Told to Maintain Professional Boundaries With 4 yr Old

[Nurse Beth, MSN]

Dear Nurse Beth,

I have been a nurse for 32 years. I have worked in hospitals and clinics and have done a little of everything. Recently, I have done home health and home care for pediatric patients (nursing care for one patient on certain days with a nursing agency.

Currently, I am caring for a 4 year old in a preschool setting. My agency is drilling into me about maintaining a professional distance/boundary from other children in the class. I am finding this particularly difficult. These are 3 and 4 year olds. How do you explain to a young child that you can only pay attention to your client? This child has severe dermatology problems with open wounds and can not sustain any type of pressure or friction to the skin or injury will occur.

Is it ok to intervene before my patient gets into a scuffle/ fight with other preschoolers? What is the best professional way to do this with young children without hurting feelings or making the preschool teachers upset?

Dear What is Best Way,

It sounds like you are in a new role/setting and not sure of the expectations. Is there a colleague in your agency you can talk to? Something may have happened in the past to prompt this caution.

Maintaining professional boundaries doesn't equate to not paying attention to others. Maintaining a professional boundary would mean not treating another child or entering into a nurse-patient relationship with another child. Three and four year olds are curious little people and it's expected that you'd acknowledge them and be friendly. Clarify with your agency what the concerns are around professional boundaries with four year olds.

If you observe your patient in a dangerous situation, you need to prevent them from getting hurt and take them out of harm's way. Have a meeting with the preschool teachers and ask for their help and advice to these questions. This is assuming that they care for the child in pre-school the majority of the time when you are not there, but even if you are there for the entire class time, you need to work as a team. Pre-schools do not allow fighting but maybe some additional education is needed around your patient's special needs.

Also visit the School Nurses forum here on site, as they have a lot of experience and wisdom to offer. Good luck and the best with your little patient.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next