Professional boundaries

Professional boundaries are an important consideration in the relationship between any professional and his/her client.

Nurse-client boundaries

Boundaries are an integral part of the nurse-client relationship. They represent invisible structures imposed by legal, ethical, and professional standards of nursing that respect the rights of nurses and clients.^[1] These boundaries ensure that the focus of the relationship remains on the client’s needs, not only by word but also by law. The College of Nurses of Ontario (CNO) Standards identifies that it is the nurse’s responsibility to establish the boundaries and limits of the relationship between the nurse and client.^[2] The boundaries have a specific purpose and health goal, and the relationship terminates when identified goal is met.^[1]

Any action or behaviour in a nurse-client relationship that personally benefits the nurse at the expense of the client is a boundary violation. Some examples of boundary violations are engaging in a romantic or sexual relationship with a current client, extensive non-beneficial disclosure to the client and receiving a gift of money from the client. Abuse and neglect are extreme examples. They involve the betrayal of respect and trust within the relationship. This includes withholding communication from a client because it is considered to be an example of neglect.^[3]

It is the nurse’s job to be aware of signs that professional boundaries may be crossed or have been crossed. Warning signs of boundary crossing that may lead to boundary violations include frequently thinking of a client in a personal way, keeping secrets with a specific client, favouring one client’s care at the expense of another’s and telling a client personal things about yourself in order to make an impression. Anything that could comprise the client’s well-being if the relationship with a registered nurse is continued or discontinued can be considered a warning sign.^[3] Boundary violations are never acceptable and it is the nurse’s job to handle any situation with any regards to it professionally and therapeutically regardless of who initiated it.

Clinical mental health counseling

There are multiple boundaries that could be crossed between a client and a counselor, including physical, psychological, emotional, and social boundaries. Some of these boundary lines may be blurry. For example, there are differing opinions on whether touch is ever appropriate between a counselor and their client. Sexual intercourse, however, is uniformly disagreed upon. Dual relationships, where a counselor holds two or more different roles within a client’s life at the same time, are also typically avoided, as well as the acceptance of gifts of significant monetary value.^[4]

See also

• Profession
• Professional abuse
• Professional conduct
• Professional ethics
• Personal boundaries
• Sexual misconduct

References

Nursing further reading

• Anewalt P Fired up or burned out? Understanding the importance of professional boundaries in home healthcare and hospice - Home Healthcare Nurse Nov-Dec;27(10) Pages 590-7 2009
• Beardwood B The loosening of professional boundaries and restructuring: the implications for nursing and medicine in Ontario, Canada - Law & Policy, 1999
• Byrne C Facilitating empowerment groups: Dismantling professional boundaries - Issues in Mental Health Nursing, 1999 Jan-Feb;20(1):55-71.
• Cameron ME Professional boundaries in nursing - Journal of Professional Nursing, 1997
• Campbell RJ Attitudes and behaviours of Alberta mental health nurses toward professional boundaries, boundary crossings, and boundary violations in patient care - 2002
• Chapple A, Rogers A, Macdonald W, Patients' perceptions of changing professional boundaries and the future of 'nurse-led'services … - Primary Health Care …, 2000
• Clarke D Multi-professional Learning for Nurses: Breaking the Boundaries - Journal of Management in Medicine, 2002
• Fischer HR, Houchen BJ, Ferguson L Professional Boundaries Violations: Case Studies From a Regulatory Perspective - … - Nursing Administration …, 2008
• Peternelj-Taylor C Professional boundaries. A matter of therapeutic integrity. - Journal of psychosocial nursing and mental …, 2002
• Procter PM, Hible G Communications across professional boundaries: can technology help?, CTI Centre for Nursing and Midwifery - 1998
• Rafferty AM, James V Prescribing the boundaries of nursing practice: Professional regulation and nurse presaibing E Shepherd, - Nursing Times Research, 1996
• Wicks D Nurses and doctors at work: rethinking professional boundaries (1999) ISBN 0-335-20273-X
• Standards for therapeutic relationships and professional boundaries Nurses Board of South Australia - 2002
• A Midwife's Guide to Professional Boundaries Australian Nursing and Midwifery Council Staff - 2009
• Professional boundaries for registered nurses: the nurse-client ... Alberta Association of Registered Nurses - 1998
• Main R, Dunn N, Kendall K 'Crossing professional boundaries': barriers to the integration of nurse practitioners in primary care - Education for Primary Care, 2007
• Quick reference for professional boundaries and sexual misconduct ...National Council of State Boards of Nursing (U.S.). Sexual Misconduct Task Force - 1996
• Standard for therapeutic relationships and professional boundaries Nurses Board of South Australia - 2002
• Professional boundaries guidelines for registered nurses in Victoria Nurses Board of Victoria - 2001
• Professional boundaries: Staying in the lines VR Sheets - Dimensions of Critical Care Nursing, 2001
• Parkes N, Jukes M Professional boundaries in a person-centred paradigm - British journal of nursing, 2008
• Ward-Griffin C Nurses as caregivers of elderly relatives: negotiating personal and professional boundaries. - The Canadian journal of nursing research= …, 2004
• Lillibridge J, Axford R, Rowley G The contribution of nurses' perceptions and actions in defining scope and stabilising professional boundaries of nursing practice - Collegian: Journal of the Royal College …, 2000
• May C, Fleming C The professional imagination: narrative and the symbolic boundaries between medicine and nursing - Journal of Advanced Nursing, 1997
• Tye CC, Ross FM Blurring boundaries: professional perspectives of the emergency nurse practitioner role in a major accident and emergency department - Journal of Advanced Nursing, 2000
• Martsolf DS Codependency, Boundaries, and Professional Nurse Caring: Understanding Similarities and Differences in Nursing Practice - Orthopaedic Nursing, 2002
• Holder KV, Schenthal SJ Watch your step: Nursing and professional boundaries - Nursing Management, 2007
• Wright LD Violating professional boundaries - Nursing2010, 2006
• Wright LD Professional Boundaries in Home Care - Home Healthcare Nurse: November/December 2006 - Volume 24 Issue 10 Pages 672-675
• Linda K Crossing professional boundaries: nurse-led catheter insertion. - Nursing management (Harrow, London, England: 1994 …, 2009
• Shaw S Leadership in Advanced Practice: Challenging Professional Boundaries - Advanced Practice in Nursing and the Allied Health …, 2009

Further reading

Books

• Cummings I The Vigorous Mind: Cross-train Your Brain to Break Through Mental, Emotional, and Professional Boundaries
• Goldstein J In the best interests of the child: professional boundaries - 1986
• Harrington-O'Brien K How do professional boundaries influence multi-disciplinary, La Trobe University - 2006
• Kagle JD, Northrup P Dual relationships and professional boundaries Giebelhausen - 1994
• Linell P Discourse across professional boundaries - 1998
• McIntosh N The educated heart: professional boundaries for massage therapists, bodyworkers, and movement teachers (2005)
• Milne R Unhealthy Professional Boundaries?: Working Together in Health and ... - 2007
• The construction of personal and professional boundaries in ...
• Peterson MR At Personal Risk: Boundary Violations in Professional-Client Relationships (1992)
• Richardson S Cunningham M Broken Boundaries - stories of betrayal in relationships of care (2008)
• Thompson LE Profession and place: contesting professional boundaries at the ... - 2006
• Zubrzycki J, Curtin University of Technology. School of Social Work and Social Policy - 2003
• Zubrzycki J Personal and Professional Boundaries in Australian Social Work: A ...,- 2009
• Professional boundaries and how these impact on the quality of effective work practice between professionals and support for clients in the health care sector appears to be problematic in some settings.
• Challenging professional boundaries: technical papers, 29th Institution of Surveyors, Australia - 1987
• Defining professional boundaries in therapeutic relationships Suzanne Eileen Vallally - 1995
• Primary health care and social care: working across professional ...: Issue 4 Gill Callaghan, Nuffield Institute for Health. Community Care Division - 2000

Academic papers

• Professional Boundaries in Social Work: A Qualitative Study. Final report prepared for the GSCC, May 2009 Prepared by PJ Parker. 1-2 Munton Road, London SE17 1PR / WITNESS. 32-36 Loman Street, London SE1 0EH
• Anderson DM Sexual abuse, professional boundaries, and the rural world - Journal of Child Sexual Abuse, 1547-0679, Volume 8, Issue 3, 1999, Pages 85–93
• Andrew S Professional Boundaries: You are the Professional Exploring professional boundaries in anaesthetics - 2006
• Austin W, Bergum V, Nuttgens S, Peternelj C A re-visioning of boundaries in professional helping relationships: exploring other metaphors- … - Ethics & …, 2006
• Banks S Professional boundaries and personal lives Perspectives from European social education students - Gutes Gelingen: Festgabe zum 60. Geburtstag von …, 2006
• Barbour LT Professional-Patient Boundaries in Palliative Care# 172 - Journal of Palliative Medicine, 2008
• Beecham L Crossing professional boundaries - BMJ, 1996
• Bell J Facilities management and changing professional boundaries - Facilities, 1993
• Bishop R The accidental journalist: shifting professional boundaries in the wake of Leonardo DiCaprioʼs interview with former President Clinton- Journalism Studies, 2004
• Browne J, Russell S My home, your workplace: people with physical disability negotiate their sexual health without crossing professional boundaries - Disability & Society, 2005
• Butler PV Diagnostic line-drawing, professional boundaries, and the rhetoric of scientific justification: A critical appraisal of the American psychiatric association's dsm project - Australian Psychologist, 1999
• Buzaityte-Kasalyniene J, Edwards M, Ųsterhaug R Young people today face problems and issues that transcend national borders and challenge professional boundaries. Developing collaborative European … - 2009
• Cameron A Impermeable boundaries? Developments in professional and inter-professional practice - Journal of Interprofessional Care, 2010
• Chavkin W, Breitbart V Reproductive health and blurred professional boundaries.
• Chan EHW, Chan MW, Chan ATS Disintegrating professional boundaries: a case with the building professions in Hong Kong- International Journal of Project …, 2001
• Clark G, Cole J, Cody J, Lopez C, K Professional boundaries in the home care setting … - Home Healthcare …, 2002
• Clavering EK, McLaughlin J Crossing multidisciplinary divides: Exploring professional hierarchies and boundaries in focus groups - Qualitative Health Research, 2007
• Crowden A Professional boundaries and the ethics of dual and multiple overlapping relationships in psychotherapy. - Monash bioethics review, 2008
• Doel, M., Allmark, PJ Conway, Professional boundaries: research report MARCH 2009
• Davidson JC Professional relationship boundaries: A social work teaching module - Social Work Education, 2005
• Doel M, Allmark PJ, Conway P, Cowburn M, Flynn M, P Professional boundaries: research report … - 2009
• Doel M, Allmark P, Conway P, Cowburn M, M Professional boundaries: crossing a line or entering the shadows? … - British journal of social …, 2009
• Dressler LG Biobanking and Disclosure of Research Results: Addressing the Tension Between Professional Boundaries and Moral Intuition - The Ethics of Research Biobanking, 2009
• Duckworth KS, Kahn MW, Roles TG, Quandaries, and Remedies: Teaching Professional Boundaries to Medical Students … - Harvard Review of …, 1994
• Eliason ML, Gohl-Giese A A question of professional boundaries: implications for educational programs.- The American journal of occupational …, 1979
• Ellingsen G, Munkvold G Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: Infrastructural arrangements for … - International Journal of Integrated Care, 2007
• Kagle JD, Giebelhausen PN Dual relationships and professional boundaries. - Social Work, 1994
• Falls C Building Bridges and Crossing Boundaries: Dialogues in Professional Helping
• Fitzgerald L, Dopson S Professional Boundaries and the Diffusion of Innovation - Knowledge to Action?, 2005
• Fitzgerald L Management development in the NHS: Crossing professional boundaries - Public Money & Management, 1990
• Fronek P, Kendall M, Ungerer G, Malt J, E Too hot to handle: reflections on professional boundaries in practice … - Reflective …, 2009
• Gabbard GO, Crisp-Han H Teaching Professional Boundaries to Psychiatric Residents - Academic Psychiatry, 2010
• Gabbard GO, Nadelson C, Professional Boundaries in the Physician-Patient Relationship JAMA. 1995;273(18):1445-1449.
• Galletly CA Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation - The Medical Journal of Australia, 2004
• Galley R, Conole G, Dalziel J, Ghiglione E Cloudworks as a 'pedagogical wrapper'for LAMS sequences: supporting the sharing of ideas across professional boundaries and facilitating collaborative design, - 2010
• Gaufberg E Alarm and altruism: professional boundaries and the medical student - The Clinical Teacher, 2006
• Gaufberg E, Fitzpatrick A The favour: a professional boundaries OSCE station - Medical Education, 2008
• Gaufberg E, Baumer N, Hinrichs M, E Professional Boundaries: The Perspective of the Third Year Medical Student in Negotiating Three Boundary Challenges … - Teaching and Learning …, 2008
• Goad J Understanding roles and improving reporting and response relationships across professional boundaries - Pediatrics, 2008
• Granfield R Constructing Professional Boundaries in Law School: Reactions of Students and Implications for Teachers - S. Cal. Rev. L. & Women's Stud., 1994
• Granlien MF, Simonsen J Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: Challenges for IT-supported shared care - International Journal of Integrated …, 2007
• Grant S, Huby G, Watkins F, K The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study … - Sociology of health …, 2009
• Griffin MD Crossing Professional Boundaries: Human Issues. - 1983
• Gulliver P, Peck E, Towell D Balancing professional and team boundaries in mental health services: pursuing the holy grail in Somerset - Journal of Interprofessional …, 2002
• Hägglund M, Scandurra I, Moström D, S Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: Bridging the gap: a virtual health record … - International Journal of …, 2007
• Halpern SA Dynamics of professional control: Internal coalitions and crossprofessional boundaries - American Journal of Sociology, 1992
• Hamre GA, Berntsen KE integration across professional and organisational boundaries in health care: local needs and local adaptations
• Hamre GA A common medicine chart in primary health care: Integration across organizational and professional boundaries - Infrastructures for Health Care
• Hardy B, Hudson B, Keen J, Young R, M Partnership and Complexity in Continuity of Care: a study of vertical and horizontal integration across organisational and professional boundaries… - Report for the National …, 2005
• Heldal F Multidisciplinary collaboration as a loosely coupled system: Integrating and blocking professional boundaries with objects Journal of Interprofessional Care, 2010
• Holly E, Deborah K, Geoffrey A, Nathaniel S Re-imagining Your Professional Boundaries and Future Patrons: Are You Ready for Your Second Life? - 2007
• Holz CL When Professional Kindness Is Misunderstood: Boundaries and Stalking Issues: A Case Study for the Home Health Clinician - Home Healthcare Nurse, 2009
• Hopkins A, Solomon J, Abelson J Shifting boundaries in professional care.- Journal of the Royal Society of …, 1996
• Hudson B Primary Health Care and Social Care: Working across Professional Boundaries: Part Two: Models of Inter-Professional Collaboration - Journal of Integrated Care, 1999
• Hudson B, Hardy B, Henwood M, G … Strategic Alliances: Working Across Professional Boundaries: Primary Health Care and Social Care - Public Money & …, 1997
• Jain S, Roberts LW Ethics in psychotherapy: a focus on professional boundaries and confidentiality practices - Psychiatric Clinics of North America, 2009
• Kane M, Smith A, Milne R Exploring professional boundaries in anaesthetics,
• Kimble C, Grenier C, Goglio-Primard K Innovation and knowledge sharing across professional boundaries: Political interplay between boundary objects and brokers - International Journal of …, 2010
• Kimball R Professional boundaries- DBMS, 1998 - ... Professional boundaries. Source, DBMS archive Volume 11, Issue 9 (July 1998)
• Knapp S, Slattery JM Professional Boundaries in Nontraditional Settings 1 - Professional Psychology: Research and Practice, 2004
• Knowles A Boundaries, dual relationships and professional practice - Ethics and professional practice for psychologists, 2006
• Krueger G, Canellos G Where Does Hematology End and Oncology Begin? Questions of Professional Boundaries and Medical Authority - Journal of Clinical Oncology, 2006
• LaBrie RA, LaPlante DA, Peller AJ, DE Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: The interdependence of behavioral and …[ … - … Journal of Integrated …, 2007
• Lane K The plasticity of professional boundaries: A case study of collaborative care in maternity services- Health Sociology Review, 2006
• Lang PO, Schwarze ML, GC New technologies meeting old professional boundaries: the emergence of carotid artery stenting … - Journal of the American …, 2005
• Lipscomb CE Professional boundaries and medical records management - Journal of the Medical Library Association, 2003
• Love JH, Stephen FH Deregulation and professional boundaries: evidence from the English legal profession - Business and Economic History, 1997
• Lynn I, Darling E Collaborative care and professional boundaries: maternity care in Canada1 - Rethinking professional governance: …, 2008
• Marie K Exploring professional boundaries in anaesthetics - 2004
• Martin P Impermanent Boundaries-Imminent Challenges to Professional Identities and Institutional Competence', Commentary 2000 - The Journal of Information, Law and Technology (JILT), 2000
• Martin GP, Currie G, Finn R Reconfiguring or reproducing the intra-professional boundaries of expertise? Generalist and specialist knowledge in the modernization of genetics provision in England, Knowledge and Capabilities; 28 April 2008
• Martin GP, Currie G, Finn R Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the [] modernization'of the medical workforce - Social Science & Medicine, 2009
• Mayer LM Professional Boundaries in Dual Relationships: A Social Work Dilemma - Journal of Social Work Values and Ethics, 2005
• McClure FH COMMENTS ON" KEEPING AND CROSSING PROFESSIONAL AND RACIALIZED BOUNDARIES - Innovations in feminist psychological research, 1999
• McKee M, Dubois CA, Sibbald B Changing professional boundaries - Human resources for health in Europe
• McDaniel SH, Campbell TL, Seaburn DB Managing personal and professional boundaries: how to make the physician's own issues a resource in patient care - Families, Systems & Health, 1990
• McDonald JP Beyond professional boundaries: the reflective practitioner, identity and emotional labour in social work - 2009
• McLaughlin J Risky professional boundaries: Articulations of the personal self by antenatal screening professionals - Journal of Health Organization and …, 2003
• de Mul M, de Bont A, Berg M Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: IT-supported skill-mix change and …- International Journal of Integrated …, 2007
• Nancarrow SA, . Borthwick AM Dynamic professional boundaries in the healthcare workforce Sociology of Health & Illness Volume 27, Issue 7, pages 897–919, November 2005
• Neal M, Younis T Fueling the fire: Professional values and departmental boundaries in the management of the BSE crisis in the UK - Disaster Prevention and Management, 2006
• Nielsen LA Substance Abuse, Shame and Professional Boundaries and Ethics - Alcoholism Treatment Quarterly, 1988
• Okamoto SK The function of professional boundaries in the therapeutic relationship between male practitioners and female youth clients - Child and Adolescent Social Work Journal, 2003
• Payne SA, Kerr C, Hardey M, Hawker S Delivering care across professional boundaries: the communication of information about older people between health and social care practitioners. - Age and Ageing, 2002
• Pearson A, Urquhart C Health informatics education–working across the professional boundaries - Library Review, 2002
• Peternelj‐Taylor CA, Yonge O Exploring Boundaries in the Nurse‐Client Relationship: Professional Roles and Responsibilities - Perspectives in Psychiatric …, 2003
• Pirnejad H, Bal R, A Special issue: Infrastructures to support integrated care: connecting across institutional and professional boundaries: Inter-organisational communication
• Plaut SM Sexual and nonsexual boundaries in professional relationships: principles and teaching guidelines - Sexual and Relationship Therapy, 2008
• Poole R, Higgo R, Strong G, Kennedy G, Ruben S, R Religion, psychiatry and professional boundaries … - Psychiatric Bulletin, 2008
• Poole R, Higgo R, Strong G, Kennedy G, Ruben S, R Concerns over professional boundaries remain unresolved … - Psychiatric Bulletin, 2010
• Post SG, Puchalski CM, DB Physicians and patient spirituality: professional boundaries, competency, and ethics … - Annals of Internal Medicine, 2000
• Price K Debating the value of professional boundaries and expertise - Focus on Health Professional Education: A Multi- …, 2007
• Pugh R Dual relationships: Personal and professional boundaries in rural social work - British Journal of Social Work, 2007
• Ravotas D, Berkenkotter C Genre as tool in the transmission of practice over time and across professional boundaries, - Mind, culture, and activity, 1997
• Reynolds TS Defining Professional Boundaries: Chemical Engineering in the Early 20th Century - Technology and Culture, 1986
• Richmond PA Perspectives of professional boundaries from adolescent females in a residential treatment facility: a case study - 2005
• Rushmer R, Pallis G Inter–Professional Working: The Wisdom of Integrated Working and The Disaster of Blurred Boundaries - Public Money & Management, 2003
• Russell CS, Peterson CM The management of personal and professional boundaries in marriage and family therapy training programs - Contemporary Family Therapy, 1998 - Springer
• Sarangi S, Clarke A, Bennert K, L 10 Categorisation practices across professional boundaries: some analytic insights from genetic counselling … - Applied linguistics and …, 2003
• Schoener GR Boundaries in professional relationships - Norwegian Psychological Association in Oslo, …, 1998
• Schryer CF, Gladkova O, Spafford MM Co-management in healthcare: negotiating professional boundaries, … - Discourse & …, 2007
• Serrano AC, Gunzburger DW Incest and professional boundaries: Confidentiality versus mandatory reporting- Contemporary Family Therapy, 1983
• Shapiro S Boundaries and quandaries: Establishing a professional context for IT - Information Technology & People, 1994
• Shernoff M Sexuality, Boundaries, Professional Ethics, and Clinical Practice - Journal of Gay & Lesbian Social Services, 2001
• Sherratt S, Hersh D You feel like family…” Professional boundaries and social model aphasia groups - International Journal of Speech- …, 2010
• Smith S, Roberts P, Balmer S Role Overlap and Professional Boundaries: Future Implications for Physiotherapy and Occupational Therapy in the NHS:: Forum - Physiotherapy, 2000
• Stone J Respecting professional boundaries: What CAM practitioners need to know - Complementary Therapies in Clinical Practice, 2008
• Stuart M Shifting professional boundaries: gender conflict in public health, 1920-1925 - Caring and curing: Historical perspectives on women …, 1994
• Sykes O, Prigent L Delivering Professional Planning Education Across National and Professional Boundaries
• Tearle P The transfer of educational multimedia across professional boundaries - Innovations in Education and Teaching International, 2003
• Thompson LE Profession and Place: Contesting Professional Boundaries at the Margins - 2006
• Vamos M The concept of appropriate professional boundaries in psychiatric practice: a pilot training course- 2009
• White GE Setting and maintaining professional role boundaries: an educational strategy - Medical education, 2004
• Wilkinson P, Bissell G Physical Boundaries and Professional Space: Social work in Health Service inter-professional settings - Critical Social Work, 2008 Vol. 9, No. 1

External links

• http://knights-agency.com/professional-boundaries/