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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