Professional Boundaries in Nursing

As a BsN++ you need to know this that
"Boundaries are mutually understood, unspoken physical and emotional limits of the relationship between the patient and the nurse." (Farber, 1997)

When these limits are altered, what is allowed in the relationship becomes ambiguous and possibly unethical. The health and well being of patients depends upon a collaborative effort between the nurse and the patient. Patients are extremely vulnerable to boundary violations because they trust us as their health care providers. They come to us in a time of need, presenting with physical, and often emotional, distress. Some patients demand continuous attention but are unaware of their insatiable neediness. (Muskin and Epstein, 2009)

Warning signs of unhealthy boundaries could be:

1. You share personal problems or aspects of your intimate life with patients.

2. You keep secrets with patients.

3. You become defensive when someone questions your interaction with a patient.

4. You have received gifts from a patient.

5. You speak to the patient about your own professional needs or inability.

6. You speak poorly of co-workers or the hospital to patients.

7. You talk to patients/families about things that are out of your scope of practice.

8. You give certain patients extra time or attention.

9. You give patients personal contact information or money.

10. You fail to set limits with a patient.

11. You spend duty time with patients.

12. You feel that you understand the patient’s problems better than other members of the healthcare team.

Violations of professional boundaries are almost always to make ourselves come across to the patient as the victim. It does not matter whether you are whining to a patient about your personal life or accepting a gift, you have altered the role of caregiver to the person in need of care.

When you speak ill of coworkers or the hospital, you are looking for sympathy from the patient to feel sorry for your situation, whatever that may be. If you speak to a patient about the poor staffing or your inability to perform a task, you instill fear in the patient in order to achieve power. You are using their situation for personal gain.

All nurses are vulnerable to boundary problems. Nurses who have patients with extended length of stay or treatment are especially vulnerable.

To be more aware of boundary issues you may be unaware of, begin to listen to what you say to patients. Is your tone, approach and conversation professional? Is there a clear distinction that this is your patient and you are the professional nurse? Are you telling the patient or family specific information for personal gain?

If you see other nurses violating professional boundaries, you do not help the patient or the nurse by not bringing the issue to someone's attention. Take the time to mentor less experienced nurses with what they could have said, or other choices. If the violation is repeated, you need to inform the nurse’s supervisor.

Boundary violations occur one small step at a time and almost always without warning, yet if we are aware, the warning signs are there. What appears to be innocent may end up being a commitment to an unprofessional relationship with a patient.

The best thing you can do is to remain mentally healthy. Take time to take care of yourself and your family. If you are feeling vulnerable with a specific situation or patient, do not be afraid to ask a peer to help you by taking that patient assignment.


by Kim Holland

Professional Boundaries in Nursing

Posted by Unknown No comments

As a BsN++ you need to know this that
"Boundaries are mutually understood, unspoken physical and emotional limits of the relationship between the patient and the nurse." (Farber, 1997)

When these limits are altered, what is allowed in the relationship becomes ambiguous and possibly unethical. The health and well being of patients depends upon a collaborative effort between the nurse and the patient. Patients are extremely vulnerable to boundary violations because they trust us as their health care providers. They come to us in a time of need, presenting with physical, and often emotional, distress. Some patients demand continuous attention but are unaware of their insatiable neediness. (Muskin and Epstein, 2009)

Warning signs of unhealthy boundaries could be:

1. You share personal problems or aspects of your intimate life with patients.

2. You keep secrets with patients.

3. You become defensive when someone questions your interaction with a patient.

4. You have received gifts from a patient.

5. You speak to the patient about your own professional needs or inability.

6. You speak poorly of co-workers or the hospital to patients.

7. You talk to patients/families about things that are out of your scope of practice.

8. You give certain patients extra time or attention.

9. You give patients personal contact information or money.

10. You fail to set limits with a patient.

11. You spend duty time with patients.

12. You feel that you understand the patient’s problems better than other members of the healthcare team.

Violations of professional boundaries are almost always to make ourselves come across to the patient as the victim. It does not matter whether you are whining to a patient about your personal life or accepting a gift, you have altered the role of caregiver to the person in need of care.

When you speak ill of coworkers or the hospital, you are looking for sympathy from the patient to feel sorry for your situation, whatever that may be. If you speak to a patient about the poor staffing or your inability to perform a task, you instill fear in the patient in order to achieve power. You are using their situation for personal gain.

All nurses are vulnerable to boundary problems. Nurses who have patients with extended length of stay or treatment are especially vulnerable.

To be more aware of boundary issues you may be unaware of, begin to listen to what you say to patients. Is your tone, approach and conversation professional? Is there a clear distinction that this is your patient and you are the professional nurse? Are you telling the patient or family specific information for personal gain?

If you see other nurses violating professional boundaries, you do not help the patient or the nurse by not bringing the issue to someone's attention. Take the time to mentor less experienced nurses with what they could have said, or other choices. If the violation is repeated, you need to inform the nurse’s supervisor.

Boundary violations occur one small step at a time and almost always without warning, yet if we are aware, the warning signs are there. What appears to be innocent may end up being a commitment to an unprofessional relationship with a patient.

The best thing you can do is to remain mentally healthy. Take time to take care of yourself and your family. If you are feeling vulnerable with a specific situation or patient, do not be afraid to ask a peer to help you by taking that patient assignment.


by Kim Holland

Called to be a Nurse?

As a BsN++ are you called to be a nurse?

Nursing. It’s not just a career – it’s a calling.

My hospital used that as an advertising campaign a few years back. Effective, yes, but is it true?

We think of nursing as a job, our work, a profession (which it is). It’s what we do – a choice we’ve made. Nurses can live comfortably on our incomes and even in hard times, there are usually jobs to be had.

And the variety! E.R. and flight nursing for adrenaline junkies, floor nursing for those gifted in multi-tasking, Intensive Care for techies, hospice, school nursing, home and public health – the list goes on and on.

I went around the unit last week asking random colleagues why they’d become nurses. Had they pro-and-conned their way into the field, decided they needed something to “fall back on” (as my mother used to say), or heard a voice from Heaven?

As to the last, no one had.

Their faces softened, though, as they considered how they’d ended up in this place, caring for a living.

Megan, a Gen Y nurse, didn’t feel called. “It was just what I always wanted to be,” she said. We discovered we shared a fondness for those little plastic nurses’ kits when we were little girls thirty years apart. Neither of us wanted to be the doctor.

Denise couldn’t come up with a reason. Yet, here she is with a bright shiny Master’s Degree, beginning a preceptorship as a Nurse Practitioner, after many years at the bedside. Called? She couldn’t say so.

Being a nurse is a privilege. And a calling.

Like many nurses, I shy away from saying such a thing out loud, but, here’s the truth: I am called to nursing.

Not by an audible voice or a sign from God. Rather, I have been drawn gradually and steadily to this work, my vocation.

Vocation.

No less than the Oxford American Dictionary uses nursing as an example of a vocation – a word that literally means a calling. Novices in religious orders want to know if they have a vocation. Nurses do too; my best friend quit nursing school because she didn’t feel enough compassion for the patients. My hospital’s nurse residency program gives new graduates the opportunity to try out different specialties to find a good fit.

Some of us pray.

I didn’t originally see myself as called. I needed a better-than-minimum-wage job. Then I remembered my childhood love of nursing. I moved near a university with a good nursing program. I got my paperwork together and registered just in time for the Fall Quarter. I thought all of this was good luck.

I surprised myself by doing well in the sciences (I hadn’t in high school). Our class quickly tired of books, longing to see real patients. I loved it.

I found I was suited for this. I had a shirt that said “Nurses Make It All Better”, and for a while, I believed it.

Then discovered it wasn’t true. I saw death. And worse.

But kept coming back.

And started to see beyond the sadness and secretions, the chaos and complaining, to the secret that this work is so much more than a succession of tasks to be done. We nurses are in the unique position of being able to act as instruments of healing – listening, touching, validating, soothing.

My sister called me one day and said, “I wish I could do something important like you. Your work matters.”

These things drew me. I wanted to be good at this, to gain new skills, and I did. I learned that listening was as much a skill as starting an I.V. Doing nursing well became less like gaining competence and more like participating in an intricate dance, relating and responding to my patients and co-workers with humility and (I hope) patience.

Like hearing the sound of a voice without understanding the words, I turned to the call and followed it. I moved toward what was beautiful and sacred in nursing, occasionally catching a glimpse of what lies just below the surface of our ordinary days of tending to and attending to our patients.

We may not be aware of our call or maybe we just don’t want to speak of something so holy. But, oh yes, we have a vocation.

We are called. And we’re answering.


by Suzanne Davenport Tietjen, RN, NNP-BC

Called to be a Nurse?

Posted by Unknown No comments

As a BsN++ are you called to be a nurse?

Nursing. It’s not just a career – it’s a calling.

My hospital used that as an advertising campaign a few years back. Effective, yes, but is it true?

We think of nursing as a job, our work, a profession (which it is). It’s what we do – a choice we’ve made. Nurses can live comfortably on our incomes and even in hard times, there are usually jobs to be had.

And the variety! E.R. and flight nursing for adrenaline junkies, floor nursing for those gifted in multi-tasking, Intensive Care for techies, hospice, school nursing, home and public health – the list goes on and on.

I went around the unit last week asking random colleagues why they’d become nurses. Had they pro-and-conned their way into the field, decided they needed something to “fall back on” (as my mother used to say), or heard a voice from Heaven?

As to the last, no one had.

Their faces softened, though, as they considered how they’d ended up in this place, caring for a living.

Megan, a Gen Y nurse, didn’t feel called. “It was just what I always wanted to be,” she said. We discovered we shared a fondness for those little plastic nurses’ kits when we were little girls thirty years apart. Neither of us wanted to be the doctor.

Denise couldn’t come up with a reason. Yet, here she is with a bright shiny Master’s Degree, beginning a preceptorship as a Nurse Practitioner, after many years at the bedside. Called? She couldn’t say so.

Being a nurse is a privilege. And a calling.

Like many nurses, I shy away from saying such a thing out loud, but, here’s the truth: I am called to nursing.

Not by an audible voice or a sign from God. Rather, I have been drawn gradually and steadily to this work, my vocation.

Vocation.

No less than the Oxford American Dictionary uses nursing as an example of a vocation – a word that literally means a calling. Novices in religious orders want to know if they have a vocation. Nurses do too; my best friend quit nursing school because she didn’t feel enough compassion for the patients. My hospital’s nurse residency program gives new graduates the opportunity to try out different specialties to find a good fit.

Some of us pray.

I didn’t originally see myself as called. I needed a better-than-minimum-wage job. Then I remembered my childhood love of nursing. I moved near a university with a good nursing program. I got my paperwork together and registered just in time for the Fall Quarter. I thought all of this was good luck.

I surprised myself by doing well in the sciences (I hadn’t in high school). Our class quickly tired of books, longing to see real patients. I loved it.

I found I was suited for this. I had a shirt that said “Nurses Make It All Better”, and for a while, I believed it.

Then discovered it wasn’t true. I saw death. And worse.

But kept coming back.

And started to see beyond the sadness and secretions, the chaos and complaining, to the secret that this work is so much more than a succession of tasks to be done. We nurses are in the unique position of being able to act as instruments of healing – listening, touching, validating, soothing.

My sister called me one day and said, “I wish I could do something important like you. Your work matters.”

These things drew me. I wanted to be good at this, to gain new skills, and I did. I learned that listening was as much a skill as starting an I.V. Doing nursing well became less like gaining competence and more like participating in an intricate dance, relating and responding to my patients and co-workers with humility and (I hope) patience.

Like hearing the sound of a voice without understanding the words, I turned to the call and followed it. I moved toward what was beautiful and sacred in nursing, occasionally catching a glimpse of what lies just below the surface of our ordinary days of tending to and attending to our patients.

We may not be aware of our call or maybe we just don’t want to speak of something so holy. But, oh yes, we have a vocation.

We are called. And we’re answering.


by Suzanne Davenport Tietjen, RN, NNP-BC

5 "Must Haves" for a Nursing Career

BsNs++ You will not find this information listed on your State Board of Nursing websites or your nursing school brochures. However, here are 5 traits you must have for a successful nursing career:


1. PATIENCE: That’s “patience” not “patients”. You will be provided your patients but must bring your own patience. You must have a huge internal storage house of patience in order to be a nurse. In a single shift you may have to handle a belligerent patient, an angry family member, a moody peer or supervisor, and a patient who has several “intestinal accidents”. All while having to do your “normal” work tasks. You must temper this day with patience and a sense of humor. Utilize your common sense to realize that none of these situations are personal and you can get through your day with a smile on your face!


2. DILIGENCE: Nursing is not for the worker looking to make a quick buck sitting around on his/her laurels. You must have the diligence and a positive work ethic. You are responsible (literally) for peoples’ lives and you will have to work hard your entire shift to meet their needs and expectations. If you are not diligent, you will not make it in nursing. Your patients, peers, and supervisors expect (and deserve) diligence from you.


3. COMPASSION: Is compassion really a skill? I believe it is. According to Wikipedia, “Compassion (from Latin: "co-suffering") is a virtue —one in which the emotional capacities of empathy and sympathy (for the suffering of others)” (wikipedia.org, n.d.). With this being said, my personal belief is that you are either born with compassion or not. Can a person really be taught to care about people if they do not have that innate ability? I don’t believe so. So dig deep folks and see if you possess true compassion before jumping into the nursing profession. The career is tough work and if you don’t have the inner compassion that drives you because you care, you will never make it! You can’t learn true compassion in acting school…


4. COMMUNICATION SKILLS: If you can not communicate well, to include verbal, written, and listening skills, you are doomed as a nurse. You must be able to understand what your patients are saying (by listening), what orders the doctors are given (by hearing) and reading, and how to effectively chart your activities and talk to your patients and peers.

5. DIPLOMACY SKILLS: Didn’t you know that you had to be a diplomat to be a nurse? You need to learn diplomacy and how to be “politically correct” when working with your patients, physicians, and other staff members. Getting what you need to help care for you patients can be effectively (and quickly) enhanced with exemplary diplomacy. As Dale Carnegie said, “If you want to gather honey, don't kick over the beehive.” Diplomacy will take you a long way in future interactions with those you have been positively diplomatic with.

by Sue Heacock, RN, MBA, COHN-S

5 "Must Haves" for a Nursing Career

Posted by Unknown No comments

BsNs++ You will not find this information listed on your State Board of Nursing websites or your nursing school brochures. However, here are 5 traits you must have for a successful nursing career:


1. PATIENCE: That’s “patience” not “patients”. You will be provided your patients but must bring your own patience. You must have a huge internal storage house of patience in order to be a nurse. In a single shift you may have to handle a belligerent patient, an angry family member, a moody peer or supervisor, and a patient who has several “intestinal accidents”. All while having to do your “normal” work tasks. You must temper this day with patience and a sense of humor. Utilize your common sense to realize that none of these situations are personal and you can get through your day with a smile on your face!


2. DILIGENCE: Nursing is not for the worker looking to make a quick buck sitting around on his/her laurels. You must have the diligence and a positive work ethic. You are responsible (literally) for peoples’ lives and you will have to work hard your entire shift to meet their needs and expectations. If you are not diligent, you will not make it in nursing. Your patients, peers, and supervisors expect (and deserve) diligence from you.


3. COMPASSION: Is compassion really a skill? I believe it is. According to Wikipedia, “Compassion (from Latin: "co-suffering") is a virtue —one in which the emotional capacities of empathy and sympathy (for the suffering of others)” (wikipedia.org, n.d.). With this being said, my personal belief is that you are either born with compassion or not. Can a person really be taught to care about people if they do not have that innate ability? I don’t believe so. So dig deep folks and see if you possess true compassion before jumping into the nursing profession. The career is tough work and if you don’t have the inner compassion that drives you because you care, you will never make it! You can’t learn true compassion in acting school…


4. COMMUNICATION SKILLS: If you can not communicate well, to include verbal, written, and listening skills, you are doomed as a nurse. You must be able to understand what your patients are saying (by listening), what orders the doctors are given (by hearing) and reading, and how to effectively chart your activities and talk to your patients and peers.

5. DIPLOMACY SKILLS: Didn’t you know that you had to be a diplomat to be a nurse? You need to learn diplomacy and how to be “politically correct” when working with your patients, physicians, and other staff members. Getting what you need to help care for you patients can be effectively (and quickly) enhanced with exemplary diplomacy. As Dale Carnegie said, “If you want to gather honey, don't kick over the beehive.” Diplomacy will take you a long way in future interactions with those you have been positively diplomatic with.

by Sue Heacock, RN, MBA, COHN-S