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You know the client. Now what?

Case study about boundaries when caring for friends

Jay glanced at the list of client names on the ER assignment board in the small rural hospital where he works. He paused as he recognized one of the names of his assigned clients. It was someone he knew — Frank, his son’s hockey coach.


Jay needed to think about what he should do. This kind of situation was not that uncommon in Jay’s practice. After living in this small community for most of his adult life, he felt he knew everyone!

He was aware that the CRNBC Practice Standard for boundaries in the nurse-client relationship indicated that when nurses encounter family or friends as clients, they transfer the responsibility for care to another health care provider. Jay scanned the board to see who was working with him that day. Jill, the only other RN on the day shift, also had a son on the hockey team, so her situation was really no different from his.

What actions did they take? 

When Jill arrived a few minutes later they had a quick discussion about how they might best handle the situation. After recognizing that their relationships with Frank were similar, they decided that he would remain as part of Jay’s assignment. They also called the administrator in charge of ER for the day and informed her of the situation. She agreed that it would be hard to find a nurse in their community that didn’t know Frank, but she would see what she could do.

Jill and Jay also considered the challenges in the situation and how they might respond. They recognized that this might be a difficult situation for Frank. He was admitted after an apparently accidental drug overdose; something Frank would likely not want parents of children in the hockey team to know. They agreed that as soon as Frank was alert enough to understand, Jay would reassure him that his privacy and confidentiality would be maintained at all times.

As well, Jay and Jill were quite horrified about the implications of Frank being a recreational drug user and driving the hockey team to games in his van. Initially Jay felt angry about Frank’s seeming lack of responsibility. He struggled with how this would impact his ability to be Frank’s nurse. At Jill’s suggestion, he focused on Frank as ‘just a client’ and he felt his feelings slowly settle. As Jay consciously reconnected with his professional responsibilities to provide client care, he realized he could provide care for Frank, just as he would for any other person.

Were these appropriate nursing actions?

Use the Professional Standards web module to reflect on this case. Case discussion takes place on slide 84.

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