Overview of the Event
The event is that I was asked, as a student nurse, to continue the medication round without supervision – which is a breach of professional boundaries, as all medication rounds as a student need to be supervised. Professional boundaries provide structure and clarity in relationships between patients and healthcare providers, which is an essential ethical consideration in nursing care. Appropriately, appropriate boundaries are adhered to protect the patient and the healthcare provider. As such, I declined to continue the medication round unsupervised.
Professional boundaries relate to the relationship between healthcare professionals and their patients or clients. They establish expectations of behavior regarding communication, physical contact, clinical decision-making, setting limits on services provided by healthcare providers, and other related aspects of patient care (Mitchell & Pearce, 2021). The principles of professional boundaries include respect for autonomy; maintaining personal distancing, and establishing well-organized deleaion (Gorski et al., 2021). Moreover, avoiding exploitation, promoting safety; providing adequate information about services being provided, protecting patient privacy, and providing appropriate referrals for assistance if needed are vital (Nursing and Midwifery Council, 2023). Professional boundaries must be respected by healthcare providers who work with vulnerable populations such as children and people with disabilities.
Reflection Using Borton’s Reflective Cycle
What?
I must recognize inherent risks if I disregard the NMC Code of Conduct guidelines. In this situation, I was presented with an ethical dilemma: to either comply with the request or to stand by my professional boundaries and refuse to continue the medication round without supervision. Ultimately, I found it necessary to decline the request and suggest another qualified clinician supervise the medication round.
So What?
The implications of breaching a professional boundary can be far-reaching and severe. Firstly, there is a direct effect on patient safety and well-being; if medications are administered incorrectly or without supervision, this could lead to adverse impacts or even injury (Montgomery, 2020). Furthermore, there is the potential for legal repercussions; depending on the severity of the breach and any associated consequences, a practitioner may face disciplinary action from their employer or educational institution.
Aside from these practical implications, there is an impact on professional reputation and trustworthiness. Suppose a nurse fails to adhere to professional boundaries on multiple occasions. In that case, this could have long-term ramifications for their career as they may be seen as unreliable or untrustworthy by their peers or colleagues. The attittude towards colleagues and patients’ personal borders is the revelation of ethical principles of a specialist (Nursing and Midwifery Council emergency procedures, 2020). In addition, it can seriously compromise the public’s confidence in healthcare professionals; if people feel that nurses are not taking proper care when dealing with vulnerable individuals, they may be less likely to seek help or advice from these services in the future.
Now What?
To ensure compliance with professional standards and uphold the NMC Code of Conduct, nurses must make changes to their future practice. Nurses must understand the expectations in the Code, so they can act accordingly when providing care (Devlin, 2022). This includes being aware of potential risks associated with specific scenarios and taking steps to mitigate them. For example, nurses should always supervise or double-check their work for accuracy and safety when administering medications.
Nurses should also establish clear professional boundaries with their patients. This involves setting clear expectations of appropriate behavior and maintaining good communication throughout all interactions (Evans et al., 2020). Physical contact should only be offered when necessary and explicitly agreed upon; it should never be assumed that it is alright without consent from the patient or guardian (Jones et al., 2021). Additionally, research note that confidentiality should be preserved at all times; conversations between a nurse and patient should stay private unless there is a risk of harm to either party. Furthermore, nursing students need guidance on maintaining professional boundaries in clinical settings (Evans et al., 2019). They should receive support from educators and mentors in developing an understanding of these boundaries and how best to adhere to them during practice (Chan, 2019). This could include role-play activities designed to help students recognize elements of unprofessional conduct before they are exposed to real-life scenarios where such behavior may arise.
Finally, nurses must have access to resources that clarify acceptable standards of practice to remain up-to-date with current regulations. Reiff et al.’s (2022) research state that regular training sessions or seminars should focus on critical professional conduct and boundary maintenance. By ensuring they are familiar with the NMC Code of Conduct, nurses can feel confident that they are upholding their duty of care appropriately and protecting themselves and their patients against any potential harm or injury-related breaches of boundary protocols.
Summary
In conclusion, nurses must ensure they always adhere to appropriate professional boundaries when interacting with patients and colleagues by understanding the NMC Code of Conduct and any other local regulations regarding practice behavior and being aware of any potential risks associated with specific scenarios. Nurses must make changes to their future practice by becoming familiar with expectations set out in the Code, setting clear professional boundaries with their patients, receiving support from educators on developing an understanding of these boundaries, and having access to resources that clarify acceptable standards of practice. Thus, nurses will maintain a high standard of care for themselves and their patients while upholding the NMC code of conduct.
Reference List
Chan, C. (2019) ‘Crossing institutional borders: Exploring pre-service teacher education partnerships through the lens of border theory.’ Teaching and Teacher Education, 86, p.102893.
Devlin, B. (2022) ‘Registered Nurses’ experiences of working within professional and contractual boundaries: A Grounded Theory study.’ chesterrep.openrepository.com. [online] Web.
Evans, K., Nizette, D., O’Brien, A. and Johnson, K. (2019) Psychiatric and mental health nursing in the UK. [online] Elsevier. Web.
Evans, C., Pearce, R., Greaves, S. and Blake, H. (2020) ‘Advanced clinical practitioners in primary care in the UK: a qualitative study of workforce transformation.’ International Journal of Environmental Research and Public Health, [online] 17(12), p.4500.
Gorski, L.A. et al. (2021) ‘Infusion Therapy Standards of Practice, 8th Edition.’ Journal of Infusion Nursing, 44(Supplement 1), pp.S1–S224.
Jones, L.A. et al. (2021) ‘Public opinion on sharing data from UK health services for clinical and research purposes without explicit consent.’ BMJ Open, 12.
Mitchell, A. and Pearce, R. (2021) ‘Prescribing practice: an overview of the principles.’ British Journal of Nursing, 30(17), pp.1016–1022.
Montgomery, A.J. (2020). Well-being, patient safety and organizational change: quo vadis? In Connecting healthcare worker well-being, patient safety and organisational change, pp.345–350. Springer International Publishing.
Nursing and Midwifery Council (2018). The Code: Professional Standards of Practice and Behaviour for nurses, Midwives and Nursing Associates. [online] Nmc.org.uk. Web.
Nursing and Midwifery Council emergency procedures (2020). London: Hachette.
Reiff, M. et al. (2022) ‘From role-play to real life: using gatekeeper skills in real-world situations.’ Journal of College Student Psychotherapy, pp.1–30.