Professional conduct; maintaining boundaries between health professionals and patients

In short, nurses, midwives and doctors are some of the most trusted and respected professions in the community. Patients expect them to act in their best interests and to respect their dignity. A breach of professional boundaries will lead to a violation of the practitioner’s professional responsibility (see Codes of Professional Conduct and Code of Ethics). It doesn’t matter if the boundary violation was inadvertent, thoughtless, altruistic, or even purposeful. It’s still a boundary violation.

The doctor/nurse-patient relationship isn’t a friendship; it’s a therapeutic relationship directed by the patient’s health needs. The community entrusts practitioners to act in the best interest of those in their care and that their care will be based on an assessment of their specific needs.

What are professional boundaries?

Professional boundaries are defined as limits which protect the space between the professional’s power and the client’s vulnerability. They are the borders that mark the edges between a professional, therapeutic relationship and a non‑professional or personal relationship between a health practitioner and a person in their care.

When a health practitioner crosses a boundary, they are generally behaving in an unprofessional manner and misusing the power in the relationship.

What is a boundary violation?

Boundary violations occur when the practitioner behaves in an unprofessional manner by misusing their power in the nurse-patient or midwife-patient relationship. This is because there is an inherent power imbalance between vulnerable patients and the practitioner providing care. That is, there is an inherent power imbalance in therapeutic and care relationships.

If there is a breach, each circumstance would need to be assessed on the gravity of the departure from expected professional standards. The context of:

1. the type of service or health facility;
2. the physical setting;
3. characteristics of the consumer; and
4. the complexity of care required by the patient,
5. would all be considered in coming to any conclusions.

Is the behaviour or activity within the scope of practice of the health practitioner and in keeping with contemporary competency and practice standards?

Examples of improper boundary-crossing behaviour (non‑therapeutic behaviour) by a health practitioner, include:

• having sex with a patient (consent is not a defence);
• breaches of patient confidentiality or privacy;
• use of social media between the parties - blurring the lines between professional and personal lives;
• accepting gifts or benefits from patients and/or their families;
• developing a personal or intimate relationship with a patient (going out together on weekends or exchanging personal telephone numbers);
• financial exchanges (the lending or giving of money);
• favouritism of any kind;
• excessive personal/self-disclosure or secrecy;
• seductive, sexually demeaning or harassing conduct; and
• flirtatious communication, employing sexual innuendo, off‑colour jokes or offensive language.

To avoid a breach, practitioners should simply abstain from this type of behaviour.

What can happen if you breach professional boundaries?

In serious cases, health practitioners may be liable for disciplinary action brought by their Board, or regulators, such as the Queensland Office of the Health Ombudsman (‘OHO’) or NSW HCCC for unprofessional conduct or professional misconduct.

Regulators bring such “charges” in a tribunal which has the power to suspend or cancel a practitioner’s registration, impose a fine and leave the health practitioner liable for legal costs in some cases.  It can be career ending.

Subject to a notification or complaint?

Do not delay seeking advice!

Get help from an employment lawyer

Hall Payne Lawyers has a team of experienced lawyers who can provide advice and representation to you and help you get through the stressful process following a notification or complaint.

We see too many health practitioners who have tried to go it alone before seeking advice and suffer adverse outcomes. Health practitioners who get advice early on have the best outcomes – it can be the difference to being able to continue to work or not.

If you are facing disciplinary action for actions which constitute a breach of professional conduct or code of ethics, it is vital you seek early assistance from your union or a lawyer experienced in these matters.