Maintaining Professional Boundaries
By Don Brunnquell and Marty Lewis-Hunstiger
Children’s Hospitals and Clinics of Minnesota has a new policy, titled “Professional Relationships with Patients and Families,” that helps interpret issues arising from the interpersonal relationships that develop between health care professionals and the patients and families we serve. Healthy professional relationships facilitate family-centered care by empowering and encouraging families to function without undue dependence on hospital staff.
Healthy relationships are characterized by careful attention to issues of power, trust, respect, and intimacy. Maintaining healthy professional relationships is more challenging than ever before, due to the broadening scope of practice amid rapid societal changes and pressures.
Relationships in the real world
In some cases, professional relationships with patients and families can intersect with other areas of our lives. These intersections constitute Dual Relationships. The most prevalent Dual Relationships for most of us result from working at Children's and simultaneously having other human relationships (for example, nurse and relative, physician and church member, volunteer and neighbor).
Dual Relationships are bound to come up for each of us. Maintaining professional boundaries helps keep all aspects of these relationships healthy and empowering for everyone. Each Dual Relationship can be categorized as Minimal or Significant.
Minimal Dual Relationships: Maintaining Objectivity
Minimal dual relationships are relationships that occur a single time or repeatedly but do not involve intentional or substantive contact and do not and are not likely to affect professional judgment, objectivity, or performance of professional duties. Examples of minimal dual relationships include:
- Seeing someone at a store or fitness club
- Being members of the same church or school
- Children playing on the same sports team
In each instance it is our responsibility to monitor the relationship, ensure that it remains minimal, and take appropriate steps if the relationship becomes significant.
Significant Dual Relationships: The Greater Challenge
Significant dual relationships are relationships that involve social, interpersonal, financial, business, or contractual relationships that do or are likely to affect professional judgment, objectivity, or performance of professional duties. Examples of significant dual relationships include:
- Friendships with a patient's family
- Paid work including babysitting
- Shared vacations
- Providing more than minor or emergent care for children of friends or relatives
- Developing new business relationships with a patient's parent
Significant Dual Relationships should be avoided whenever possible. If they already exist, our most important responsibility is disclosure. Informing those we report to of the existence and nature of the Significant Dual Relationship will help keep it transparent. The manager will address how to assure that significant dual relationships do not interfere with our professional roles.
Other Steps to Healthy Boundaries
Giving and receiving gifts is an important part of life in many cultures. To keep the process healthy:
- Acknowledge relationships with cards, not gifts.
- Avoid accepting gifts of more than nominal value ($50). Offers of gifts or donations of more than this amount should be politely deferred, or, if that is not possible, should be routed to appropriate Children’s funds.
- Gifts of food can be accepted and shared with all staff.
Participating in significant life events of patients/families (e.g. weddings, graduations, birthdays, funerals) can create boundary issues. Guidelines include:
- Limit attendance to events involving pre-existing relationships or where attendance has a therapeutic goal.
- Attendance should be disclosed to the person you report to.
- Attending a patient's funeral is considered part of a therapeutic goal; disclosure is not needed in this case.
Significant Dual Relationships should be avoided whenever possible, and disclosed if and when they do occur.
Information from:
Minnesota Nurses Association Position Statement: Professional Relationships and Boundaries in Nursing Practice
Don Brunnquell, PhD, is Director of the Office of Ethics at Children's. Marty Lewis-Hunstiger, RN, BSN, MA, is a staff nurse and preceptor in NICU.
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