Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the BC College of Nurses and Midwives, and all legislation relevant to nursing practice.
nurse1-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. It is therapeutic and focuses on the needs of the
client.2 It is based on trust, respect and professional
intimacy,3 and it requires the appropriate use of authority. The nurse-client relationship is conducted within boundaries that separate professional and therapeutic behaviour from non-professional and non-therapeutic behaviour. A client's dignity, autonomy and privacy are kept safe within the nurse-client relationship.
Within the nurse-client relationship, the client is often vulnerable because the nurse has more power than the client. The nurse has influence, access to information, and specialized knowledge and skills. Nurses have the competencies to develop a therapeutic relationship and set appropriate boundaries with their clients. Nurses who put their personal needs ahead of their clients' needs misuse their power.
The nurse who violates a boundary can harm both the nurse-client relationship and the client. A nurse may violate a boundary in terms of behaviour related to favouritism, physical contact, friendship, socializing, gifts, dating, intimacy, disclosure, chastising and coercion.
Some boundaries are clear cut. Others are not so clear and require the nurse to use professional judgment. This is true particularly in small
communities4 where nurses may have both a personal and a professional role. Employers that provide education, supervision and support related to boundary issues will help staff recognize and resolve problems in the early stages.
Ensure you review legislation relevant to the nurse-client relationship, as some laws may affect the roles that nurses can assume.
Be transparent, therapeutic and ethical with all your clients and former clients. When the issues are complex and boundaries are not clear, discuss your concerns with a knowledgeable and trusted colleague.
Disclose your personal information only with a therapeutic intent, such as to develop trust and establish a rapport with a client. Focus on the client’s needs. Do not disclose intimate details or give long descriptions of your personal experience.
If you accept clients as personal contacts on social media sites, you may be crossing a boundary. You may also breach client privacy and confidentiality. Do not discuss clients (even anonymously or indirectly) or share client pictures on social media sites or in any public forum.
Nurses who work and live in the same community often have a dual role. Ensure that the applicable legislation does not prohibit you from acting in a nursing role and a personal role at the same time. If you have a personal relationship with a client or former client, be clear about when you are acting in a personal relationship and when you are acting in a professional relationship. Explain your commitment to confidentiality and what the client can expect of you as a nurse. Consider the difference between being friendly and being friends.
Be cautious in forming a personal relationship with a former client. Consider the amount of time that has passed since the professional relationship ended; how mature and vulnerable the former client is; whether the former client has any impaired decision-making ability; the nature, intensity, and duration of the nursing care that was provided; and whether the client is likely to require your care again.
Before touching or hugging a client, determine whether such contact would be appropriate, supportive and welcome.
Be careful about accepting a token gift from a client. Consider why the client has offered the gift to you, and the value and appropriateness of the gift. When you refuse a gift, explain why in a sensitive manner. Discuss ways the gift could be redirected.
If you are a nurse administrator, educator or researcher, consider how these principles apply to your relationships with staff, students and research participants.
Seek impartial help to clarify the boundaries of a therapeutic relationship if you become aware of any of the following behaviour in yourself or a colleague:
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For more information
BCCNM’s Standards of Practice (Professional Standards, Practice Standards, and Scope of Practice Standards) set out requirements for practice that nurses must meet. They are available from the Nursing Standards section of the BCCNM website
Web module — Boundaries