A nurse comes up to you at a party and says, “Attorney Bill Walters has asked me to become his legal nurse consultant. He also wants to start dating. I met Bill when he had a bad skin infection and was in my hospital. What do you think I should do?”

This nurse is facing a boundary issue. Nurses may be brought before the board of nursing for violating boundary issues. What does that mean? A nurse is in a sensitive position of power with patients and is required to keep relationships professional. Patients trust nurses and consistently place nurses at the top of the most respected professions. A nurse should not benefit financially or romantically from a relationship with a patient. Professional boundaries safeguard patients.

When I was a student nurse I took care of an older married man. I remember he was grateful for my care and asked for my phone number. Not knowing any better, I gave it to him. I thought he might call me later to thank me for taking care of him. I was flabbergasted when he called me to ask me out on a date. I refused. Had I gone, I would have violated a boundary issue. I am a lot less naive now.

Red Flag Warnings of Boundary Violations
The psychiatric field is one where boundary issues are most visible. Some of the warning signs that may provoke a supervisor to step in include

• Off hour phone calls to and from the patient
• Giving and receiving gifts with the patient
• Flirting
• Not recognizing an attraction to the patient
• Keeping secrets with the patient
• Believing that no one else can meet the patient’s needs
• Having social contact with former patients
• Getting overinvolved in a patient’s personal or business affairs
• Inappropriately sharing personal information with the patient
• Having extended sessions with a client, which sends subtle message of over-involvement and favoritism
• Having sexual contact with the patient

Sexual misconduct
Sexual misconduct is more than having an affair with a patient. It may include seductive comments, sexually demeaning remarks, kissing, and dating.

Sources of standards
These are entities that form a framework for nursing practice:

• The nurse practice act
• Board of Nursing regulations
• American Nurses association Code of Ethics
• American Nurses Association Standards of Practice
• The facility’s policies and procedures

Duty to report
Boundary violations are taken so seriously that colleague and supervisors of the nurse are obligated to report the inappropriate conduct to the board of nursing. Outright sexual misconduct is often easiest to spot. Nurses are often reluctant to report others to authorities and may find it easier to turn a blind eye to what is occurring. Employers should have a process in place to report boundary violations, using objective documentation. The board of nursing performs an investigation and may remove the nurse’s license. The nurse could face civil liability. Allegations of sexual misconduct can be difficult to defend and not covered by professional liability insurance. A settlement against a nurse can be recorded to the Health Integrity and Protection Data Bank, affecting future employment.

What do you tell the nurse about her relationship with Attorney Walters?

• Maintain your boundaries with patients. Your relationship with Mr. Walters was for his benefit and should never be used for your own personal gain.
• Even if Mr. Walters asked you to work for him, this represents a violation of boundaries which could lead to disciplinary action by your board of nursing.
• In a civil lawsuit, actual patient harm has to be proved. This is not necessary for a nurse to be found guilty of professional misconduct.
• Even if Mr. Walters was not your patient, it is unwise to get into a romantic relationship with an employer.

Med League is a legal nurse consulting firm that assists attorneys handling cases involving medical negligence, personal injury and other litigation with medical issues at stake. Call us for assistance.