Scenario 12 - Determining if a nurse-patient relationship exists
Rogelio is a nurse practitioner in the only hospital in the region. He becomes friendly with a registered practical nurse (RPN) who works at the hospital. Their interactions have only happened on the ward. He considers asking the RPN out for dinner and decides he will when the opportunity arises. As Rogelio is prepping for a clinic, he sees the RPN’s name on his list of patients to see that day.
About a week after seeing her as a patient in the clinic, Rogelio sees the RPN in the nurses’ lounge. He decides to ask her if she would be interested in having dinner with him on Saturday night. She agrees and after having such a lovely time together, they start dating and commence a sexual relationship. She continues to be a patient at the hospital, seeing Rogelio. This means there are times when Rogelio participates in appointments and he is well-acquainted with her chart.
Questions for discussion
- Should seeing the nurse’s name on the list of patients be cause for concern for Rogelio? Why or why not?
- Was it okay to ask the nurse out, seeing as she agreed?
- Has Rogelio violated a professional boundary? If so, which and in what way? Why?
- If Rogelio approached you as a peer seeking guidance or advice, what would you say to Rogelio?
Key concepts this scenario illustrates:
- Practicing in a small rural town
- Determining if a patient-nurse relationship exists
- Harm to patients
At first the RPN and Rogelio are simply friendly acquaintances, but by treating her, he is entering a nurse-patient relationship with her. She is no longer simply a colleague. Rogelio has different legal and professional obligations to the RPN now that she is his patient.
As described in the Therapeutic Nurse-Client Relationship practice standard, a nurse-patient relationship is established when there is an interaction between a patient and nurse. This is regardless of the context and length of interaction. For example, a nurse-patient relationship is established during a five-minute triage assessment in an emergency room, and when working as the primary nurse on a chronic care in-patient unit.
By deciding to ask the RPN out after seeing her as a patient, then going on a date and entering into a personal relationship with her, Rogelio violated the professional boundary that exists between nurses and patients. This boundary must exist because of the inherent power imbalance that favours the nurse when a person becomes a patient. As a patient, the RPN provides him with sensitive information and may allow him to conduct intimate examinations. This requires trust between the patient and the nurse. Rogelio’s access to her personal health information and participation in her ongoing care puts him in a position of authority over her.
When they entered into a sexual relationship (which includes remarks of a sexual nature and kissing or touching of a sexual nature), Rogelio engaged in sexual abuse of a patient because of the concurrent nurse-patient and sexual relationship.
A nurse’s certificate of registration with CNO may be revoked if they are found to have sexually abused a patient.
Rogelio should not have entered into a personal and sexual relationship with the nurse while she was still his patient. If Rogelio approached you for advice, you are expected to make it clear that he should not engage the RPN in a personal and sexual relationship while she is a patient.