Case Scenarios

  1. Scenario 1 - Personal needs and interests

    Nancy, a registered nurse, is caring for Dan. Nancy discovers they have a lot in common and finds a certain connection with Dan. Nancy finds she cannot stop thinking about Dan, and eventually emails him. They begin to chat over email and, after a month or so, she asks Dan to go to dinner with her. Dan agrees.

  2. Scenario 2 – Oversharing personal information

    Mrs. Smith goes to see her nurse practitioner, Sandeep, because she is feeling overwhelmed. Mrs. Smith admits she is having marital difficulties with her husband. This is making her feel very anxious and unable to sleep. Sandeep acknowledges that ‘marriages can be hard work’, and begins to tell her about his own prob­lems with his spouse. Sandeep becomes emotional speaking about his spouse, and asks Mrs. Smith if he can take a minute to compose himself. Mrs. Smith comforts Sandeep and says her problems seem insignificant in comparison, so she should just ‘get over it already’. Sandeep says he is running late for his next appointment, and asks Mrs. Smith to reschedule.

  3. Scenario 3 - Accepting gifts

    Layla, a registered practical nurse, has been caring for resident, Kate, for many years in a long-term care facility. Kate’s grandson, Ben, has been extremely grateful for Layla’s care with his grandmother. When Ben next visits, he presents Layla with a very expensive bottle of wine to thank her for caring for his grandmother. Layla accepts the gift and says she looks forward to sampling it after work. About a month later, Ben notices that Layla is very busy with other residents and having a difficult time getting in to see his grandmother. He finds this frustrating and tells the charge nurse, “I’m surprised I can’t get timely care from Layla.” The next day, Layla receives extra help from a student nurse so has more availability to see Kate. Ben is so grateful, he brings her another gift when he comes to visit; this time it’s an annual subscription to Wine Monthly that comes with a limited edition set of wine glasses.

  4. Scenario 4 - Risk management

    Olivia, a registered practical nurse working in an outpatient mental health program, cares for Bill. Bill has a lot of trust issues, feelings of rejection, and is very emotionally needy. Olivia often allows sessions outside office hours, and they often run late. Olivia drives Bill home in bad weather. One day, Bill asks Olivia to go to a show with him, but Olivia says no, saying this would cross a line. Bill gets upset and accuses her of ‘running hot and cold’.

  5. Scenario 5 - Rural practice and scarcity

    Mary is completing a placement on a local farm as part of her veterinary degree requirements near the town. One day she mentions to her supervisor that she has been experiencing pain. When she’s advised to see a health care provider, Mary mentions her family nurse practitioner is in her home town which is over five hours away. Mary’s supervisor recommends she book an appointment with Max. A few days later, Mary reports for her appointment with Max and he welcomes her warmly. Once the appointment has finished, he gives her a hug. Mary leaves his office feeling perplexed; she’s never had a nurse practitioner or any other nurse hug her.

  6. Scenario 6 - Incompetent practice

    Brian is a registered nurse who provides psychotherapy to Ms. Khan. Brian mentioned to Ms. Khan that massage is a helpful way to help her connect to him as a RN psychotherapist, and to relax into her memories. Brian frequently massaged Ms. Khan’s body during sessions and would end each session with a long hug.

  7. Scenario 7 - Legal versus professional and ethical obligations

    Sam and Amy grew up together and have been friends for many years. They both decided to enter the health profession. Amy became a nurse practitioner and Sam became a doctor. They both work in the same clinic in their hometown and have many common patients.

  8. Scenario 8 - Sexualized comments

    Barrie is a fourth-year nursing student observing a surgical case with Dr. West. One day, Barrie is observing Dr. West perform surgery. While the patient is under general sedation, Dr. West makes sexualized comments about the patient’s breasts and then fondles them. Barrie is disturbed by what he sees. He knows he should do something but isn’t sure how proceed.

  9. Scenario 9 - Professionalism and language

    Heather, a registered nurse working in an emergency department, examines a male patient who presents with chest pain. Heather asks the patient about his sexual orientation and if he is sexually active. The patient appears to be uncomfortable and says that he has a boyfriend.

  10. Scenario 10 - Consent and boundary violation

    Ji, a nurse practitioner, treated Mary for four years. Three years into the nurse-patient relationship, Mary began to discuss her romantic feelings for Ji, usually after hours by email and phone.

  11. Scenario 11 - Colleague’s duty to report

    A nurse, who also offers psychotherapy, often sees adolescents who are struggling with depression or anxiety. The patients are often shy and slow to open up. The nurse wants to ‘put them at ease’ and so makes a lot of sexualized jokes and comments.

  12. Scenario 12 - Determining if a nurse-patient relationship exists

    Rogelio is a nurse practitioner in the only hospital in the region. He becomes friendly with a registered practical nurse (RPN) who works at the hospital. Their interactions have only happened on the ward. He considers asking the RPN out for dinner and decides he will when the opportunity arises. As Rogelio is prepping for a clinic, he sees the RPN’s name on his list of patients to see that day.

  13. Scenario 13 - Determining if a nurse-patient relationship exists

    Leo is a nurse practitioner (NP) working in a rural community health clinic. He heads to the local bar for a drink and sees Kayla. Kayla was a patient of Leo’s the previous year. Leo is interested in dating her and asks her out for dinner