Boundaries sit on a continuum that ranges from under-involvement to over-involvement. The zone of the therapeutic relationship is in the middle. Client harm can occur at either end of the continuum. Appropriate professional boundaries create a zone that allows for a safe, effective relationship between the nurse and the client.
As the nurse, you are always responsible for establishing and maintaining appropriate boundaries, regardless of how a client behaves. Some boundaries are clear-cut; others are less clear and require your professional judgment. It’s important that you recognize when a professional relationship is moving out of the zone of helpfulness and into the nonprofessional zone, and that you take immediate action.
Some minor behaviours may appear harmless but can lead to behaviour patterns that indicate the nurse-client relationship is no longer in the therapeutic zone.
Signs of inappropriate behaviour can be subtle; however, these signs indicate a need to reflect on the nurse-client relationship and clarify boundaries. The following behaviours can signal potential boundary issues.
In situations where you have both a personal and professional relationship with a client, you are acting in a dual role. When you have a personal relationship with someone, you may find it difficult to be objective enough to have an effective professional relationship. You may have difficulty separating personal feelings, values, and beliefs from your professional and ethical obligations.
BCCNM recommends that, when possible, nurses avoid dual roles and transfer overall responsibility for care to another health-care provider.