Scenario 10 - Consent and boundary violation
Ji, a nurse practitioner, treated Mary for four years. Three years into the nurse-patient relationship, Mary began to discuss her romantic feelings for Ji, usually after hours by email and phone.
Mary felt the two women had ‘something special’. They began to date and started a sexual relationship. Within a year, the relationship fell apart and Mary stopped her treatment with Ji. She later filed a complaint with CNO alleging Ji withheld medications after their relationship ended.
Questions for discussion
- Did Ji sexually abuse Mary? Explain your answer.
- What should have Ji done when Mary started expressing her feelings, and making sexual advances?
- Does it matter that Mary was the one who initiated the relationship, and that she and Ji had a consensual sexual relationship? Why or why not?
- What was the first boundary violation in this case?
- What could Ji have done earlier on to re-establish professional boundaries before it progressed to sexual abuse?
- How might the CNO respond when presented with a complaint like this?
Key concepts this scenario illustrates:
- Boundary violation that led to sexual abuse
This case shows a pattern of boundary crossings and violations. Ultimately this situation is sexual abuse. Sexual abuse occurs when there is a concurrent therapeutic relationship and sexual relationship between a nurse and patient. It is also sexual abuse, if a sexual relationship between a nurse and a patient occurs within the year after the therapeutic relationship ends.
Mary is a patient of Ji’s. Even though Mary consented to a sexual relationship, this consent is irrelevant. Ji missed repeated opportunities to re-establish appropriate boundaries with Mary. Instead, Ji let Mary continue to express her feelings through email or by phone after office hours. Each time Mary did so, Ji should have paused, reflected and put a stop to Mary’s advances. If Ji couldn’t or if the nurse-patient relationship was no longer tenable, she should have supported Mary finding another health care provider who could care for her in accordance with CNO’s Therapeutic Nurse-Patient Relationship standard.
CNO has a legal obligation to follow-up on every complaint it receives. Mary’s complaint about Ji was in regards to prescribing practices and not sexual abuse. However, Ji’s relationship with Mary would likely result in an investigation of sexual abuse being brought against Ji. If found guilty of sexually abuse, Ji could have her CNO certificate of registration revoked. This is because sexual abuse occurs when a nurse engages in sexual relations with a patient, touches a patient in a sexual way and/or engages in behaviour or makes remarks that are sexual in nature. It doesn’t matter that the sexual relationship was consensual, nor does it matter who initiated it.