Within the relationship, a power imbalance exists, which can make clients vulnerable. The
Boundaries in the Nurse-Client Relationship practice standard makes clear that nurses are responsible for effectively managing this power imbalance by setting and maintaining appropriate boundaries, and acting in clients' best interests at all times.
What happens to the therapeutic relationship when boundaries are crossed and a nurse puts personal needs ahead of a client's needs? These hypothetical scenarios illustrate the types of complaints the college receives about boundary violations, financial abuse, and conflict of interest by nurses.
Read the complaint scenarios»
Engaging in any activity that results in inappropriate 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):
When your judgment and decisions are influenced, or appear to be influenced by a conflict of interest, the trust relationship established with clients, and the public in general, can be jeopardized.
Boundaries in the Nurse-Client Relationships and Boundaries in the Nurse-Client Relationship practice standards set out expectations in these situations. The nurse — not the client — is always responsible for establishing and maintaining boundaries. The nurse who violates a boundary can harm both the nurse-client relationship and the client.
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. A nurse who puts personal needs ahead of a client's needs misuses his/her power.
Generally, nurses do not accept gifts from or give gifts to clients. If a client offers a gift, consider why the client has offered it, and the value and appropriateness of the gift. Where it has therapeutic intent, it may be acceptable for a group of nurses to give or receive a token gift.
When you decline a gift, explain why in a sensitive manner. Return or redirect any significant gift, and discuss ways it could be redirected, such as to a foundation, charity or scholarship fund. Do not accept a bequest from a client.
You have the responsibility and competencies to develop therapeutic relationships and set appropriate boundaries with your clients. These questions from the Professional Boundaries thinking tool can help you determine if your actions or behaviour cross or violate a boundary with your client.
WHO: Who will benefit from this? Whose needs will be met?
WHY: Will my behaviour contribute to the therapeutic nurse/client relationship?
WHAT: Is my behaviour consistent with the plan of care for the client? Am I comfortable documenting this?
HOW: Is this behaviour something I would want colleagues to know I had engaged in with a client?
As a nurse, you are responsible and accountable for your nursing actions and professional conduct. This is includes reporting unethical conduct. Behaviours, such as financial abuse, that violate boundaries or are outside the zone of professional behaviour, require intervention and reporting.
If you are unsure if reporting is required, speak with your manager, a colleague, or call the
Intake Advisor to discuss.