Being clear about professional boundaries: nurses must always maintain their professional boundaries and be very aware of events or situations that may threaten them. There is plenty of information to help nurses understand this critical practice issue.
The boundaries of professional practice for nurses and midwives is the subject of a research project being undertaken by the Nursing Council here, in partnership with the Australian Nursing and Midwifery Council The Nursing & Midwifery Council (NMC) is the UK regulator for two professions, Nursing and Midwifery.
It does this through maintaining a register of all nurses, midwives and specialist community public health nurses eligible to practise within the UK and by setting and the University of Newcastle's Faculty of Health. The project's aim is to develop national guidelines on this issue. This year nurses were invited to attend forums in both Australia and New Zealand New Zealand (zē`lənd), island country (2005 est. pop. 4,035,000), 104,454 sq mi (270,534 sq km), in the S Pacific Ocean, over 1,000 mi (1,600 km) SE of Australia. The capital is Wellington; the largest city and leading port is Auckland. to contribute to this research. Consumer forums have also been held.
Thus it is timely to do a brief literature scan of some of the general trends and debates regarding professional boundaries professional boundary Professional ethics An ill-defined psychosocial 'frontier' maintained between a professional and a Pt or client. See Dual relationship, Sexual misconduct, Slippery slope. and where to find learning tools on this important issue.
A broad definition of professional boundaries is the "limits which protect the space between the professional's power and the client's vulnerability". (1)
Violations a significant issue
The Nursing Council here, in its forums in 2006, stated that violations of professional boundaries were a significant issue in their case reviews, including the following categories:
* sexual/intimate or inappropriate relationships;
* accepting gifts or money;
* inappropriate financial dealings with patients;
* inappropriate relationships with colleagues. 2 These cases include professional boundary issues outside the therapeutic relationship with a patient and are a reminder of the importance of trust within team relationships.
The Council noted that new graduate nurses were the focus of some cases and this emphasises the need for senior nurses to educate and alert less experienced colleagues when a boundary could potentially be crossed. (3)
Although inexperience Inexperience
See also Innocence, Naïveté.
Bowes, Major Edward
(1874–1946) originator and master of ceremonies of the Amateur Hour on radio. [Am. may be a factor in boundary crossings and/or violations, North American North American
named after North America.
North American blastomycosis
see North American blastomycosis.
North American cattle tick
see boophilusannulatus. commentators state these sometimes occur with "well-educated, ethical, law-abiding professionals during periods of stress, loss and trauma. The majority are rarely the result of deliberate exploitation. Rather, they're the consequence of the well intentioned that self deceive TO DECEIVE. To induce another either by words or actions, to take that for true which is not so. Wolff, Inst. Nat. Sec. 356. and rationalise Verb 1. rationalise - structure and run according to rational or scientific principles in order to achieve desired results; "We rationalized the factory's production and raised profits"
rationalize crossing lines for the benefit of the ill": (1)
So what factors may contribute to such boundary crossings/violations in the case of the experienced health professional? One factor may be the lack of clinical supervision or mentorship to ensure nurses have a safe place to reflect on their practice and raise any concerns they have. It is recognised that the earlier questions are discussed, the more likely it is that such issues can be resolved effectively. (4)
Other factors are contextual issues, such as managing dual relationships in rural communities. Boundary crossings are an unavoidable part of rural practice, and planning and evaluation is required to navigate these. One North American multidisciplinary health group has called for a greater emphasis on rural health care ethics to address these challenges. (5)
It is also important to consider cultural issues. The Nursing Council states cultural safety "is about relating and responding effectively to people with diverse needs in a way that the people who use the service can define as safe." (6) Once again, this requires "navigation skills" to ensure that situations where boundaries could potentially be crossed are managed effectively.
Access to ongoing professional development is vital to stay informed of this critical practice issue. In New Zealand, case reviews are available on the websites of the Health and Disability Commissioner and the Health Practitioners Disciplinary Tribunal The Health Practitioners Disciplinary Tribunal of New Zealand hears and determines disciplinary proceedings brought against health practitioners.
The Tribunal was created by section 84 Health Practitioners Competence Assurance Act 2003 ("the Act") and established 18 Two examples are HDC (Hard Disk Controller) See disk controller.
HDC - Disk Controller Case report 06HDC06218, and HPDT HPDT High-Performance Data Transfer Decision no46/ Nur06/31P. (7,8) (See also pp32-33 of this issue.) It is useful to read these cases, with the latter relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc some of the complexities in the rural context. Such reviews also outline the standards against which nursing practice is judged. An example is the Nursing Council's Code of Conduct which lists examples of behaviour that "could be considered as a basis for a finding of professional misconduct professional misconduct,
n conduct inappropriate to the practice of health care.
professional misconduct Behavior by a professional that implies an intentional compromise of ethical standards. ". (9) Nurses also need to be aware of employer policies on this issue.
Internet resources are also available, eg guidelines published by the New South Wales New South Wales, state (1991 pop. 5,164,549), 309,443 sq mi (801,457 sq km), SE Australia. It is bounded on the E by the Pacific Ocean. Sydney is the capital. The other principal urban centers are Newcastle, Wagga Wagga, Lismore, Wollongong, and Broken Hill. Nurses' and Midwives' Board and the College and Association of Registered Nurses of Alberta. (10,4) These guidelines contain details on the concept of professional boundaries, as well as decision-making frameworks, sets of principles for safe practice and clinical scenarios. They are a valuable adjunct to ethical frameworks as they discuss the less "dear cut" areas, eg self-disclosure and receiving gifts. From time to time, NZNO NZNO New Zealand Nurses Organisation staff also facilitate workshops on this theme.
To summarise, nurses must remember we are nurses all the time, wherever we are in the community. It is vital to seek advice early when questions or dilemmas around professional boundaries arise. It is equally important that administrative and management staff in the health care team also understand the concept of professional boundaries and their accountabilities. This raises the need for education opportunities for the whole health care team. (1) With such education in mind, I look forward to reading the outcomes of the joint Australian and New Zealand research project in the future.
By professional nursing adviser Charlotte Thompson
(1) Holder, K.V., & Schenthal, S.J. (2007) Watch your step: Nursing and professional boundaries. Nursing Management; 38: 2, 24-29.
(2) Prendergast, C. (2006) Professional Boundaries. Paper presented at the Nursing Council Forum, Wellington.
(3) Nee, C.L. (2006) Where to draw the line? Nursing 2006; 36: 3, 6.
(4) College & Association of Registered Nurses of Alberta (2005) Professional Boundaries for Registered Nurses: Guidelines for the NurseClient Relationship. www.nurses.ab.ca/ Retrieved 01/08/07.
(5) Nelson, W., Pomerantz, A., Howard, K. & Bushy bush·y
adj. bush·i·er, bush·i·est
1. Overgrown with bushes.
2. Thick and shaggy: a bushy head of hair. , A. (2007) A proposed rural healthcare ethics agenda. Journal of Medical Ethics medical ethics The moral construct focused on the medical issues of individual Pts and medical practitioners. See Baby Doe, Brouphy, Conran, Jefferson, Kevorkian, Quinlan, Roe v Wade, Webster decision. ; 33, 136-139.
(6) Nursing Council of New Zealand The Nursing Council of New Zealand (NCNZ) are the professional body responsible for the registration of nurses in New Zealand, setting standards for nursing education and practice.
The council was established in 1902. (2005a) Guidelines for Cultural Safety, the Treaty of Woitongi and Maori Health in Nursing Education and Practice. Wellington: Author.
(7) Office of the Health and Disability Commissioner. (2006) Registered nurse, Ms B, A District Health Board. A report by Deputy Health and Disability Commissioner, Rae Lamb. www.hdc.org.nz/files/hdc/opinions/06hdc00218nurse.pdf. Retrieved 01/08/07.
(8) The Health Practitioners Disciplinary Tribunal (2007) Decision no. 46/Nur06/31P. www.hpdt.org.nz/portals/o/nur0631Pfindings.pdf. Retrieved 01/08/07.
(9) Nursing Council of New Zealand (2005b) Code of Conduct for Nurses. Wellington: Author.
(10) Nurses and Midwives Board. (1999) Boundaries of Professional Practice: Guidebnes for Registered Nurses, Registered Midwives, and Enrolled Nurses. www.nmb.nsw.gov.au. Retrieved 01//08/07.