I’m an RN on a mental health unit. At home, I keep in touch with family and friends through Facebook. Recently, a client “poked” me and invited me to become her “friend.” Would communicating with a client on Facebook be considered a violation of the nurse-client relationship?
Yes. Corresponding with a client on a social-networking website such as Facebook is crossing a professional boundary.
In the therapeutic nurse-client relationship, a boundary is the point at which the relationship changes from professional and therapeutic to unprofessional and personal. It is the nurse’s responsibility to set and maintain the boundaries within the therapeutic relationship. To that end, it is up to the nurse to help clients understand when their requests are beyond professional limits.
A nurse must abstain from disclosing personal information to clients. If a nurse discloses a personal problem, for example, then the client may feel as if his or her problems or feelings are being diminished, or the client may feel the need to help the nurse. Self-disclosure should only be considered in the rare instance when it meets a client’s articulated therapeutic need (e.g., when a child is in the hospital and the parent asks the nurse if she or he has any children).
The health care team develops strategies to promote the health and well-being of the client, not to meet the needs of the nurse. If a professional boundary is crossed, then it means the care provider is misusing the power in the relationship to meet her or his personal needs, or behaving in an unprofessional manner with the client. The misuse of power does not have to be intentional to be considered a boundary crossing.
I’m an NP who practices in a primary health care clinic. I have a personal Facebook page that I use to share photos of my new baby with my family and friends. Today, a client visited my Facebook page and sent me a “friend” request. Can I accept the request?
No. A nurse should not enter into a friendship or other personal relationship with a client. The focus of the nurse-client relationship must remain professional at all times.
Nurses are responsible for setting and maintaining appropriate boundaries in the therapeutic relationship and helping clients understand when their requests are beyond the limits of that relationship. You should explain to the client that you have a nurse-client relationship, not a social or personal relationship.
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