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Ethics

Nurse-client relationships
Sometimes we buy our patients gifts and cake for their birthdays and wonder if this is appropriate. What should we consider?

Gift giving is a complex issue and can blur boundaries. Giving token gifts as a group may be acceptable. When deciding, discuss with your colleagues and consider:

  • The intent of the gift
  • The implications of singling out clients
  • If a gift could be seen as an attempt to create a special relationship
  • Any agency policy about giving and receiving gifts.

Developing unit guidelines for celebrating client birthdays would provide direction.

Refer to the Boundaries in the Nurse-Client Relationship practice standard for further guidance.

A client died and left me something in her will. What should I do?

Nurses cannot benefit personally by accepting a gift that results from a professional relationship. You should discuss the situation with your employer. The best options may be to refuse the gift with an explanation or ask that it be donated to a charitable organization.

The Boundaries in the Nurse-Client Relationship practice standard provides further direction for dealing with these types of situations.

A client sent a "friend" request to my personal Facebook account. Is it okay to accept?

It's not appropriate for you to be a client's personal Facebook friend. The reason for your relationship with the client is to provide professional nursing services. Nurse-client relationships occur within boundaries that separate professional relationships from personal ones. As the nurse, you are responsible for setting, maintaining and communicating these boundaries with your clients, both face-to-face and online.

The Boundaries in the Nurse-Client Relationship practice standard sets clear expectations for nurses' relationships with clients.

Confidentiality
I work in an emergency department. If a police officer asks, should I share information about a patient?

In general, you’re expected to keep client information confidential unless your client consents or you are legally or ethically obligated to disclose – regardless of where you work. Some examples of situations where you would be obligated to share:

  • Under a court order or warrant
  • When legislation requires e.g., reporting a child in need of protection (under the Child, Family and Community Service Act)
  • When you’ve determined there is a substantial risk of significant harm to the health or safety of the client or others

In some circumstances, your manager or the privacy officer can also determine that you may disclose personal client information.

Check your agency policy to see when and what information you may share with the police. If there is no policy or you have questions, speak with your manager or privacy officer.

If you do disclose, restrict the information you share and people you inform to the minimum necessary to fulfill your obligation.

You’ll find more information and guidance in the Privacy and Confidentiality Practice Standard.

We often talk about patients during breaks in the staff room. I think this is okay because we all work on the same unit. Am I right?

in order to provide care, it's appropriate to share 'need to know' client information with other care team members. Talking about clients for other purposes may be breaching confidentiality.

You’ll find more information and guidance in the Privacy and Confidentiality Practice Standard.

I work in a clinic where staff from other agencies provide services to our clients. How do my colleagues and I decide what client information to share? Do we need to ask the client for consent?

The Privacy and Confidentiality Practice Standard sets out expectations for maintaining client privacy and confidentiality.

You need to tell your client that their personal information will be collected, used and shared with other members of their health care team. Make sure the client knows who is on the care team. Only share information with people currently involved in providing or planning care. Limit information you share to what each team member needs to know to provide appropriate care. Consider getting specific consent for sharing sensitive information such as test results.

My colleague shares information about clients on Facebook. Although the clients’ names aren’t posted, I don't think it's okay. What should I do?

You're right. Even without using a name, other identifiers may make clients recognizable. It's important for you to share your concerns with your colleague. The resource Acting on concerns about practice may help you.
You’ll find more information and guidance on social media use on our social media page.

Our clients want us to contact them by text. Is this okay and what should we consider?

Your primary obligation is providing competent, ethical care to your clients. You’ll need to make sure you’re able communicate appropriately with them and protect the privacy and confidentiality of their health care information. Text messaging, like other electronic communication, poses risks and challenges.

Check to see if your agency has a policy. If not, work with your colleagues and manager to develop guidelines for this practice. Consider how you will:

  • Maintain client privacy e.g., use agency issued phones, protect with passwords, use screen savers, limit access to phones
  • Keep client information confidential e.g., monitor for messages, delete after documenting, encrypt information , keep phones secure, safely dispose of old phones
  • Decide what information may be shared and clarify with clients
  • Obtain client consent for text messaging
  • Document your communication with clients according to your agency policy
  • Manage off hours texts
  • Report privacy breaches
  • Manage infection control
  • Enter information into the permanent client record

The Privacy and Confidentiality and Documentation practice standards will provide additional information and guidance.

Conflict of interest
A company supplying products to our agency has offered funding for nursing education. Would it be a conflict to accept it?

Use careful judgment when determining whether to accept a gift of this sort. Consider:

  • the motives of the giver
  • any constraints, conditions, or obligations attached to the gift
  • the potential for a conflict of interest
  • organizational policy

Gifts from commercial sources have the potential to create an obligation and a loss of objectivity.

For example, could this funding influence the content or activities of the nursing education? Or could the funding influence the products you choose to use or recommend? Identifying and discussing the issues will help raise awareness of possible conflicts and assist in your decision-making.

The Conflict of Interest practice standard provides more information and direction.

Consent
Do I need written consent to perform immunizations?

This depends on your agency policy. Consent may be:

  • verbal
  • written
  • via an alternative communication system (e.g., computer-assisted)
  • implied (e.g., client rolls up sleeve to receive injection)

Check your agency policy regarding the consent process. For more information about nurses' responsibility for obtaning consent, refer to the Consent practice standard.

What happens if a client signs a consent form, but doesn't really understand what is happening?

When you participate in care or treatment provided by other health professionals, you are expected to act if you believe the client does not adequately understand the planned care or treatment.

Document your assessment and notify the other health professionals involved if you believe your client does not understand the information being presented.

The Consent practice standard provides guidance.

Do I need client consent to give a placebo?

Yes. Before giving a placebo, your client must know that placebos are part of the treatment plan, and must consent to the plan. If your client is not capable of providing consent, a parent or a substitute decision-maker can consent on his or her behalf.

The Consent practice standard provides additional information and guidance about the consent process and nurses’ ethical and legal responsibilities.

Duty to report
I work on a psychiatric unit. My client, an RN, was admitted for a drug overdose and possible addiction. Should she be reported to CRNBC? If so, who should report her?

Yes, under the Health Professions Act, Section 32.3, the chief administrative officer, or someone working in that role, and the medical practitioner must report in writing to CRNBC. For more information see the Duty to Report practice standard or contact the CRNBC Nursing Concerns Coordinator at 604-736-7331 local 202 or 1-800-565-6505 (In Canada) local 202.

What protection is there if I report another health professional?

When you have a legal duty to report and report in good faith, the Health Professions Act protects you from legal liability.

For more information and guidance about your legal and professional obligations, read the Duty to Report practice standard.

 Related resources

Profes​sional Standards

Standard 4: Ethical Practice

 Need help?

For further information on the Standards of Practice or professional practice matters, contact us:

  • Telephone 604.736.7331 ext. 332
  • Toll-free in Canada 1.800.565.6505
  • Email practice@crnbc.ca
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