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What happens to the therapeutic relationship when boundaries are crossed and a nurse puts personal needs ahead of a client's needs?

 These scenarios show the types of complaints the college receives about boundary violations, financial abuse, and conflict of interest by nurses. ​​​​​​

Scenario 1

Dianne has been providing home care for Mr. Adams for several months and enjoys their weekly visits. Mr. Adams is easygoing and often calls Dianne his favourite nurse. When Dianne arrives late one morning, she apologizes and tells Mr. Adams about her car troubles. Dianne confesses that she can't afford to have it fixed right now. Mr. Adams offers to lend Dianne his car, reminding her that he can't drive right now anyway.​​

What does Dianne do?

Telling herself that she's only borrowing it for a few days, Dianne accepts the offer. When Mr. Adams’ son learns of the situation, he reports Dianne to the agency manager. After meeting with her and investigating the situation, the manager finds out that Dianne used the car for a period of eight weeks, only returning it when her actions were reported. The manager reports Dianne's actions to the college.​​

​​Scenario 2

Barbara is hired to provide private nursing care for Mr. Smith in his home. She soon recognizes that Mrs. Smith needs help with banking and bill paying. Knowing that Mrs. Smith has no close family, Barbara offers to assist by driving her to the bank and helping her pay bills. After several weeks, Mrs. Smith tells Barbara that she really depends on her and asks her to act as her power of attorney.

What does Barbara do?

Barbara doesn't consider Mrs. Smith her client and agrees to take this on. When another agency nurse learns of this agreement, she reports Barbara to the college.

A BCCNM investigation reveals that Barbara accepted an appointment as power of attorney for Mrs. Smith, which breaches the Boundaries practice standard. The investigation also found that Barbara paid several of her own personal bills, totalling close to $500, from Mrs. Smith's account, which is financial abuse. ​

Engaging in any activity within the nurse-client relationship that results in financial or personal benefit to you or loss to the client violates the boundaries of a therapeutic relationship. Putting your personal needs ahead of your client's needs is a breach of trust and misuse of your power.  

Behaviours that are unacceptable in any therapeutic nurse-client relationship include (but are not limited to):​

  • Borrowing money or property from a client
  • Soliciting gifts from a client
  • Withholding finances through deception or theft
  • Using influence, pressure, or coercion to obtain the client's money or property
  • Having power of attorney, guardianship, or financial trusteeship
  • Misusing a client's bank accounts or credit cards
  • Assisting with the financial affairs of a client without the employer’s knowledge
  • Referring to or promoting a private or personal business to clients

Boundaries in the Nurse-Client Relationship and Conflict of Interest practice standards set out expectations in these situations. The nurse — not the client — is always responsible for establishing and maintaining boundaries. The nurse is also responsible for terminating the therapeutic relationship. The nurse who violates a boundary can harm both the nurse-client relationship and the client.

​Scenario 3

Jarrod works on a rehab unit and is caring for Mrs. Wong, a client with diabetes and a recent amputation. Mrs. Wong, concerned about her ability to manage on her own, has decided to move into an independent housing facility. Mrs. Wong tells Jarrod about the home she's lived in for 50 years and confesses she doesn't know anything about selling a house.

What does Jarrod do?

Jarrod tells Mrs. Wong that his partner is a realtor. Jarrod leaves his partner's business card and organizes to have him drop by that evening. When Mrs. Wong tells another nurse about how helpful Jarrod has been, the nurse reports the incident to the manager. The manager had cautioned Jarrod about discussing his partner's business with clients on two previous occasions and gave him a letter of expectation. The manager also required all staff, including Jarrod, to review organizational policies related to conflict of interest. Despite this, Jarrod repeated the behaviour, breaching the conflict of Interest practice standard. Jarrod's manager reports him to the college.​

What, when, and how to report

As a nurse, you are responsible and accountable for reporting unethical conduct. Behaviours that violate boundaries or are outside the zone of professional behaviour, such as those described above, require intervention and reporting.

If you are unsure if reporting is required, speak with your manager, a colleague, or your organization's p​atient care quality office, or call BCCNM's Intake Advisor to discuss. ​​​​

​​Need help or support?​

For further guidance on understanding and applying the standards of practice, contact our team by completing the Standards Support intake form.​

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Vancouver, BC  V6C 1S4

​Toll-free 1.866.880.7101 (within Canada only) ​

We acknowledge the rights and title of the First Nations on whose collective unceded territories encompass the land base colonially known as British Columbia. We give specific thanks to the hən̓q̓əmin̓əm̓ speaking peoples the xʷməθkʷəy̓əm (Musqueam) and sel̓íl̓witulh (Tsleil-Waututh) Nations and the Sḵwx̱wú7mesh-ulh Sníchim speaking Peoples the Sḵwx̱wú7mesh Úxwumixw (Squamish Nation), on whose unceded territories BCCNM’s office is located. We also give thanks for the medicines of these territories and recognize that laws, governance, and health systems tied to these lands and waters have existed here for over 9000 years.

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