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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



Sometimes we buy our patients gifts and cake for their birthdays and wonder if this is appropriate. What should we consider?

Gift giving is a complex issue and can blur boundaries. Giving token gifts as a group may be acceptable. When deciding, discuss with your colleagues and consider:

  • The intent of the gift
  • The implications of singling out clients
  • If a gift could be seen as an attempt to create a special relationship
  • Any agency policy about giving and receiving gifts.

Developing unit guidelines for celebrating client birthdays would provide direction.

Refer to the Boundaries in the Nurse-Client Relationship practice standard for further guidance.

A client sent a "friend" request to my personal Facebook account. Is it okay to accept?

It's not appropriate for you to be a client's personal Facebook friend. The reason for your relationship with the client is to provide professional nursing services. Nurse-client relationships occur 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.

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

I think I have the flu. If I call in sick, the unit will be short-staffed. Can I work?

If you have flu-like symptoms such as fever, chills and achiness, stay home. It may be difficult for you to work effectively and you may be contagious. Although it’s difficult knowing your absence might impact your colleagues’ work, you have a duty to protect your clients from the risk of infection. Staying home when ill is one way to do this. Washing your hands frequently and keeping your immunizations up to date are other ways to prevent infection and provide safe care to your clients.

The Communicable Diseases: Preventing Nurse-to-Client Transmission Practice Standard provides more information about your responsibilities to provide safe care to clients.​​