Official Source for Patient to Nurse Boundaries?

Thunderwolf, MSN, RN · Nov 6, 2005

Check with your nurse practice act in your state. I'm sure several states have it clearly worded.

Kabin · Nov 7, 2005

Thanks for the input.

It's amazing how loosely defined the topic is. Paragraph 2.4 of the ANA Code of Ethics says "the nurse recognizes and mantain boundaries that establish appropriate limits" but doesn't spell out what the nurse should recognize.

Just in case anyone else needs to find something slightly more useful, here's an online brochure on the subject from the National Council on State Boards of Nursing:

http://www.ncsbn.org/pdfs/ProfessionalBoundariesbrochure.pdf

Thunderwolf, MSN, RN · Nov 7, 2005

Here is something from the Ohio Nurse Practice Act:

4723-4-06 Standards of Nursing Practice Promoting Client Safety

When providing direct nursing care to a client or through any form of telecommunication, the licensed nurse shall display (direct nursing care) or identify (telecommunications) the applicable title or initials to identify the nurse's relevant licensure. A healthcare facility cannot issue an identification tag stating simply "Nursing Services" or "Healthcare" (Morris, 2003).

Licensed nurses must delegate a nursing task only in accordance with Ohio Administrative Code and must document nursing assessments or observations, care provided, and the client's response to that care in a complete, accurate, and timely manner. The licensed nurse must report to the appropriate practitioner errors in, or deviations from, the prescribed regimen of care in an accurate and timely manner. Licensed nurses must not falsify client records or any other document prepared or utilized in the course of, or in conjunction with, nursing practice (OAC, 2003).

SCENARIO 1. The licensed nurse must implement measures to promote a safe environment for each client and delineate, establish, and maintain professional boundaries with each client. Licensed nurses shall provide privacy during examination or treatment and in the care of personal or bodily needs and treat each client with courtesy, respect, and with full recognition of dignity and individuality (OAC, 2003).

SCENARIO 2. A licensed nurse shall not:

Engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a client.
Engage in behavior toward a client that may reasonably be interpreted as physical, verbal, mental, or emotional abuse. (OAC, 2003).

SCENARIO 3. The nurse-patient relationship is a professional one. The boundaries in the relationship are established by the nurse because the nurse is the professional in the relationship. The professional nurse-patient relationship is not a business, personal, social, or sexual relationship. Having more than one relationship with a patient can lead to role confusion, boundary crossing, and sexual misconduct. In Ohio law, a client cannot consent to, or have consented to, sexual activity with a nurse.

A licensed nurse shall not misappropriate a client's property or:

Engage in behavior to seek or obtain personal gain or behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client's expense.
Engage in behavior that constitutes inappropriate involvement or may reasonably be interpreted as inappropriate involvement in the client's personal relationships. (OAC, 2003).

A licensed nurse shall not:

Engage in sexual conduct or in conduct that may reasonably be interpreted as sexual with a client.
Engage in any verbal behavior that is seductive or sexually demeaning or that may reasonably be interpreted as seductive or sexually demeaning to a client (OAC, 2003).

A licensed nurse functioning in an administrative role shall assure that adequate procedures are in place and implemented to verify that each nurse under the nurse administrator has a current valid license to practice nursing in Ohio and, if applicable, other documents of approval or certification as required by the Board. When nursing practice is supervised or evaluated, only a registered nurse shall supervise and/or evaluate the practice of nursing by other RNs and LPNs. In matters other than the practice of nursing, a non-nursing supervisor may evaluate a nurse employee (OAC, 2003).