Nursing: Professional Boundaries Case Study


The issue of professional boundaries is critical in the nursing practice. Professional boundaries protect the nurse and the patient. Thus, they facilitate a safe relationship between the health care provider and the patient. According to recent research, most disciplinary cases involved boundary crossing and the issue of professional boundaries is widely discussed in the literature. As a result, this paper will analyze a case study involving professional boundary-crossing.

The boundary that John crossed

John crossed a professional boundary that entails a therapeutic relationship. According to this boundary, a health care professional should behave in a therapeutic manner (Baca, 2011). This means that the nurse should not engage in activities that involve the personal life of the patient. On the contrary, John crossed the boundary through over-involvement. According to Fischer & Betsy (2008), involvement entails spending more time with a specific patient and off-duty visiting. Additionally, it involves a situation where the nurse practitioner thinks that he or she is the only person who is of help to the patient.

According to the case study, John spent an inappropriate amount of time with Susan. For example, he formulated a specific care plan for her. Besides, he insisted on having a walk or a drive with Susan around the town. This shows that John created more time for Susan and not for other patients. According to the professional boundaries, too much attention to a particular patient is in the category of boundary-crossing (Karen, 2010). Additionally, John used to pay unplanned visits to Susan. For instance, He made an unscheduled visit to Susan and offered her a drive. This is unprofessional. According to a therapeutic relationship, all visits to the client require planning (Butts, 2009) and the client has a right to refuse or accept. Additionally, the client should schedule the appropriate time.

Furthermore, John crossed the professional boundary by thinking that he was the only person who could help Susan. For example, He sent a teddy bear to Susan so that she could accept a dinner invitation. This portrays involvement in the personal life of the patient. According to the professional code of ethics, there should be a clear distinction between a therapeutic and a personal relationship (Peterson, 2009). In analyzing the case study, the distinction did not exist. This is because John knew a lot about their personal life of Susan. For instance, He knew that Susan was not together with Brad and thus took the opportunity to be close to her.

Lastly, giving gifts to the patient can obscure a therapeutic relationship (Baca, 2011). This is because the patient will start socially viewing the nurse practitioner. According to the case study, John crossed the boundary of the therapeutic relationship by giving Susan gifts. For instance, he gave her a teddy bear. This impressed her and prompted her to accept the offer. As a result, a personal relationship started to develop between John and Susan.

The reasons why John crossed the boundary

In the nursing practice, the nurse should act for the good of the patient (Fischer & Betsy, 2008). As a result, John’s intention for crossing the boundary was to help Susan cope with the disease process. For instance, John realized that Susan had an ineffective coping mechanism and that was why he formulated a specific care plan for her. Additionally, John’s concern made him pay off duty and unplanned visits to Susan.

Nurses must obtain consent before establishing a therapeutic relationship with patients (Karen, 2010). This is the reason why John easily crossed the boundary. For example, John did not force Susan to meet with her but he obtained consent. According to the case study, John sent Susan a teddy bear so that she could accept the invitation. In this situation, Susan voluntarily accepted. On the other hand, John did not force Susan to accept any offer. For instance, when Susan refused the drive and the walk, John did not coerce her.

The primary focus of nursing is the well-being of the patient. Butts (2009) explains that well-being involves the biological, psychological, social, and physical health of the patient. This holistic nursing is what made John cross the boundary. For instance, John based his care plan on the fact that Susan was experiencing a loss in self-esteem, body image as well as self-worth. As a result, John wanted to improve her self-esteem by making her realize that she is still significant in society. Finally, John wanted to care for the psychological wellness of Susan. This is why he wanted to spend more time with her so that he could teach her coping mechanisms. This could help Susan accept herself thus reducing is stress and depression.

The responsibility of Susan in John losing his Job

On the one hand, Susan had a responsibility in John losing his job because she accepted the offer. On the other hand, Susan is not responsible for John losing his job. This is because John is the one who persistently followed Susan. In the final analysis, John is responsible for losing his job. This is because he is the one who started all this process of being close to Susan.

To begin with, John became so close to Susan that he learned a lot about her personal life. For instance, he learned that Susan was not together with a brad. Although this information is useful in the psychological care of a patient, it led to John losing his job. This is because it increased his closeness to Susan thus losing touch of a therapeutic relationship. For instance, his plan to make Susan feel better about herself led to the dinner invitation where another nurse practitioner found him.

Additionally, by John crossing the professional boundary, he was likely to lose his job. According to the nurses’ code of ethics, a person who violates the standards should face the law (Peterson, 2009). In the case study, John violated the standards by crossing the boundary. For instance, he visited Susan during the off-duty hours. Additionally, he saw himself as the only practitioner who could help Susan with the coping mechanisms. This is why he kept on insisting on a walk with her. Therefore, John is responsible for losing his job.

Furthermore, John could have lost his job because of his unprofessional demeanor. Demeanor involves appearance, speech as well as body language. Baca (2011) explains that the nurse’s professional demeanor influences how people perceive others. Additionally, personal as well as professional demeanors are different from each other. In the analysis of the case study, there is a high probability that unprofessional demeanor existed when John and Susan were having dinner. This is probably the reason why the other nurse reported John. According to this situation, John is still responsible for the loss of their job because he is the one who behaved in an unprofessional manner.

Finally, John is responsible for losing his job because of his persistent nature. For instance, he did all he could to make sure that he was close to Susan. According to the case study, John used to ask for a walk or a drive with Susan. Unfortunately, Susan used to refuse. If John had stopped following her, he could still have his job. On the contrary, John continued following her by sending her a teddy bear. This persistence made Susan change her mind. Therefore, John is completely responsible for the loss of his job.

If I were John Supervisor

If I were John’s supervisor, I would do something different. I would employ the discipline process instead of sacking him. First, I would begin with a verbal reprimand. I would call him and discuss the whole issue in detail. This will involve a statement of the accusation followed by a discussion of the reason behind his behavior. If John accepts the accusation, I would make him write a letter stating that he has agreed with the allegations and that he is ready to change.

Upon receiving the letter, I would keep it in his records so that it acts as a future reference. I would then teach him all the professional codes of ethics so that he is equipped with knowledge. I would then tell him to make a vow that he is not going to repeat the same mistake. After the vow, I would inform him that the next time he repeat the same mistake he would receive a suspension. I would then give him another chance of working for an intercity Visiting Nurses Association.

Why I would do something different

I would do something different because it is not fair to sack someone without proper investigations. This is because, in a situation where some nurses do not agree with each other, one can always try to find a way that distracts another person. This is the reason why I would call John and discuss the whole scenario with him so that he accept or refuse. In case he refuses, an investigation can be made and the nurse who accused him of being interrogated. In case he accepts, I would establish the reasons behind his behavior. This is because some people behave in the way that they do. After all, they do not know the right procedure. For instance, John could be involved with Susan because he is trying to help him and not for a personal benefit.

Finally, I would do something different because it is unethical to sack someone without warning him or her. Karen (2010) states that the discipline process should begin with a verbal reprimand, followed by a written warning, suspension then sacking. This is the reason why I would not sack John but give him another chance so that he can rectify his behavior. Additionally, when someone has a second opportunity, he is likely to change and produce quality services. Thus, by not sacking John, he is likely not to cross the professional boundary again.


In conclusion, professional boundaries are imperative because they dictate the relationship between the patient and the nurse. As a result, nurses should ensure that they are familiar with the professional boundaries. This will facilitate the provision of holistic and comprehensive care to the patients.


Baca, M. (2011). Professional Boundaries and Dual Relationship in Clinical Practice. Journal for Nurse practitioner, 7 (3), 195-200.

Butts, J. (2009). Ethics in Professional Nursing. Boston: Jones and Barlett Publisher.

Fischer, R., & Betsy, J. (2008). Professional Boundaries Violation: Case Study from a Regulatory Perspective. Nurse Administrator, 32 (4), 316-322.

Karen, V. (2010). Watch your Steps: Nursing and Professional Boundaries. Nursing Management, 38 (2), 24-29.

Peterson, M. (2009). At Personal Risk: Boundary Violations in Professional-Client Relationship. New York: WW Norton and Co.

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