What happens to the therapeutic relationship when boundaries are crossed, and a nurse puts personal needs ahead of a client's needs?
When a nurse prioritizes personal needs over a client's, the therapeutic relationship is compromised. These scenarios show the types of complaints the college receives about boundary violations, financial abuse, and conflict of interest.
Scenario 1: Borrowing a client's car
Dianne has been providing home care for a client for several months and enjoys their weekly visits. The client is easygoing and often calls Dianne his favourite nurse. One morning, Dianne arrives late, apologizing for car troubles and mentioning she can't afford repairs. The client offers to lend Dianne their car.
- What does Dianne do?
Telling herself that she's only borrowing it for a few days, Dianne accepts the offer. When the client's son learns of the situation, he reports Dianne to the agency manager. After meeting with Dianne and investigating the situation, the manager learns Dianne used the car for eight weeks, only returning it when her actions were reported. The manager reports Dianne's actions to the college.
Scenario 2: Financial exploitation
Barbara provides private home nursing care for a client. She notices that the client's spouse struggles with banking and bill paying. Since the spouse has no close family, Barbara offers to drive them to the bank and help pay bills. After several weeks, the spouse asks Barbara to act as their power of attorney.
- What does Barbara do?
Barbara doesn't consider the client's spouse her client so agrees to act as power of attorney. When another agency nurse learns of this agreement, they report Barbara to the college.
A BCCNM investigation reveals that Barbara accepted an appointment as power of attorney, which breaches the
Boundariesin the Nurse-client Relationshippractice standard. The investigation also finds Barbara paid several $500 in personal bills from the spouse's account, which is financial abuse.
Engaging in any activity within the nurse-client relationship resulting in 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 position.
Behaviours that breach professional boundaries in the therapeutic nurse-client relationship include (but are not limited to):
- Borrowing money or property from a client
- Soliciting gifts from a client
- Withholding finances through deception or theft
- Using influence, pressure, or coercion to obtain the client's money or property
- Having power of attorney, guardianship, or financial trusteeship
- Misusing a client's bank accounts or credit cards
- Assisting with the financial affairs of a client without the employer's knowledge
- Referring to or promoting a private or personal business to clients
The Boundaries in the Nurse-Client Relationship and the
Conflict of Interest practice standards set out expectations in these situations. The nurse—not the client—is always responsible for establishing and maintaining boundaries, and terminating the therapeutic relationship. The nurse who violates a boundary can harm both the nurse–client relationship and the client.
Scenario 3: Conflict of Interest
Jarrod works on a rehab unit and is caring for a client with diabetes and a recent amputation. The client is concerned about their ability to manage and decides to move into an independent housing facility. The client mentions to Jarrod the need to sell their house.
- What does Jarrod do?
Jarrod recommends their partner who is a realtor, leaves a business card, and arranges a visit for that evening. The client tells another nurse how helpful Jarrod has been. The nurse reports Jarrod's actions to the manager.
Jarrod has been previously warned about promoting his partner's business and received a letter of expectation. All staff, including Jarrod, were instructed to review organizational policies related to conflict of interest. Despite this, Jarrod repeated the behaviour, breaching the
Conflict of Interest practice standard. Jarrod's manager reports him to the college.
Reporting boundary violations: What, when, and how to report
As a nurse, you are responsible and accountable for reporting unethical conduct. Behaviours that violate boundaries or are outside the zone of professional behaviour, such as those described above, require intervention and reporting. If you are unsure if reporting is required, speak with your manager, or a colleague, your organization's patient care quality office, or call BCCNM's Intake Advisor.