When does a nurse-patient relationship cross the line?

I’m a medical-surgical nurse at a large urban hospital. Five days ago, I was assigned as the primary care nurse for a patient—let’s call him Dan—who’s recovering from injuries caused by a motor vehicle accident. He’s a 45-year-old personal injury attorney, good-looking, with a great sense of humor.

In the last 2 days, he has made it clear he’s attracted to me—and the feeling is mutual. Today, he asked if I’d have dinner with him after his discharge. He also offered me a part-time job working as a legal nurse consultant (LNC) in his law office, and said he’d pay the $3,500 tuition for the 4-week LNC training program.

Is it wrong for me to even consider dating him? We’re both single and seem to share a lot of interests. Still, I have this nagging feeling I’d be crossing an ethical line if I got involved with him romantically, accepted tuition money from him, or went to work for him.

Should I request an immediate transfer to a different unit so I can date him now? Or should I try to keep things on a professional-only basis for the time being, saying “no” to a date but accepting his offer to pay my tuition? Or should I play it safe and wait until a few weeks after his discharge before considering taking our relationship beyond that of nurse and patient?

— C.W., BSN, RN

The act of providing nursing care may sometimes seem to confer an intimacy with a patient—and this may foster feelings that go beyond the professional.

However, as a nurse, you’re obligated to keep your relationships with patients strictly professional. The nurse-patient relationship is a professional one; it shouldn’t be used as a springboard for a personal, romantic, business, or financial involvement. Dating Dan would be legally and ethically improper. Transferring to a different unit wouldn’t change the underlying issues or remedy the situation; you’d still be bound by nursing ethics.

Being clear about boundaries
As a licensed healthcare professional, you’re responsible for establishing and maintaining professional boundaries with patients. Failing to do so can be disastrous. State nurse practice acts, state board of nursing regulations, and in many cases both, require nurses to practice according to the standards of safe nursing practice and to make patient safety a priority. Also, many employers have codes of ethics or policies that address nurse-patient boundaries. Suspicion of boundary violations can spur an employer’s internal investigation or a disciplinary investigation by the state nursing board.

Unlike a friendship, which may evolve over several months or years, the nurse-patient relationship develops in the context of care provided to the patient and ends once the nursing care plan goals have been met or the patient is discharged. Even when a nurse provides care to the same patient over several months or years, as in a home care or long-term care setting, the nurse-patient relationship is structured. The relationship ends when the therapeutic relationship ends.

Power position
In the nurse-patient relationship, the nurse holds a position of power and authority. Patients trust and respect us. They look to us for care and comfort during what’s often a highly stressful time, when they may be vulnerable and more susceptible to influence. Professional boundaries exist to protect them.

Romantic and business involvements with patients aren’t the only types of boundary taboos for nurses. Others include:

  • accepting money or gifts from patients
  • giving money or gifts to patients
  • having social contact with former patients
  • getting too involved in a patient’s personal affairs
  • buying real property or personal property from patients or selling such property to them
  • developing a multifaceted relationship (such as a combination of business, personal, sexual, or financial) with a patient.

Cooling things off
Waiting a few weeks after Dan’s discharge before dating him would not be “playing it safe” because that’s too soon after his discharge. Review your state nurse practice act and board of nursing regulations to determine if these require you to establish a cooling-off period—a defined interval after the professional relationship ends—before you can initiate a personal or business relationship with a patient. But even if your state’s nurse practice act and board of nursing regulations address the professional boundary issue but don’t specifically stipulate a cooling-off period, a cooling-off period may be implied. Depending on circumstances, a reasonable cooling-off period is at least 1 year after the nurse-patient relationship ends or the patient is discharged.

Detaching from Dan
If you’re in doubt as to how to interpret nursing law, ethics, and professional practice standards, consult a legal expert. In the meantime, the American Nurses Association’s Code of Ethics for Nurses requires that you promptly remove yourself from serving as Dan’s nurse. Speak with your nurse-manager about the situation and ask that Dan’s care be transferred to another nurse.

One more thing: If you decide to pursue a personal relationship with Dan after waiting out the cooling-off period, think twice before letting him pay your tuition or working as his LNC. Being romantically involved with your employer (if that’s what he ultimately becomes) can lead to a host of ethical and legal dilemmas.

— LaTonia Denise Wright,
BSN, RN, JD
Attorney at Law
Home health nurse (per diem)
Cincinnati, Ohio

The information above does not constitute legal advice. For a complete list of selected references, see June 2007 references.

 American Nurse Today would like to thank Nancy Brent, MS, RN, JD, and LaTonia Denise Wright, BSN, RN, JD, cochairs of the Publication and Products Committee of the American Association of Nurse Attorneys, for organizing and coordinating this article.

9 COMMENTS

  1. Does anybody know who to contact or how to report a wound therapist at a hospital who broke the patient/physician realationship oath..by making advance towards me and ending out in some sexual contact…i was told this wouldnt be a problame by the nurse and asked me to sign a paper removing me from her care before we started flirting but i said no that the medical part of this was more important then the relationship she wanted so i didnt sign and then she continued and told me not to worry bout the paper and we couldnt get into any trouble…turns out her boss foind out bout rumors and she got worried discontinued me as a patient and and sent me a text saying i couldnt come back to the facilities cause she could loss her job ive been going to this lady for 22 years and she promised this wouldnt happen and it did she shouldnt get off scot free while i currently dont have a wound therapist i can trust cause of this any suggestions…

  2. My wife just started an affair with a patient that she was taking care of for about 2.5 months. The day he was released they met up and shes been with him every other day. On the weekends and rubbing it in my face. We have a family and I am an emotional wreck. Of course the kids don’t know about it, nor any friends or family. I love my wife and my family but feel I may lost my wife and family to this guy she doesn’t really even know. I am praying that she wakes up and realizes it was a huge mistake but everyday it gets a little harder.

  3. I like that you said that nursing regulations consist of making patients as their priority. my sister told me that she wanted to find a certified nurse that could help her with her mother in law. Thank you for sharing the benefits of a certified nurse.

  4. The nurses have a responsibility toward their patients. If there is no boundary and law, and if a nurse-patient relationship is allowed to cross the line, there will be chaos in a facility. In these scenario, the medical unit will be like a dating site because nurses will be in competition for dating the handsome and rich patients.

  5. Does anyone have actual evidence on what is and is not acceptable at this point. Is it state or facility choice? At what point is this person not your patient since they’ve be D/C and as a friend you continue your relationship?

  6. I’m not a nurse, I’m a Medical Assistant. I met my current husband in a local Family Practice office where I was working while he was a patient. We began dating after the PA-C I worked with (one of a couple of providers), whom he was a patient of exchanged our contact info. After 2 weeks of dating, we found out we had gone to preschool together. At that point, we both felt it was some form of fate that brought us together, however unethical the start of our relationship was. I moved on from that clinic and have been working at an unaffiliated practice for almost 14 years (5 months after we started dating). We’ve now been happily married for 13 years. I’m not sure if there’s a statute of limitations, but I posted our love story as a comment to a local news story about preschool sweethearts marrying, and was immediately met with a comment from one “gentleman” saying I should have my credentials revoked. He then went on to say that he wasn’t going to report me, but I’d feel better about my position if I knew that any legal actions were beyond any statute. Can anyone answer this for me? Should I be worried?? I live in Washington state.

  7. I feel that a nurse should be allowed to keep contact with a patient at least 6 months after nurse patient interaction especially if the nurse has played an important role in the patients life.

  8. I think after discharge a relationship should be acceptable to pursue but not at all under the patient care circumstances it is too controversial and could cause lawsuits if it didn’t go well it is difficult to find a special person and we do need to take the opportunity where it arises but the logistics behind dating someone at the time you’re treating them is a dangerous idea.

  9. I believe there is no rules for a patient dating with their nurse it is racial and people should chose who to date in America in God’s eyes that is not a sin this rule should be excluded from the American Association nurse we patients s h would fight this rule and pass where patients and nurses can date who ever they please

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