The Case of the Blurred Boundaries
Roxanne, a blood and marrow transplant certified nurse, has been taking care of Jerome, a 20-year-old man diagnosed with acute myeloid leukemia (AML). Jerome is the eldest of seven children; his mother works full-time, and with younger children at home has not been able to make the trip across country to be with her son.
Roxanne feels like Jerome’s surrogate mother and stays after her shift to keep him company and play cards. When Jerome sends her a Facebook friend request, she hesitates but then accepts the request, rationalizing that he needs the extra support. She also considers using social media to raise money to surprise him with a visit from his mother.
What Would You Do?
Supporting people during a health crisis, especially cancer, can be an intimately rewarding experience for oncology nurses. This case, however, demonstrates where the edges of professional boundaries can become blurred and lead to a nurse’s overinvolvement with a particular patient.
The National Council of State Boards of Nursing (https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf) described professional boundaries as “the spaces between the nurse’s power and the client’s vulnerability.” Because patients with cancer often need ongoing care, NCSBN encouraged nurses to carefully assess their relationship with this vulnerable population. To determine whether a nurse-patient relationship is crossing the line, nurses can ask themselves: “Will this intervention be of overall benefit to my patient, or does it satisfy some need in myself?”
In this case study, Roxanne could argue that Jerome is the primary beneficiary of her extra attention. However, after a caring coworker points out that Roxanne has been increasingly lonely since her last child left for college, she recognizes that her overinvolvement is based on filling her own personal need. Roxanne asks the oncology social worker and her supervisor for help in establishing more appropriate boundaries.
Nurses are responsible for developing helpful patient connections, observing professional boundaries, and fostering therapeutic relationships focused on patients’ needs. Figure 1 lists examples of under- and overinvolvement and can help nurses recognize when their actions cross out of the zone of helpfulness (https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf).