Unfortunately, setting boundaries isn't straightforward. The Code of Ethics for Nurses states, "When acting within one's role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships."4 The familiarity and trust that develop between a nurse and a patient, combined with the seductive pull of helping, the complexity of the patient's treatment needs, the dependence of vulnerable patients (such as pediatric patients), and a general lack of understanding of boundary theory, can threaten the integrity of the relationship and lead to boundary violations.5 Male and female nurses alike can be influenced by emotions during patient encounters, leading them to perceive that interactions may have a deeper meaning.

Noticing that the patient is very upset, the nurse sits on his bed and holds his hand, saying, "You seem upset. I'll be okay." She says, "I'm here if you need me," and then leaves.

Can the nurse's behavior be considered inappropriate? A nurse giving a patient a quick hug that's not seductive can be interpreted as a sign of compassion.

According to the National Council of State Boards of Nursing (NCSBN), professional boundaries are "the spaces between the nurse's power and the client's vulnerability."2 In relationships with any level of comfort and closeness, boundaries are needed to separate individuals appropriately.

According to Baca, professional boundaries support key elements of the nurse practitioner-patient relationship: trust, compassion, mutual respect, and empathy; these elements are needed in the nurse-patient relationship as well.3 Boundaries also serve to keep lines of communication open and let patients and nurses interact in a professional atmosphere.

Using touch as a therapeutic agent is another gray area.

(See A female nurse enters a male patient's room just after the healthcare provider has informed him that he has lung cancer. He stops crying after a few minutes, saying, "I just didn't expect that.

Minor boundary crossings are generally acceptable when performed for a patient's well-being, such as asking an older patient about his or her home environment before discharge.

But seemingly trivial boundary crossings sometimes lead to more troublesome unprofessional behaviors.

In 2009, the NCSBN reported that of those nurses who were disciplined within a 10-year period, less than 1% were disciplined for sexual misconduct.6 However, the actual number of nurses involved in sexual misconduct is potentially greater than this due to underreporting.