Maintaining Professional Boundaries Between Healthcare Professionals And Patients Vitally Important

Deputy Health and Disability Commissioner Dr Vanessa Caldwell today released a report finding a registered nurse in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) by failing to maintain professional boundaries with her client.

The nurse, who was employed by a support service contracted to provide mental health services in prisons, provided mental health support to a male prisoner in his thirties between 2017 and 2019.

As part of her work, the nurse was privy to personal details about his life including his physical and mental health. When her employment with the support service ended, the nurse shared her personal contact details with the man and engaged in frequent telephone calls of a personal nature with him.

Dr Caldwell considered that the registered nurse breached the Code by initiating, and engaging in contact of a personal and often intimate nature with the man after the end of the therapeutic relationship.

"The nurse had an ethical duty to maintain professional boundaries with the man even beyond the conclusion of the therapeutic relationship. The continued vulnerability of the man, combined with the high sensitivity of the information that she had access to, meant that the nature of their relationship was inappropriate," said Dr Caldwell.

This case highlights the important role professionals have in maintaining professional boundaries with their patients. The power imbalance between a healthcare professional and their patient is not necessarily displaced at the end of the therapeutic relationship because of the level of knowledge held by the health professional about a person’s sensitive and personal information.

"As a healthcare provider, the nurse was required to provide services that complied with professional, ethical, and other relevant standards, including the Nursing Council of New Zealand’s Code of Conduct, and Guidelines on Professional Boundaries. These standards and guidelines place the onus of responsibility on healthcare professionals to maintain appropriate professional boundaries.

"Healthcare consumers can be in an unfamiliar situation and may be unaware of the boundaries of a professional relationship. Therefore, healthcare professionals have a responsibility to assist healthcare consumers to understand the appropriate professional relationship," said Dr Caldwell.

The report noted that the risk of crossing professional boundaries can be prevented by maintaining the appropriate boundaries of the nurse-healthcare consumer relationship, and helping people to understand when a request is beyond the limits of the professional relationship. Any approach or activity that could be perceived as crossing boundaries should be included in the care plan developed by the healthcare team.

The Code of Health and Disability Services Consumers’ Rights (the Code) establishes the rights of people using health and disability services, and the obligations and duties of providers to comply with the Code.

"Under Right 2 of the Code, every consumer has the right to be free from discrimination, coercion, harassment, and sexual, financial or other exploitation. Maintaining professional boundaries between healthcare professionals and patients is vitally important to uphold people’s rights in this regard," said Dr Caldwell.

Dr Caldwell recommended that the Nursing Council consider the nurse’s fitness to practice should she seek to return to the workforce, and that her former employer circulate an anonymised copy of this report to staff, to reinforce the importance of maintaining professional boundaries.

The full report for case 20HDC01728 is now available on the HDC website.

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