Professional Boundaries in Staff-Resident Relationships

Written by Linda Hall, AHI RN Consultant

Residents expect staff to always act in their best interest by respecting their privacy, dignity, and decision-making autonomy. To maintain resident trust, foster a person-centered environment, and avoid breaching Bill of Rights or privacy regulations, staff must interact with residents in a manner consistent with professional boundaries.

In settings where professional boundaries are established and expected, lapses are often unintentional and even viewed as being helpful to a resident or group of residents. A professional boundary is crossed when staff act in a way that results in an unfavorable effect on resident wellbeing. Examples include:

· Sharing resident information with other residents or their family members

· Gossiping about a resident with other team members

· Sharing resident information on social media including photos on Facebook

· Believing you are the only one who truly understands a residents needs

· Showing favoritism for a particular resident/over involvement with one or more residents

· Meeting residents socially when not at work which can lead to a disrupted or complicated professional/work relationship (e.g. Resident- “I thought you were my friend!”)

· Discussing your personal problems with a resident resulting in role reversal

· Discussing your frustrations about your job (e.g. pay, hours, workload, co-workers)

· Serving as a resident’s confidante (e.g. keeping secrets) that as a result negatively affects the resident’s relationships with his/her family or other health care providers

When considering whether an action is a potential boundary violation, ask this question, “Am I serving the resident or attempting to meet my needs or the needs of other residents/interested parties?”

In the end, particularly in reference to a resident’s personal information, it is not up to a team member to decide whether personal information regarding a resident can/should be shared or discussed with other residents or resident families. The source of shared information should always be the resident or resident’s responsible person.

Here are two examples of professional boundary crossing:

Scenario #1

May Smith is a well-known and popular resident in the community. During breakfast, a group of residents realize they haven’t seen May for two days. A CNA, Stella, happens to walk by the table as the residents discuss the possible reasons May is missing. One resident asks Stella about May and why she hasn’t been around. Stella, who feels uncomfortable with the question, but doesn’t want the residents to worry about May says, “May had a pretty bad heart attack two days ago and is in the hospital. I heard she is pretty sick, but I am sure she will be OK.” (Privacy breach)

By sharing information about May, Stella relieved any discomfort she may have felt by not giving the residents an answer to their question and most likely believes she helped the residents by sharing why May has been absent. What really happened is Stella focused on her own need as well as the resident’s needs, not May’s right to privacy. A better way to have handled the situation could have been simply stating, “I know you are concerned about May. While I can’t give you specific details for privacy reasons, I can tell you she is safe.”

Scenario #2

While getting her mail, Olga Swenson asks Lana the concierge whether she wants to join her for dinner. Lana enjoys talking to Olga and misses her own mother who passed away last year. Like her mother, Olga loves flowers, and they often talk about gardening.

When Lana ends her shift, she calls Olga in her apartment and drives her car around to pick Olga up at the front door (could be seen as favoritism). At the restaurant, Lana and Olga order a glass of wine and begin discussing their favorite flowers. As the conversation progresses Olga asks Lana how many tulip bulbs she will plant this year. Lana’s happy demeanor suddenly turns dark as she explains that she won’t be planting any bulbs because she and her husband may need to file bankruptcy because of mounting hospital bills related to her husband’s chronic illness (sharing personal problems).

After a few moments of silence, Olga says, “You are like a daughter to me. I can’t stand the thought of you being unhappy. I want to buy you dinner and give you money to buy some tulip bulbs.” Please tell me more about your husband’s illness. I want to give you support during this difficult time (role reversal).

In this situation, it is not about enjoying conversation with someone and sharing information such as hobbies you enjoy, a child starting school, the trip you just returned from or are planning. It is about the conversation being of interest to the resident and a way to engage the resident in meaningful discussion and activity; it should never be for the purpose of fulfilling a personal need.