Question:
Dear Nancy,
I work with an APN who specializes in psychiatric nursing and adult nursing. He has prescriptive authority. Recently, he took a female client as a date to a co-worker's wedding. Even though he is not this patient's counselor, is it a boundary violation to knowingly date a client of a co-worker in a psychiatric setting? If he is writing this patient's prescriptions, does that automatically qualify her as his patient? What if they were dating before she came to the clinic, and how does that affect the prescription-writing aspect of this scenario?
I am afraid to confront him with this as he is a clinic director and co-owner of two of the six sites. He was sued by another patient a few years back and settled out of court. The past lawsuit involved a sexual relationship with a patient. I know he is involved in a divorce right now due to this current relationship. I would like to know where I stand before I talk to his superior because I am sure it will mean my job.
Rose
Dear Nancy replies:
Dear Rose,
The APN you work with who is conducting himself in this manner has a serious problem with professional boundary issues. Although there may be more to the current relationship between this patient and the APN, such as dating before she became a patient at the clinic, his conduct is
not acceptable.
Resources that may be helpful to you in evaluating how to handle this situation are: the National Council of State Boards of Nursing's publication "Professional Boundaries: A Nurse's Guide To The Importance Of Appropriate Professional Boundaries" available on the Council's website at www.ncsbn.org (click on "NCSBN" then "Brochures" in the drop-down menu) and the American Nurses Association's "Code of Ethics For Nurses With Interpretive Statements" available on the association's website: www.nursingworld.org (click on "Ethics" for the drop-down menu that includes the Code and other resources).
If you are concerned about speaking with the APN's superior, you might want to try another route. Sharing your concerns confidentially with your immediate superior and/or the CNO should be a safer way to express your misgivings. They most likely would be able to handle the matter without getting you directly involved. Either or both can then speak to the APN's superior after they investigate and evaluate the full range of the APN's behavior.
It would be hoped that after obtaining the facts concerning this person's conduct, they would take appropriate action, such as counseling him, terminating him and/or reporting him to the board
of nursing.
You also could report the APN to the board of nursing for its review, but you need to be certain that you do so with only the facts concerning his behavior. Such reports are usually handled in a confidential manner by the board. The board can take over the investigation and determine how it will handle this APN's conduct once its investigation is complete.
Cordially,
Nancy
