You take care of Brian Waters, a personal injury attorney, at the hospital where you work. He asks you about your interests, and you say, “I am trying to break into the field of legal nurse consulting. He says, “I need a legal nurse consultant. I’d also love to go out with you. I think you are cute.” What do you do? Should you date a former patient?
Boundary issues when you date a former patient
You are facing a boundary issue.
Nurses may be brought before the board of nursing for violating boundary issues.
What does that mean? A nurse is in a sensitive position of power with patients and is required to keep relationships professional. Patients trust nurses and consistently place nurses at the top of the most respected professions. A nurse should not benefit financially or romantically from a relationship with a patient. Professional boundaries safeguard patients.
When I was a student nurse I took care of an older married man. I remember he was grateful for my care and asked for my phone number. Not knowing any better, I gave it to him. I thought he might call me later to thank me for taking care of him. I was flabbergasted when he called me ask me out on a date. I refused. Had I gone, I would have violated a boundary issue. I am a lot less naive now.
Red Flag Warnings of Boundary Violations
Some of the warning signs that may provoke a supervisor to step in to talk to a nurse include
- Off hour phone calls to and from the patient
- Giving and receiving gifts with the patient
- Not recognizing an attraction to the patient
- Keeping secrets with the patient
- Believing that no one else can meet the patient’s needs
- Having social contact with former patients
- Getting overinvolved in a patient’s personal or business affairs
- Inappropriately sharing personal information with the patient
- Having extended sessions with a client, which sends subtle message of over involvement and favoritism
- Having sexual contact with the patient
Sexual misconduct when you date a former patient
Sexual misconduct is more than having an affair with a patient. It may include seductive comments, sexually demeaning remarks, kissing, and dating.
Sources of standards
These are entities that form a framework for nursing practice:
- The nurse practice act
- Board of Nursing regulations
- American Nurses association Code of Ethics
- American Nurses Association Standards of Practice
- The facility’s policies and procedures
Duty to report
Boundary violations are taken so seriously that colleague and supervisors of the nurse are obligated to report the inappropriate conduct to the board of nursing. Outright sexual misconduct is often easiest to spot. Nurses are often reluctant to report others to authorities and may find it easier to turn a blind eye to what is occurring.
Employers should have a process in place to report boundary violations, using objective documentation. The board of nursing performs an investigation and may remove the nurse’s license. The nurse could face civil liability. Allegations of sexual misconduct can be difficult to defend and not covered by professional liability insurance. A settlement against a nurse can be recorded to the Health Integrity and Protection Data Bank, affecting future employment.
Dating a former patient who wants to become a client is just bad news. I know a prominent legal nurse consultant who began an affair with an attorney client. When the client got behind in his bills, the nurse had difficulty collecting. Her personal relationship was horribly intertwined with her professional one.
What do you do about Attorney Walters?
- Maintain your boundaries with patients. Your relationship with Mr. Walters was for his benefit and should never be used for your own personal gain.
- Even if Mr. Walters asked you to work for him, this represents a violation of boundaries which could lead to disciplinary action by your board of nursing.
- In a civil lawsuit, actual patient harm has to be proved. This is not necessary for a nurse to be found guilty of professional misconduct.
- Even if Mr. Walters was not your patient, it is unwise to get into a romantic relationship with an employer.
Pat Iyer MSN RN LNCC is president of The Pat Iyer Group. She has never dated a patient or a client. She is a past president of the American Association of Legal Nurse Consultants.