Professional boundary violations are common issues in the world of healthcare. Boundary crossings are often innocent or well-intentioned. However, any boundary violation may result in unintentional patient harm. This is why nursing programs spend time discussing boundaries, the therapeutic relationship, and the multitude of ways a nurse can violate boundaries.
Whether you believe the boundary violation allegations against you are true or unfounded, a strong legal defense is necessary to protect the future of your career and your reputation. Having worked as a nurse for 35 years before moving exclusively to the practice of nursing defense law, Barb Forshier is a Minnesota nurse attorney who understands the challenges you’re facing. Contact Forshier Law, LLC today to schedule a free consultation.
What Are Boundary Violations?
The National Council of State Boards of Nursing goes into great detail about what constitutes a boundary violation. Violations are primarily defined by a prioritization of the nurse’s needs over the patient’s needs. For a nurse, the goal of the therapeutic relationship is to meet the patient’s needs with their specialized training and knowledge. A boundary violation plays on the patient’s vulnerable position. It may put them in a position where they are taking care of the nurse, having their own needs ignored, or being embroiled in an inappropriate relationship with the nurse.
Boundary Violation Examples
- A nurse oversharing details about their personal life. In a therapeutic relationship, a nurse may share something about their personal life to provide comfort to a patient or show understanding. However, when the information is shared for the nurse’s own benefit, it is considered a violation.
- The patient provides for the nurse’s needs, either by providing money, keeping secrets for them, or providing emotional support.
- The nurse becomes too emotionally close to the patient. The nurse may feel that they are the only ones who can meet the patient’s needs, show favoritism, spend more time than is necessary with the patient, or keep secrets from the patient’s family.
- Becoming romantically involved with a patient. Romantic or sexual involvement with a patient is a significant violation that takes advantage of the patient’s dependence on the nurse for medical care. The consent of the patient does not stop this from being a boundary violation. This is very serious and will result in disciplinary action by the Board of Nursing. This is one of the few times a nurse may actually lose their license. The nurse is in a position of power and will be viewed by the board as a predator.
- Be especially diligent if you work in a corrections or substance use facility where those with criminal backgrounds/psychopathic personalities reside. There has been more than one case where the inmate/client preys on the nurse. They may ask for favors, tell the nurse they are special, and then turn to extortion and/or blackmail of the nurse. Any involvement with a client/inmate/patient will likely ruin a nurse’s career and life.
- Involving themselves in the social lives of their patients. There are many times when a nurse is introduced to the friends and families of their patients or overhears personal conversations between patients and their loved ones. However, in most situations, getting overly involved in these conversations outside of a professional setting or context is considered a violation.
Consequences of Boundary Violations
The consequences of a boundary violation depend on the severity of the violation and whether a crime has been committed. Depending on the circumstances, a nurse who has been accused of a boundary violation may face:
- Disciplinary action: If a boundary violation is serious enough, the Minnesota Board of Nursing will investigate the claim and issue penalties such as fines, mandatory education, probation, suspension, or even license revocation.
- Loss of employment: If a nurse is found in violation of a professional boundary with their patient, it could lead to dismissal. Any termination for that is a result of a violation of the Nurse Practice Act will result in a complaint to the Board of Nursing and you will be called to defend your license.
- Criminal charges: If a crime has been committed, criminal charges may be filed against the nurse, which could result in fines or jail time.
- Civil lawsuits. Some boundary violations result in emotional trauma, physical injury, or financial loss for the patient. In these cases, the patient or their family may sue the violating nurse for damages.
Boundary Violation vs. Boundary Crossing: What’s the Difference?
While it’s important for nurses to avoid crossing boundaries with their patients, there is usually a distinction in the healthcare field between a boundary crossing and a boundary violation.
A boundary crossing is typically defined as a deviation from a professional boundary that is both non-exploitative and situational based on the patient’s needs. Some examples of a boundary crossing may include:
- A nurse hugging a child after getting a vaccination.
- Offering to pick up groceries or prescriptions for a patient.
- Bringing in food from home for a patient.
A boundary violation on the other hand is typically considered more exploitive or even abusive. This may include a nurse receiving money as a tip or becoming romantically involved with a patient in their care. Both crossings and violations are generally frowned upon, but a violation is explicitly forbidden where a crossing may be forgiven especially if it is considered beneficial to the patient’s care.
Red Flags for Boundary Violations in Nursing
Knowing the red flags for boundary violations can help you avoid unsafe situations or identify times when you need to step back from a patient’s care. Watch for these signs:
- Showing favoritism to one patient over others
- Meeting patients outside of work
- Keeping secrets with or for a patient
- Spending more time than is necessary or appropriate with a patient
- Discussing personal or intimate details of your life
- A patient attempting to give you money or other gifts because they know of your personal struggles or needs
- Flirting with a patient or participating in behavior that an outsider might see as flirting
- Speaking about your workplace or colleagues in a negative light with the patient or their family members
- Feeling jealous when another nurse is assigned to a patient
- Believing you are the only one capable of meeting a patient’s care needs
How to Avoid Professional Boundary Violations as a Nurse
Crossing or violating a professional boundary can happen quickly and you might not even realize when it happens until it’s too late. Here are a few tips to avoid violating your relationships with your patients:
- Be mindful of self-disclosure: Share personal information rarely and only if absolutely necessary to the patient’s well-being.
- Avoid dual relationships: In all situations, remember that your relationship with your patients is a professional one. Do not seek friendships or relationships with your patients outside of work.
- Give equal care to all your patients: Most nurses have a “favorite” patient at some point in their career, but giving one patient a higher level of care than the others is wrong.
- Avoid accepting gifts: In some healthcare institutions, accepting gifts is allowed, but usually only in specific situations. Refer to your supervisors and training if you’re uncertain.
- Use social media wisely: It’s never okay to post pictures of your patients or disclose personal information about them online. Do not accept “Friend” requests from a patient.
What to Do If You Have Boundary Violation Allegations
If you have received a letter regarding boundary violation allegations, it is crucial to move quickly. Letters from the Board of Nursing usually have short deadlines for your response and failing to meet that deadline or leaving your response to the last moment can seriously and negatively impact your claim.
In Minnesota, a nurse may first become aware of a boundary violation allegation when a letter is received from the Office of the Attorney General. You will be asked to participate in a recorded investigatory interview. Be sure to seek legal counsel from a Minnesota nurse attorney before you speak to them. It is important to be honest with your nurse attorney and not hide anything that you fear will make you look bad. An attorney with all of the information they need is better able to craft a strong defense for their client.
When choosing a nurse attorney in Minnesota, consider selecting one who focuses exclusively on nursing license defense. While many attorneys offer professional license defense in addition to other areas of practice, working with an attorney who only does license defense, and who has devoted their entire career to the well-being and protection of healthcare providers, will serve you the best.
Barb Forshier has had a long career as an RN which has laid the groundwork for her vigorous defense of nurses. She understands and empathizes with your situation. Not only will she advocate for you, but she will also educate you on what went wrong and how to avoid future license issues.
Nursing Boundary Violations: FAQs
Below are a few common questions that our firm receives regarding professional boundaries in nursing. If you don’t see your question listed here, you can reach out to us directly to learn more.
When Is It Safe to Date a Former Patient?
The answer to this question is not cut-and-dry and involves a substantial amount of consideration. First, a patient must be a former patient before any romantic or sexual activity occurs. Under Minnesota state law 609.344, a psychotherapist who engages in sexual conduct with a patient while the therapeutic relationship exists is guilty of criminal sexual conduct in the third degree. Note that under Minnesota law, nurses are held to this standard as employees in correctional or secured treatment and certain other facilities. Consent by the former patient is not a defense.
Outside of the legal definitions, the Board of Nursing looks at these nursing board complaints individually. Generally, the more time between treatment and dating, the less likely it is to be a boundary violation. The type of care received is also important. A nurse who sees a patient every day for five years as part of chronic illness treatment will have a different patient-nurse relationship than a nurse who sees a patient once for help with a broken leg.
Can a Nurse Care For a Neighbor or Friend?
While you are allowed to provide care for a neighbor or friend, it is best to avoid doing so as maintaining professional boundaries can be difficult in these situations. You will need to ensure that your neighbor or friend understands you are acting in a professional capacity and you should be extra careful to avoid becoming over-involved.
What If the Patient Initiated the Inappropriate Behavior?
If a patient initiates inappropriate behavior, it is still the nurse’s responsibility to maintain professional boundaries. Nurses must respond by setting clear limits, redirecting the conversation, and, if necessary, reporting the behavior to a supervisor. Facilities often provide training and policies on handling such situations, and nurses should document any incidents to protect themselves from potential boundary violation claims.
Can a Nurse Continue Working While Under Investigation For a Boundary Violation?
It depends, but typically no. In some cases, a nurse may be given an alternative role, such as admin work, that doesn’t involve patient interaction while the investigation is ongoing. However, in other cases, they will be dismissed or placed on leave.
What Evidence Can Help a Nurse Defend Against a Boundary Violation Claim?
If you’ve been accused of a boundary violation, you’ll typically have the opportunity to defend yourself, whether it’s through a preliminary investigation or during a hearing or appeal. The most successful way to combat these accusations is by compiling evidence that demonstrates that they are baseless or at the very least, conflated. Your nurse lawyer will help you gather this evidence through witness testimony, medical records, security footage, or recorded communications, such as email or text messages. However, the initial conference at the Board of Nursing is considered an investigation. That means that your attorney is not able to obtain “discovery” which includes the Board’s investigative file. To obtain the information that the Board has on you, it will be necessary to go to a Contested Case Hearing, which is an appeal if you do not agree with the proposed disciplinary outcome of the Board conference. This process is costly and takes up to a year. It is important to protect your license with professional liability insurance. You never know when you may need it. This insurance not only pays for malpractice claims, but it pays for your license defense attorney.
Forshier Law Can Help You Defend Yourself Against Boundary Violation Claims
Never fear accepting the claims against you without defending yourself, especially at the expense of a career you love. Turn to Forshier Law for the support and representation you need. Our nurse attorney can help you understand how to navigate the situation and battle the claims brought against you. Call or contact us online to schedule your free consultation.
