Setting Professional Boundaries Protects the Patient and Healthcare Provider

Professional boundaries within healthcare are established to set limits to the provider-patient relationship. They are informed or set by legal, ethical and organization frameworks, and protect the therapeutic connection between the professional and patient. As caregivers, we are dedicated to giving support to the patients we serve and it can be difficult to see where the line was crossed until it's too late. But when boundaries are adhered to, they help maintain a safe psychological working environment for both the patient and caregiving staff. Understanding professional boundaries and how to achieve them helps healthcare providers support both themselves and the patients and families they serve.

Professional boundaries can look different dependent on the setting, but they are commonly informed by: the nature of care provided, patient needs, and community influences. They may also include physical, emotional, and mental involvement limitations. Maintaining appropriate professional boundaries is all about achieving the right balance, identifying what is going on, and not allowing past experiences or our emotions to negatively impact us.

What Do Professional Boundaries – or Lack Thereof – Look Like in Healthcare?

Maintaining balance can be difficult, so understanding what it looks like to get over or under-involved can be helpful in gauging your own boundary levels.

• Over-involved relationships: Over-involvement can include boundary crossings, violations, and/or sexual misconduct. It may involve over-sharing because you had a bad day and just need to blow off steam. It can also involve telling patients what they “should” do, and/or falling into a parental or familial relationship with the patient.
• Under-involved relationships: An under-involved relationship might involve distancing, disinterest, and neglect. Difficult situations can result in discomfort for the healthcare professional, resulting in them not being fully present for some or all of their patients.

Unhealthy professional boundaries can lead to risks for the caregiver, their colleagues, patients, and families. When one caregiver is overly-involved and the next is under-involved, patients and families may experience confusion and distress or develop unreasonable expectations which may affect the entire caregiving team. Unbalanced boundaries can also lead to burnout, moral distress, and compassion fatigue for caregivers.

A balanced relationship with clear boundaries must address trust, respect, and intimacy, and power. Balanced boundaries protect the patient against potential exploitation and inconsistent sub-standard care, and protect the patient’s self-determination and dignity. They also protect the healthcare agency from legal and liability issues, and the healthcare provider from unhealthy habits which may lead to deteriorated mental and physical health.

3 Ways to Achieve and Maintain Professional Boundaries

By clearly delineating where your work and personal life meet, and what types of professional interactions, conversations, and requests are appropriate, you can achieve a better work-life balance and bring your best self to your caregiving each day.

• Self-Awareness - Insightfulness​. The first step is often simply checking in with yourself after patient interactions. How are you feeling? Did a certain experience result in you feeling taken advantage of? Are you over-burdened? Are situations in your personal life causing you to look to your professional life for reinforcement and fulfillment, or causing you to neglect it? Examining how we’re feeling and what we’re going through can be very helpful in assessing a situation to see where we may still need to achieve balance.
• Self-Monitoring - Vigilance​. If you’ve identified a situation where boundaries may have been crossed, review what happened. You can ask questions like, was it in the patient’s best interest? Was the incident documented? Is the situation known to fellow caregivers? Did it optimize or detract from the care being provided? Identifying and naming the situation can help prevent similar incidents from happening in the future.
• Self-Care - Mindfulness​. Be aware of your boundaries, and identify the right time and place to clearly delineate them. If you experience or find yourself crossing a boundary, identify how you’ll respond to avoid it in the future. You can also partner with colleagues to strategize about dealing with a patient and family who habitually cross boundaries, and rely on your organization’s ethics committee and training.

Greater levels of awareness positively affect the healthcare provider’s ability to maintain and manage emotional balance when working in difficult situations. Using these three strategies can help maintain healthy boundaries so the caregiver is protected and relationships with patients and families thrive.

Sources

• Perry, A. (2011). Crossing the line: Real stories of boundary violations and what we can learn from them. Newsline: National Hospice and Palliative Care Organization.
• Sanders, S.; Bullock, K.; Broussard, C. (2012). Exploring professional boundaries in end-of-life care: Considerations for hospice social workers and other members of the team. Journal of Social Work in End of Life & Palliative Care, 8-10-28.
• Understanding Professional Boundaries. Published:28 August 2019.
• Professional Boundaries. CareSearch palliative care knowledge network.
• Self-Care. CareSearch palliative care knowledge network.
• A Nurses Guide to Professional Boundaries. (NCSBN Leading Regulatory Excellence)
• Draw the Lines: The Art of Setting Boundaries. Lizzy Miles, MA, MSW. Pallimed, a hospice and palliative medicine blog.
• Professional – Patient Boundaries in Palliative Care. Lise Taylor Barbour, M.D.