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Boundaries in the Nurse-Client Relationship

Nurses use professional judgment to determine the appropriate boundaries of a therapeutic relationship with each client. The nurse — not the client — is always responsible for establishing and maintaining boundaries.

Practice Standard

Case studies



A client and their family want to show their appreciation for the care they received and have offered me a gift. What should I do?

Clients and their families often show their appreciation for the care they've received with gifts. Generally, nurses do not receive or exchange gifts with clients or their families as the professional, therapeutic relationship could be compromised. Nurses may give or receive a gift if it supports the therapeutic relationship or is part of a client’s cultural practices.

Before accepting a gift, ask yourself these questions:

  • Would I be uncomfortable having colleagues know about the gift?
  • Will accepting this gift affect my relationship with my colleagues?
  • Could the gift be viewed by others as a tip, bribe, or favour?
  • Is the giver seeking preferential treatment?
  • Would accepting the gift change my professional, therapeutic rel​​ationship with this client or any of my other clients?

If the answer to any of these questions is YES, it's best to tactfully decline. Most gifts are well-meaning gestures so a refusal is unlikely to offend if you explain the rationale behind your refusal.

Be sure to review your employer/organizational policies about gifts.

The Boundaries in the Nurse-Client Relationship practice standard provides further direction for navigating gifting situations.

One of my clients has an interest in cycling, which I share. I recently received a Facebook friend request from them. Is it okay to accept?

No. Nurses don’t enter into a friendship with clients or have a personal connection on social media with clients. You cannot ‘friend’ a new client; however, if you’re already personally know the client, the standards allow for you to provide care if appropriate in the context of the friendship.

Nurse-client relationships take place within boundaries that separate professional relationships from personal ones. As the nurse, you are responsible for setting, maintaining, and communicating these boundaries with your clients, both face-to-face and online. Social media can blur the boundaries between a nurse’s personal and professional lives and change the nature of the nurse-client relationship. By connecting on your personal social media account(s), you are crossing the boundary where the professional relationship changes to a personal relationship. Clearly explain to clients that connecting through personal social media sites is not appropriate. Direct them to your professional profile if relevant.

The Boundaries in the Nurse-Client Relationship practice standard sets clear expectations for nurses' relationships with clients.​​​​