Key messages from the case

Boundary breaches do not necessarily involve sexual behaviour. Blurring of boundaries is often problematic because it involves a loss of objectivity. It can cause psychological harm and interfere with patients’ medical care. Boundary breaches will be treated particularly seriously where patients are vulnerable, for example because of their age or the nature of their illness. A case involving a psychiatric nurse and two young patients illustrates the concerns.

Details of the decision

Boundary breaches

Ms C admitted breaching professional boundaries with two patients (aged 18 and 20) while she was employed as a nurse at a private psychiatric hospital. The patients were being treated for mental health issues and drug addiction. Ms C admitted to communicating with the patients by Snapchat, mobile telephone and text outside of their treatment at the hospital. She also took them camping with her and her then partner for two nights.

Unauthorised supply of medication

Ms C also admitted giving the patients access to Schedule 4 medications, which she had misappropriated from the clinic. She also admitted purchasing cannabis from the brother of one of the patients and sharing it with the patient.

Outcome

Ms C admitted her behaviour constituted professional misconduct.

The tribunal acknowledged that Ms C had lost her job and had been unable to work as a registered nurse. The tribunal accepted that Ms C’s personal health and wellbeing issues had contributed to her poor decision-making and that she had since sought treatment and support for these. She demonstrated insight into her behaviours and the fact that they had put the patients at risk.

Ms C was reprimanded, and her registration suspended for 18 months.

Conditions were imposed including mentoring, education on ethics and professional boundaries, prohibition on non-clinical communication with patients.

Key lessons

It is essential that health care practitioners establish clear boundaries with all patients and ensure that communication with patients is conducted within a clinical context.

Aim to keep your social and professional lives separate and wherever possible avoid connecting with patients socially or via social media.

Avoid providing treatment to family members and anyone with whom you have a close personal relationship except in an emergency.

Pay attention to your own stress levels and risks. Be aware of issues that may make you more vulnerable to boundary breaches – for example, illness, relationship problems, personal or professional isolation or unusual stresses.

References and further reading

Avant factsheet – Boundary issues

Avant factsheet – Treating family members, friends or staff

Avant factsheet – Social media for doctors - keeping it professional

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