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A question of boundaries

Case study about boundaries in the nurse-client relationship

Peta has been a nurse for two years and recently moved to a new community to take a position as a home care nurse. Mr. and Mrs. Kovack have been her clients for six months and they remind her of her grandparents.


Mrs. Kovack has diabetes complicated with renal failure and leg ulcers. Mr. Kovack has mobility problems due to a stroke. Peta tries to schedule their visits at the end of her day so she has extra time to visit with the couple as they seem to enjoy her company.

Mrs. Kovack was admitted to hospital a week ago and Peta visits with her during her lunch hour. She spends time with the couple at the bedside and then one day has lunch with Mr. Kovack in the cafeteria. During lunch, Mr. Kovack asks Peta if she could find someone to walk their dog while he is at the hospital. Peta reassures Mr. Kovack that she can walk the dog.

Back at the office Peta shares her lunch conversation with her colleague Susan, telling her she offered to walk the couple's dog. Susan thinks for a minute, and then asks Peta if she thinks it's a good idea for her to walk a client's dog.

Have you ever wondered if you’ve crossed a boundary with a client?

 What would you do?

Listen and consider Susan’s comments
Peta reflects
Peta reflects on her relationship with the elderly couple.
Identifies a concern
She becomes concerned that she may have crossed a professional boundary and seeks help to clarify this.

Clarifies the problem
She reviews her standards of practice, especially the Professional Standards and the practice standard Boundaries in Nurse-Client Relationship. In reviewing the principles in this standard, Peta becomes increasingly concerned and checks out her concerns with one of her work colleagues.
Considers her options
Peta realizes she has crossed a professional boundary and needs to redefine her relationship with the couple. She discusses her plan with Susan.

Develops a plan
Peta needs to be clear about her professional boundaries and discuss this with the Kovacks or ask another nurse to take over their care.

Implements the plan
Peta speaks with the Kovacks, explaining her role as the nurse and providing suggestions for other supports. When planning her future visits she will consider the boundaries of her role along with her clients' needs when making decisions about scheduling appointments and providing care.

Evaluates the plan
On reflection, Peta decides she needs a better understanding of the CRNBC Standards of Practice so that she can use them as a framework for her practice.
Listen and dismiss Susan’s comments
Peta rationalizes
Peta is irritated with Susan for even suggesting that she has acted inappropriately. The Kovacks need extra support and she is looking out for them. So what if she walks their dog? Although walking their dog is not nursing practice she rationalizes it as acceptable because the couple needs additional support.

She ignores concerns
Peta doesn’t think that she crossed nurse-client boundaries or violated her professional standards.
Colleague’s professional responsibility
Susan is concerned about Peta’s lack of insight, specifically:
  • preferential treatment of clients
  • scheduling a workday and other clients' care around these clients
  • doing favours for clients
  • seeing clients on personal time
Susan meets with her manager to discuss her concerns around Peta’s actions and lack of insight. Following the conversation, Susan documents her concerns. The manager then follows up to address the nurse-client boundary issue.

 What do the Standards say?

  • The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings.
  • It is therapeutic and focuses on the needs of the client.
  • It is based on trust, respect and professional intimacy, and it requires the appropriate use of authority.
  • The nurse-client relationship is conducted within boundaries that separate professional and therapeutic behaviour from non-professional and non-therapeutic behaviour.

Some boundaries are clear cut. Others are not so clear and require the nurse to use professional judgment. The nurse who violates a boundary can harm both the nurse-client relationship and the client.

Nurses use professional judgment to determine the appropriate boundaries of a therapeutic relationship with each client. The nurse, not the client, is always responsible for establishing and maintaining boundaries. Nurses are careful about socializing with clients and former clients, especially when the client or former client is vulnerable or may require ongoing care. 

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