It’s more important than ever to be aware of professional boundaries.
On April 1, 2019, amendments to the Health Professions Act (HPA) to protect Albertans from sexual abuse and sexual misconduct when accessing health services are coming in to effect. These amendments establish mandatory penalties for sexual abuse and sexual misconduct by all regulated health professionals. CARNA is finalizing new standards to clearly define a “patient” within the context of sexual abuse and sexual misconduct, and outline expectations for the nurse in the therapeutic and professional relationship.
HPA does not make a distinction between workplace or ‘after hours’ settings when referring to the nurse-patient relationship. It’s important to understand that the professional position of a nurse and their access to private information puts the registered nurse in a position of power. The obligation of maintaining professional boundaries lies with the nurse, not the patient.
Factors which may contribute to determining if an individual is considered a nurse’s patient are:
In the context of sexual abuse and sexual misconduct an individual is not considered to be a “patient” if the nurse is their spouse, adult interdependent partner or if they are in an ongoing, pre-existing sexual relationship with the nurse. If this type of relationship exists, a nurse should only provide health services if:
An individual is considered to be a patient for one-year period after a health service was provided by the nurse. This means a nurse must not engage in a sexual relationship for a minimum of one year after the last clinical encounter.
In some circumstances, sexual conduct may still be considered inappropriate even after the one-year period. These factors should be considered:
Episodic care may occur when the nurse provides care to a patient in a single encounter for a defined health care need and there is no expectation of continuing care or continuation of the nurse-patient relationship. While a nurse-patient relationship is formed in these situations, the individual is not considered to be a patient after the completion of the episodic care. However, sexual conduct at any time after the conclusion of episodic care may still be considered inappropriate if there is a risk of an ongoing power imbalance.
It is NEVER appropriate for a nurse to engage in a sexual relationship with a former patient they provided psychotherapeutic treatment.