Professional Boundaries in Nursing: Tips for Nurse Leaders

Nurse leaders play a critical role in our health care system, not only promoting patient care but also supporting family members and assisting physicians. Given how integral nurse leaders are, it’s only natural that patients and colleagues alike might start to feel a close bond with them, increasingly turning to nurse leaders not just for clinical assistance but for emotional support. The challenge for nurse leaders is to show empathy and compassion while also facilitating healthy and appropriate relationships. Often, this means putting boundaries in place.

Professional boundaries can help nurses to protect their own privacy and peace of mind while also managing the pressure of their jobs. Professional boundaries in nursing can ultimately support the well-being of patients, who benefit from care by a level-headed, uncompromised medical professional. Nurses may learn how to develop professional boundaries in an online degree program as part of their nursing education, as well as through on-the-job experience.

The notion that nurses need boundaries is nothing new. Many of the most venerated nurse ethics handbooks stipulate the importance of boundaries. For example, the American Nurses Association’s Code of Ethics for Nurses provisions 2.4 and 5.2 — Professional Boundaries and Promotion of Personal Health Safety and Well-Being — both attest to the importance of professional boundaries in nursing. So too does the International Council of Nurses’ Code of Ethics for Nurses provision 2.5.

For nurses, the ability to say no to certain demands on their time and attention, or to step away from situations that have become emotionally or physically taxing, is crucial to their performance. As such, having clear nursing boundaries in place has a number of benefits:

• Nurses who can articulate and enforce boundaries can shield themselves from burnout, recusing themselves from cases or patient needs that push them too far.
• By reducing burnout, nurses can ultimately build resilience, remaining in active practice for longer.
• Boundaries also ensure that patients receive care from nurses who are in a clear-headed, healthy state of mind.
• Professional boundaries can be most meaningful to vulnerable patients, whose confidential health information will be better protected by nurses who are careful to maintain appropriate, professional relationships.

Nurses who wish to set better boundaries with their co-workers should consider these tips and strategies.

• Know your bandwidth. Over time, most nurses develop a pretty clear idea of how much they can take on at once — and what kinds of requests tend to push them over the edge into stress or anxiety. Knowing and clearly articulating these limitations is a crucial first step.
• Use direct language. In speaking with co-workers about boundaries, beating around the bush is never productive. Instead, nurses should be clear and straightforward in articulating their boundaries.
• Limit communication. One of the best ways to place boundaries is for nurses to say that they won’t answer work texts or emails while on vacation or after a certain hour each day. It’s crucial to actually enforce this kind of boundary, consistently rejecting any efforts at contact beyond the appropriate hours.
• Learn to say no. It’s similarly important for nurses to offer a polite, professional but unequivocal no to any requests that are above and beyond core duties or comfort level.
• Address violations. It may sometimes be necessary to speak with co-workers about boundary violations, reminding them of the importance of mutual respect and professionalism.

Professional boundaries in nursing must also exist with patients. Some tips and strategies for nurse leaders include:

• Avoid inappropriate behaviors. Certain patient interactions should be considered taboo at all times. Examples include sharing personal information with patients, exchanging gifts, developing formal relationships with patients, and discussing patients or their care on social media.
• Dress and act appropriately. Nurse leaders should always reinforce the reality that they are trained professionals who are providing patients with highly specialized care and advanced clinical knowledge.
• Avoid sharing personal patient information. It’s also advisable to refrain from discussing a patient’s confidential information with co-workers, except in cases where it’s medically necessary. Nurse leaders may also wish to avoid seeking out patient information, save for on a "need to know" basis.
• Provide patient-centered care. Above all, nurse leaders can maintain appropriate boundaries by always treating patients with dignity and respect and by always putting patient needs above all else.

Nurses who work in positions of leadership, or who have less supervision, must take extra precautions. Regularly stepping back to assess their own behavior can be a critical way to keep professional boundaries in place.

Ultimately, defining and enforcing professional boundaries is an important way for nurse leaders to protect themselves, their practice, and their patients. It can also be a powerful way to set an example for other nurses on the team.

To develop a comprehensive set of nursing skills, including the ability to set boundaries, consider a formal program, such as Hawai‘i Pacific University’s online Master of Science in Nursing to Doctor of Nursing Practice. In HPU’s program, nurses can master the competencies needed to convey professionalism while administering high-quality care. Find out how we can help you become a nurse leader today.