There is growing attention to sexual misconduct in health care today and nurses are particularly vulnerable to a number of boundary violations. While It is always better to be safe than sorry, sometimes certain acts or behaviors may be misperceived as sexual in nature when they are not. It is therefore important for nurses to always keep ethical boundaries at the forefront of their practice.
Nurse-Client Relationship
The nurse-client relationship is important because it focuses on the needs of the client and is intended to be healing and therapeutic. This relationship is based on trust and respect and at times will become professionally intimate, especially during times of hands-on care. Nurses are in the authority position, so they must be aware that their client may be vulnerable during their care. Nurses must always protect the client’s dignity, privacy, and autonomy.
Nurses Have the Power
Nurses have the power because they have the information, influence, specialized knowledge and the clinical skills to help their clients. They can set the tone for the nurse-client relationship by discussing boundaries, what can and cannot be done, and talk about the importance of a clinically appropriate relationship. When a nurse places his or her needs over those of their client’s, they are misusing their power and risk violating ethical boundaries.
Violating Boundaries
When a nurse violates ethical boundaries, he or she harms the client in a number of ways. The focus should be on the care and healing of the client, not taking advantage of him or her. Boundaries can be violated by a number of behaviors including showing favoritism, engaging in sexually inappropriate physical contact, forming a personal friendship, socializing with the client outside of the healthcare space, or accepting gifts for services. Other violations include dating clients, being intimate with them, and punishing them in some way when the nurse doesn’t get what he or she wants.
Nursing Principles
Some boundaries are very clear cut and others are not. This is why nurses are taught to think critically and use their best judgement. They should always fall back on their principles as guides when boundaries are not clear. The nurse is always responsible for setting the tone of the relationship, not the client. The client’s physical and emotional health needs are first and foremost. It is never appropriate to become romantic or engage in sexual activity with a client.
More Principles
Socializing with a client must be reviewed carefully to make sure boundaries are not crossed. The same boundaries must be viewed when providing care to a friend or family member. Nurses should support one another and if some kind of behavior seems inappropriate, nurses should be honest and talk about it. Nurses need to communicate to the client that they are functioning in both professionals as well as personal ways when necessary. They should not use private information against the client, not disclose information, touch too much, humiliate or accept gifts from clients.
Take Away
In many states around the country, nurses are mandated to annually take continuing education on sexual misconduct and ethical boundaries. While sexual boundaries have been crossed for many years in not only health care, but in almost every industry, there is a major spotlight on this topic today. It is therefore important for nurses to protect themselves, understand boundaries and rely on their principles to remain professional and avoid ethical violations.