Robel Anshebo
Introduction: proffessional boundaries help define the limits of acceptable behavior and interactions in the workplace, ensuring a respectful, productive, and positive enviorment for everyone. By understanding and respecting these boundaries, we can prevent misunderstandings, reduce stress, and foster healthier working relationships. Let's explore what proffessional boundaries are and how we can uphold them in our workplace interactions.
Beverly Sumanti
1. After you read the article by Maes (2003), reflect on your own experience. How do YOU know when professional boundaries have been crossed?
Reflecting back on my own experiences as a nurse there have been situations when I have been aware of professional boundaries that have been crossed. When I was a newly graduated nurse I did not have well developed boundaries. Over time I have developed the ability to be more aware when professional boundaries are being crossed. I will redirect the conversation
2. Look for a case that a nurse violated professional boundaries and describe what the case was about in your own words. Then, analyze how the nurse violated the boundaries and why the nurse needed to face a consequence.
I found an article that discusses a case of a nurse crossing their professional boundaries. An emergency room nurse at the Good Samaritan Hospital in Puyallup, Washington was accused in 2018 of infecting at least 12 patients with Hepatitis C. She was accused of diverting patients' narcotics and injecting them with the tampered needle that she had already used on herself. In 2023 the nurse entered a plea agreement. The consequences she faces is a potential of ten years in prison, losing her nursing license permanently and paying a fine of 250,000 dollars.
KIRO 7 News. (2023, September 6). 5 years later, Puyallup nurse accused of infecting 12
patients with hep C agrees to plea deal. KIRO7.com. Retrieved March 31st, 2024, from https: www.kiro7.com/news/local/5-years-later-puyallup-nurse-accused-infecting-12-patients-with-hep-c-agrees-plea-deal/AL6VALEXZNG2RCC742GOEAFLJQ/.
3. Think of an example of professional boundaries that may change/vary with time/culture and other factors. Make an argument to see if you think this professional boundary is appropriate or not and state why.
I read an article online about a doctor and nurse who accepted a patients offer for dinner. In most circumstances I would find this an inappropriate behavior. Perhaps the patient might feel like he is building a friendship with the medical professionals and expect favorable treatment in return. In the case written about in the article the patient was an oncology patient and not expected to live must longer. It was his wish to tell the medical staff thank you by sharing a meal with them.
Vig, E.K., & Foglia, M.B. (2014). The Steak Dinner-A Professional Boundary Crossing. Journal of Pain and Symptom Management, 48(3), 483-487.
4. Identify a case of unethical use of social media, tell us the story in your own words, and analyze the case to examine why it is not appropriate. Describe your strategies for using social media.
One case of unethical use of social media is about a nurse posting a picture on Instagram. She worked in the emergency room in New York hospital. The nurse took a picture of the empty trauma room following a patient receiving care from being impacted by a subway car. The nurse posted the picture onto her Instagram account which resulted in the loss of her job.
Li, D.K. (2014, July 9). “New York Med” nurse fired for “insensitive” Instagram shot. New York Post https://nypost.com/2014/07/08/new-york-katie-duke-fired-for-insensitive-instagram-shot/
Meg Blake: Professional Boundaries
After reading Maes (2003) article regarding knowing when boundaries are crossed, ther are two ways that I know when a professional boundary has been crossed. The first tends to be when you find the nurse/employee is down-playing interactions between themself and the employee. I worked with one coworker who downplay the amount of time and affort put forth with a patient despite it being clear to everyone else that they had a much more intimate and unique connection. The second wait I know a professional boundary has to do with just knowing myself. I have found myself in previous positions unevenly dispersing my time and favoring patients. I knew that I had crossed the boundary because of thsi gut feeling that told me "this is too far, you need to reel it back in."
One case that I located in which an RN crossed the professional boundaries occured in New Zealand in 2019 and was reprimanaded in 2022. The article elimates names and uses "RN A" for the nurse and "Mr B" for the patient. RN A had been working as a mental health nurse for 3 years when Mr B who was a male teen at this time was referred to the mental health clinic for low mood and other various mental health concerns. After several sessions RN A (a male nurse) sent a personal message to Mr B a generla "Happy New Year" via his work phone. After a few nonchalat back and forths RN A then switched to using his personal phone and asked if Mr B wanted to hangout sometime and asking for a picture of his msucles at one point. After Mr B informed his parent of these messages, RN A's work started an investigation in which he was allowed to keep his job but was ordered to recieve training regrding professional boundaries.
Maintaining professional boundaries with patients. Health & Disability Commissioner. (2023, February 27). https://www.hdc.org.nz/decisions/search-decisions/2023/22hdc01879/
One example of how professional boundaires may vary is that younger generations tend to be more leniate around professional boundaries. I findmyself altering my speech when discussing with aptients of different genertions. For example, with older patients I maintain a very professional tone and vocabulary as I view them as being my "elders" on which I show them respect. not to mention when I have attempted to use layman's term they become confused with specific references to younger pop culture. Howver, when speaking with millenial and Gen Z patients, I find that they prefer to be spoken too as more of a "peer" undertone to conversation and even enjoy joking around at times. In my short time of being a nurse I feel that there is no hard line of "maintain upmost professional at all times" is the best patient care for patients as part of nursing in making connections and establishing a trusting relationship with patients. This takes time to learn as a nurse what patients prefer and how they appreciate being treated as a patient, however, just because a patient would rather have more laidback conversations, does not mean that this should develop into a further out of treatment friendship.
I personally experinced collegues get fired after establishing a personal relationship with a aptient that extended to postings on facebook and hanging out outside of work. This resulted in both cokegues getting fired for sharing patient informationn on socail media and contacting a patient outside of work through peronsal means. Thsi was incredibly unprofessional and inapproarite as the patient was at a rather vulnerable time and was seeking friendship/relationships. My Coworkers at this time had recieved a warning from management to be cautious as others had noticed they were becoming overtly familiar and friendly, howver, they neglected these warnings and recieved disciplainry actions accordingly.
Sherwin Afable
Professional Boundaries
I can’t remember exactly what I had said but I remember not feeling so great about it afterwards. I was taking care of a patient and felt comfortable with them and their family and at some point I made a comment, remark, or a joke that essentially came across as if my problems were worse than another patient's or something like that. I remember immediately feeling embarrassed, recognizing that I hadn’t acted professionally in that moment. Nurses are both people and professionals. Although my patient didn’t seem to have a particular reaction to what I had said, if they did then I would have undermined the trust between myself and the patient.
According to a Fox News article from July 2023, a nurse in Britain lost her job for having a sexual relationship with a patient and failed to call an ambulance when he had an acute health event during a sexual episode. This is wrong on multiple levels and led to her expulsion from the UK Nurse Registry. Members of the Nurse and Midwifery Council in the UK had agreed that this nurse’s behavior was so egregious that allowing her to stay on the registry would undermine the public’s confidence in the profession. Nurses are often put into positions of power over vulnerable populations. It’s important for the general public to trust in the profession so that we can perform the highest quality care possible.
Aitken, P., & Fox News. (2023, July 8). Nurse fired for secret affair with patient who died during sex in hospital parking lot. Fox News. https://www.foxnews.com/world/nurse-fired-secret-affair-patient-died-during-sex-hospital-parking-lot
Concierge care is becoming increasingly popular in the United States. I’m not super familiar with the way that it operates but I’m under the impression that it’s similar to doctor-patient relationships from generations ago where the physician went around town answering house calls. While this mental imagery may not be particularly accurate, there are still greater opportunities for physicians and other healthcare providers in this realm to build closer relationships with patients due to decreased patient loads that concierge care sees. Like Professor Niitsu had said, in Japan it is common for patients to occasionally provide gifts to their providers so it wouldn’t be surprising if patients under concierge care would have closer relationships with their PCP. It’s a refreshing perspective given that the lawsuit-happy, liability shrugging culture of the United States incentivises larger healthcare corporations to keep their professional boundary policies air-tight. However, concierge care providers can still be vulnerable to lost credibility if there’s evidence of bias towards one patient over another due to personal relationships.
I was told of this female Youtuber or Twitch streamer that had to run from the town she lived in after another online personality had posted her IP address on social media, leading to stalking and vandalization of the victim’s property. There was some kind of argument or rivalry between the two streamers that grew from what was essentially just gossip to actual threats to peoples security and safety. In the United States there is an argument to be made that citizens have the right to be “free” from fear which is clearly infringed upon in this instance. My personal social media strategies would not be helpful in the aforementioned situation but it works for me. For social media, minimization is my motto. I realized that posting myself on social media put me into a really weird headspace and that I didn’t enjoy the source of comparison between myself and others. I still use some social media sites to keep current with things that I’m interested in, but now I’m less inclined to keep up with the showmanship.
Professional Boundaries
Robel Anshebo
During my time working in healthcare, I've encountered patients whom I recognize from various social settings. For many of these individuals, I've either been assigned to care for them or briefly asked to participate in their care. I understand there are plenty of ethical concerns with caring for someone you know outside the hospital. Noticing an issue, I would approach my charge RN and request a change in patient assignment, as I didn't feel comfortable with the situation, and I am certain there are legal considerations for issues like this. Fortunately, I have always been allowed a change of patient assignment and have had the pleasure to work with understanding nursing managers.
In 2022, a Canadian nurse had her nursing license voluntarily suspended for a year after being understood to have had an intimate relationship with her former patient. The report suggests the nurse began a romantic relationship with her client as soon as two months after the end of their professional relationship. After serving the 12-month suspension, the RN will return to work with supervision for three months, along with a re-education plan in professional boundaries and ethical interactions with clients.
I've had multiple interactions with patients about the topics of faith and religion. All of these times, the conversations have been initiated by patients and their families. While I do practice my faith as a Christian, I don't impose my beliefs on clients unless invited to discuss these topics with them. I've heard stories of previous coworkers being reprimanded after discussing their religious practices and encouraging their patients through the caregiver's perspective without patient consent. I understand that the hospital or healthcare facility isn't the appropriate situation to spread your beliefs onto others unless invited to do so; otherwise, you can compromise your well-being along with the patient's.
In 2022, several nurses at Emory Hospital were retired from their positions after a TikTok video of them disparaging their patients went viral. In the video, the L&D nurses took part in noting their amusing mild annoyances with patients and families, with one RN mocking patients that forget to press their call lights. In response to the video, Emory Hospital released a statement reporting that the nurses had been fired and underlined their vision for respectful and safe patient-centered care. I'm not particularly an active user of social media aside from keeping up with current news, trends, or communicating with others. I understand that nursing can be frustrating at times and can be relieved with verbalizing this frustration in a joking manner. Nonetheless, these jokes should be kept within personal interactions and not filmed or recorded for social media.
References:
Jackson, Reeves. (2022, Dec 11). Emory hospital nurses no longer employed after viral tiktok mocking expecting mothers. Alive. https://www.11alive.com/article/news/local/emory-hospital-nurses-no-longer-employed-after-viral-tiktok-criticizing-labor-and-delivery-patients/85-2b9c8730-9949-4e1c-b5e3-2be4de04e297
Welsh, Eric. (2022, Sep 26). Chilliwack psychiatric nurse suspended after violating proffessional boundaries. Cranbrook Daily Townsman. https://www.cranbrooktownsman.com/news/chilliwack-psychiatric-nurse-suspended-after-violating-professional-boundaries-5371614
Conclusion
Robel Anshebo
We've all been in sutuations where our proffesional boundaries in the workplace were at risk and have developed skills to maintain these boundaries in order to promote patient safety. All of us shared interesing stories of instances when proffesional boundaries were broken and their impact on others. The stories on how social media has been wrongly used by healthcare workers. Social media has been a vector for abuse of patient protected infromation or have been used to contact previous patients. Nevertheless, every healthcare facility needs to have clear policy on proffesional boundaries in person and online.
