Professional Boundaries: Guidelines for the Nurse-Client Relationship

Healthy professional boundaries keep the nurse-client relationship safe and respectful. Professional boundaries separate therapeutic behaviour of the nurse from any behaviour which, well-intended or not, could decrease the benefit of care. These guidelines define the professional boundaries that result in a therapeutic relationship between a nurse and the client. Nurses in all domains of practice, whether they are an employee or a volunteer, must recognize the importance of professional boundaries for the nurse-client relationship and the differences between a therapeutic relationship and a non-therapeutic relationship. This is applicable in all practice settings.

The purpose of this document is to:

• define professional boundaries for the nurse;
• outline expectations for appropriate therapeutic relationships with clients; and
• identify the actions to take when a colleague is exhibiting signs of a boundary violation.

These guidelines are grounded in the ethical responsibilities in the Canadian Nurses Association’s (CNA) Code of Ethics for Registered Nurses (2017) and the concepts, principles, directions, and guidance align with the following College of Registered Nurses of Alberta (CRNA) documents:

• Practice Standards for Registrants (2023)
• Entry-Level Competencies for the Practice of Registered Nurses (2022a)
• Protection of Patients from Sexual Abuse and Sexual Misconduct Standards (2022b)
• Social Media and e-Professionalism: Guidelines for Nurses (College of Licensed Practical Nurses of Alberta [CLPNA], CRNA, & College of Registered Psychiatric Nurses of Alberta [CRPNA], 2021)

Amendments to the Health Professions Act (HPA, 2000) in April 2019 increased sanctions for registrants when there is a finding of sexual abuse or sexual misconduct. The CRNA document Protection of Patients from Sexual Abuse and Sexual Misconduct Standards (2022b) outlines the expectations for the nurse and their relationship with a patient that strengthens the protection of patients from sexual abuse and sexual misconduct by nurses.