Professional Boundaries

There have been many situations where an innocent act has led to severe breaches of professional boundaries.

MBC Nursing has strict Professional Boundaries policies and we do not tolerate any form of abuse. MBC Nursing employees are required to maintain high standards of integrity and ethical conduct.  All of our employees are placed in positions of trust within the community, and we expect our employees to behave accordingly.  Our providers, clients, and contractors and their employees are also expected to respect our employees’ commitments to high standards.

We recognise that we are in positions of trust and that our clients and candidates give us great responsibility, and we aim to honour and respect our relationships with everyone in the community.

We expect our employees to comply with legal, policies, procedures, industrial or administrative standards, guidelines, and any and all professional codes of conduct they may operate under.  Employees are also expected to adhere to the mbc golden rules.

A simple definition: Professional boundaries are limits which protect a worker’s professional power and their client’s vulnerability. Successful and ethical working relationships are based on a clear understanding of what the workers’ role is – and just as importantly – what their role isn’t.

Professional boundaries are the limits to the relationship of a care worker and a person in their care which allow for a safe, therapeutic connection between the carer and that person (and their nominated partners, family and friends).

Some examples of professional boundaries may include:

• Not discussing a client’s private health information with others;
• Keeping work contact numbers separate to your personal contact numbers;
• Not performing additional favours for clients, outside of the scope of your role.
• Accepting gifts from the client
• Financial control of client
• Asset control of client

Most cases of breaching in professional boundaries end up in client abuse. It starts small and can escalate quickly:

1. setting aside a lot of time for one particular client.
2. staying back after hours with a particular client on a regular basis.
3. meeting a client socially on a regular basis.
4. finding yourself giving personal or irrelevant details about your own life.
5. accepting small gifts.
6. Managing finances or financial transactions

 How to Set Boundaries with Clients

1. Self disclosure. Although in some cases self disclosure may be appropriate, care workers need to be careful that the purpose of the self disclosure is for the client’s benefit. A number of dangers may exist in self disclosure including shifting the focus from the needs of the client to the needs of the carer or moving the professional relationship toward one of friendship. The blurring of boundaries can confuse the client with respect to roles and expectations. The primary question to be asked is, “Does the self disclosure serve the client’s therapeutic goal?”
2. Giving or receiving significant gifts. Giving or receiving gifts of more than token value is contrary to professional standards because of the risk of changing the relationship. For example, a client who receives a gift from a carer could feel pressured to reciprocate to avoid receiving inferior care. Conversely, a carer who accepts a significant gift from a client risks altering the relationship and could feel pressured to reciprocate by offering “special” care.
3. Dual and overlapping relationships. Dual relationships should be avoided. These occur in situations where the carer is both the clinician and also holds a different significant authority or emotional relationship with the same person. Csrers needs to remain cognizant that the purpose of avoiding dual relationships is to avoid exploiting the inherent power imbalance in the relationship. Overlapping relationships, while potentially problematic, may not always be possible to avoid. Overlapping relationships, where a carer has contact, but no significant authority or emotional relationship with the client, may occur particularly for carer who are members of small communities, or for carers who work with a particular client population with which they are also affiliated. Situations where there may be overlapping relationships need to be judged on a case by case basis.
4. Carers should avoid relationships with their clients outside of care where either the carer or client is in a position to give a special favour, or to hold any type of power over the other. Carers should refrain from requesting favours from clients, such as financial support, typing, or any other type of assistance that involves a relationship outside care.
5. Becoming friends.Generally, carers should avoid becoming friends with clients and should refrain from socializing with them. Although there are no explicit guidelines that prohibit friendships from developing once care has terminated, carers must use their clinical judgment in assessing the appropriateness of this for the individual client. Potential power imbalances may continue to exist and influence the client well past the termination of the formal care relationship.
6. In the course of care, some carers, on occasion, may engage in activities that resemble friendship, such as going on an outing with a child or adolescent, or attending a client’s play, wedding, or special event. In all cases it is the carer’s responsibility to ensure that the relationship remains professional and does not develop into a friendship or a romantic involvement.
7. The definition of “sexual abuse” within the legislation makes it clear that it is unacceptable to date a current client. Since power imbalancesmay continue to influence the client well past termination, professional standards prohibit a carer from engaging in a sexual relationship with a client to whom any professional service is being provided. Carers are reminded that even the most casual dating relationship may lead to forms of affectionate behaviour that could fall within the definition of sexual abuse.
8. Maintaining established conventions. Ignoring established conventions that help to maintain a necessary professional distance between clients and carers can lead to boundary violations. Examples include providing treatment in social rather than professional settings, not charging for services rendered, not maintaining clear boundaries between living and professional space in home , or scheduling services outside of regular hours.
9. Physical contact. There are a variety of ways of using touch to communicate nurturing, understanding and support such as a pat on the back or shoulder, a hug or a handshake. Such touch can however, also be interpreted as sexual or inappropriate which necessitates careful and sound clinical judgment when using touch for supportive reasons. Carers must be cautious and respectful when any physical contact is involved, recognizing the diversity of cultural norms with respect to touching, and cognizant that such behaviour may be misinterpreted

For a copy if the MBC Nursing Professional Boundaries Policy, our Code of Conduct and our Client Abuse policy please email

sunette@mbcrecruitment.com.au

Sunette Opperman

WHS & IMS Manager