Boundary Crossing or Sexual Misconduct?

We developed this practice scenario to help nurses understand their accountabilities when they suspect a colleague is crossing or violating boundaries with a client. Nurses are obligated to report suspected sexual misconduct by a colleague to NSCN and your employer.

If you have any questions about the practice scenario, please reach out to us at practice@nscn.ca.

A colleague of mine repeatedly asks to be assigned to care for one particular client and spends a great deal of their shift in this client’s room. There have been occasions where we have been unable to locate my colleague, only to discover they have been spending time in this client’s room. I am concerned that the lines are getting blurry. What is my responsibility in this situation?

Questions to reflect on:

  1. Has your colleague crossed a professional boundary or is there a high risk that your colleague may cross a professional boundary?
  2. What resources could you use  to support your decision-making?
  3. Has your colleague breached the Sexual Misconduct Standard of Practice for Nurses (2020)?
  4. Are nurses obligated to report suspected sexual misconduct?

Professional boundaries are the defining lines which separate the professional, therapeutic behaviour of a nurse from any behaviour which, well intentioned or not, could harm or could reduce the benefit of nursing care.

If you are concerned that a colleague is crossing or at high risk for crossing a professional boundary with a client, you have an accountability to investigate the situation further.  There are several NSCN resources available to assist you in your decision-making, including the Professional Boundaries and the Nurse-Client Relationship Guideline.

Boundary crossings are brief excursions across professional lines of behavior made while attempting to meet a client’s therapeutic need. Boundary violations are a breach of trust in the nurse-client relationship. Boundary violations can result when there is confusion between the role of the nurse and the needs of the client. A boundary-crossing example could be establishing a personal relationship with a client while a boundary violation example could be engaging in a romantic or sexual relationship with a current or vulnerable former client.  

The Know the Warning Signs: Sexual Misconduct Fact Sheet reviews the behaviours that could be warning signs of sexual misconduct. Boundary crossings, like the ones listed in the tool, can lead to sexual misconduct, which is a boundary violation. Recognizing the warning signs will enable you to stop the behaviour and prevent it from escalating further. Ask yourself: is your colleague showing any warning signs? 

A therapeutic nurse-client relationship is built on trust and mutual respect between the nurse and client and is based on a nurse’s ethical and legal duty to protect the client’s well-being. The NSCN Therapeutic Nurse-Client Relationship: Sexual Misconduct Standard of Practice Fact Sheet outlines the five common qualities in a therapeutic nurse-client relationship. Ask yourself: is your colleague demonstrating these qualities in their relationship with the client?

A violation of professional boundaries is a breach of trust. Sexual misconduct by a nurse towards a client is a boundary violation and constitutes professional misconduct. The NSCN Sexual Misconduct Standard of Practice for Nurses outlines behaviours that are considered sexual misconduct. Ask yourself: do I see behaviour(s) inconsistent with the sexual misconduct standard? 

If after reviewing these tools, you reasonably suspect sexual misconduct by your colleague, you are obligated to report this behaviour to NSCN and your employer. The Sexual Misconduct Standards of Practice for Nurses (2020) states that nurses are required to report sexual misconduct if they have reasonable grounds to suspect that the conduct of a regulated health care professional or an unregulated care provider constitutes sexual misconduct.  For information on how to report sexual misconduct, open the NSCN How to Report Fact Sheet.

For further information on anything contained within this practice scenario, please contact an NSCN Practice Consultant at practice@nscn.ca

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