Health Professionals Must Maintain Professional Boundaries With Patients At All Times

The importance of maintaining appropriate professional boundaries with patients, even after the professional relationship has ceased, was highlighted in a decision published by Deputy Commissioner Dr Vanessa Caldwell.

In the decision, Dr Caldwell found a registered nurse in breach of the Code of Health and Disability Services Consumers’ Rights (the Code), for failing to maintain professional and ethical boundaries with the patient. Dr Caldwell has also referred the nurse to the Director of Proceedings to decide whether any proceedings should be taken.

This case concerns a young man (in his teens at the time), who was referred to the mental health service by his school counsellor. The mental health service nurse provided mental health services to the young man for eight months; including face-to-face intervention, psycho-education, coordination of services including referral to a private psychologist, and ongoing risk assessment. During the time of their therapeutic relationship, the nurse contacted the young man on social media.

Dr Caldwell considered the nurse had inappropriately sent messages of a personal nature, (including a request to send a selfie), to the young man, who was vulnerable because of his age and his mental health.

As a healthcare provider, the nurse was required to deliver services that complied with professional, ethical, and other relevant standards. Dr Caldwell noted the maintenance of professional boundaries is an integral part of the provision of health services.

"I consider the nurse contravened professional boundaries and ethical standards by initiating contact with the young man outside of a professional setting, and sending messages of a personal nature," says Dr Caldwell.

An inherent power imbalance exists between consumers and their healthcare providers, where the provider has access to intimate details about a consumer’s health, but the consumer has no such knowledge about the provider.

Dr Caldwell said "the power imbalance between the nurse and young man persisted beyond the termination of the therapeutic relationship, given the nurse’s knowledge of the young man’s personal circumstances and mental health.

"Trust is fundamental to the relationship in ensuring the consumer is assured the provider is acting in the consumer’s best interests. It is critical that relationships between health professionals and their clients stay within the professional realm, to avoid any exploitation or abuse of power," says Dr Caldwell.

Dr Caldwell recommended the nurse undertake further training on identifying and maintaining professional boundaries, and the Nursing Council of New Zealand consider the fitness of the nurse to practice, and whether any competency or conduct reviews are required. She further recommended the mental health service undertake an audit of the case load of the nurse to ensure there were no other cases of professional boundaries being crossed, and provide appropriate support if necessary to any affected patients .

Dr Caldwell also referred the nurse to the Director of Proceedings.

"The potential harm to a vulnerable young person by behaviour initiated by the nurse was significant, and there is public interest in ensuring that such a risk is minimised," says Dr Caldwell.

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