Consider the following scenario: It’s a hectic day in the Emergency Room (ER) and the nurses are short-staffed. A patient with a history of drug seeking is omitted to the ER and demands a narcotic to ease his back pain. The nurse who is taking care of him is irritated and yells at the patient stating, “you’re nothing but a drug addict!” The nurse administers the drug but continues to be rude and condescending. When the nurse gets off her shift, she feels she needs to vent about her day and calls a fellow co-worker.
Although the nurse names no names, she makes it obvious who the patient is. She continues to vent about how the majority of society drug seeks and believes that people who ask for a narcotic aren’t really in pain. The next day, the nurse’s supervisor calls and fires the nurse for unprofessional conduct towards a patient and for discussing private patient information to a fellow co-worker. The nurse doesn’t hold herself accountable, believing she was harmless when yelling at the patient, because she still gave the pain medication anyway. She then calls the coworker and blames them for getting her fired. Obviously, this nurse had no training and a lack of education in professional boundaries. This scenario is a general example that could affect any nurse that breaches his or her professional boundaries, because there will be situations where nurses may be understaffed, a patient may be drug-seeking, and where a nurse wants to vent about their day. However, it is how the nurse conducts his or her self that is critical to maintaining professionalism and accountability in coping with such situations. According to the American Nurses Association, professionalism is defined as accountability that is rooted to an ethical and moral principle. This adheres to a nurse taking responsibility, as well as, respecting self-determination of the patient (Black, 2015).
Thus, to reserve professionalism, what the nurse should have done was communicate with the supervisor from the start that the unit was understaffed, as well as, build a rapport with the patient, specifically in relations to the patient’s pain. Also, she should have maintained self-awareness to allow for unbiased attitudes, especially in regard to discussing private information to a fellow co-worker, which should have been avoided. By following the first step in communication, the nurse could have prevented the aftermath from the beginning. I believe being a good communicator is critical when it comes to any tension in the workplace, especially in the healthcare environment because it motivates staff and builds a team working experience. Furthermore, professional boundaries set the tone between the nurse and patient communication. For example, in the scenario, the nurse over-stepped her professional boundaries by yelling at the patient due to an under-involvement in patient care, biases, and neglected patient communication.
Conversing with the patient is an integral part of the nurse-patient relationship and is acknowledged as a therapeutic process that can alleviate vulnerabilities of the patient (Black, 2015). Therefore, if such a situation were to arise, I would first converse with staff, avoid stereotypical ideas, and build rapport centered around the patient, so that he or she could feel less vulnerable. Pain is subjective and ineffective pain management happens more often than not, especially for those patients who have debilitating diseases with a high tolerance to pain. Every individual experience pain and some more than others can be highly sensitive to its effects on the body. I understand that this can be a challenge in the clinical setting when assessing pain, but by focusing on individual differences, pain magnitude can be backed up by the patient’s health history. Incidentally, communication is key, thus inter-personal relationships with fellow colleagues involved in the patient’s care can support a better accurate assessment for a patient’s pain. This includes having the patient involved in treatment options and having the health care professionals do a continuous follow-up to better manage pain in the future (Glowacki, 2015); thus, these effective pain strategies can improve patient outcome and satisfaction in pain relief. When a nurse is self-aware, the nurse is able to recognize their own emotions, beliefs, and biases and how they are discerned by others (Black, 2017). I have confidence that self-awareness is one of the most important things that a nurse can attain through their profession. This type of realization comes with practice and can be mastered over time, but if it is not considered, it can be a loss of professionalism when dealing with the care of patients. This can relate to basic patient care, as well as, keeping information about that patient private.
As a nursing student, it can be difficult in realizing my personal challenges that I may have as a nurse, but by starting early on basic reflective practices, I believe I’ll overcome any obstacles that relate to patient care and privacy. More importantly, it is critical to avoid stereotyping and to attain non-judgmental acceptance as a nurse. In the scenario, the nurse lacked this which became her overall downfall. According to the National Council of State Boards of Nursing (2018), the nurse must examine when they feel that they are crossing a boundary with the patient, they must consider the potential implications and avoid any violations in the future. Again, knowing one’s own beliefs and realizing any potential outcomes if professionalism isn’t followed through, is of most importance.
Overall, if situations arise where professional boundaries are tested, I consider values such as positive communication with fellow team members to be the first go-to in a problematic situation. More importantly, building a good rapport with one’s patients is obligatory for any health care worker, because this is the groundwork for building trust with the patient, as well as, making sense of their chief complaint. Lastly, maintaining a self-awareness is imperative and I regard it as the answer to being unbiased and non-judgmental in respects to all people.
