treat all patients equally. Avoid favoritism, such as spending more time with a patient or giving gifts.
- Monitor yourself and your patients: If you feel overly attached or affected, or if you feel the patient is, seek support.
Some nurse-patient interactions require non-verbal communication. These strategies can be particularly helpful for staying compliant and within professional limits: 7 Tips to aid communication with non-verbal patients.
What should I do if a professional boundary is crossed?
If professional boundaries are crossed unintentionally, don’t panic. Moving forward, here are some tips for maintaining boundaries in nursing practice:
- Address the issue calmly and professionally in the moment, if safe to do so. For example, if your patient begins to talk about something too intimate about their lives, let them know that the conversation should stop.
- Document the incident clearly on a computerized or paper report. Write down dates, times, and what was said or done. For example, if a situation becomes violent or aggressive between a nurse and a patient, it’s vital to write down all details clearly.
- Report the violation to your head supervisor or manager and calmly explain what occurred between you and the patient. Try to keep emotions out of it.
Depending on the incident, your manager could decide to escalate the situation and report it to the state board of nursing. However, this occurs in worst-case scenarios; many times, an unintentional boundary that was crossed and caused no harm to a patient or nurse can be resolved on a managerial level.
Nurse-client relationship in PRN nursing: Special considerations
If you work as a per diem or PRN nurse, you have to build a quick connection with your patients. At the same time, you need to know where to draw the line.
For example, nursing home residents, who are familiar with the facility’s internal staff, may see a PRN nurse like a substitute teacher. A patient could take advantage of this and confide details pertaining to their lives that are not appropriate to discuss in a nurse-patient relationship, or perhaps even criticise the facility’s internal staff.
The easiest way for a PRN nurse to maintain professional boundaries is to be clear on the facility’s expectations for appropriate nurse-patient relationships.
Also, make sure you, as a PRN nurse, are taking care of yourself between shifts. Healthy snacks, stretching, and breathing exercises will help you stay calm and centered.
Building a connection with professional boundaries
Let’s be clear: There is absolutely nothing wrong with forming connections with patients within a clinical scope, as long as the interaction falls within a healthy and legal range. Plenty of nurses are left with the imprint of patients in their hearts long after discharge.
Learning how to build bonds and provide therapeutic care is easier when you understand where an appropriate nurse-patient relationship begins and ends. This advice will also help you face situations where the lines of human attachment blur.
The key is balance, staying centered, and seeking support if you ever feel the need for clarity on what entails a correct, compassionate, and positive nurse-patient relationship.
If you want more guidance on forming relationships while maintaining professional boundaries in nursing, check out how to deal with difficult patients here.
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