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Professional Boundaries Between Patients and NPs

Posted Nov 06 2010 5:54pm
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Being a professional health care provider comes with many pros and cons. The Pros include the ability to diagnose and treat my own patients, a great salary, and personal satisfaction that I have made a difference in someone’s life.

Unfortunately, there are also cons. Personal boundaries is one that I think many of us worry about. I have several Grandparents that are raising their grandchildren due to their own children’s inability to care for them due to drug habits. These grandchildren are often very difficult to manage and often have drug habits of their own. One particular patient has decided that she doesn’t feel it’s necessary to help around the house and in the garden (which most of their food comes from) because she would rather live with her 18 year old boyfriend and his mother. She has been warned by local authorities that she could be sent back into foster care and separated from her brother if she won’t behave.
She feels like the grandparents are not being fair to her due to the boyfriend’s ethnic background. The grandma says it’s because of the sneaking around and lying. The good thing is that she does well in school and hasn’t skipped much this year.

Okay..my quandary is this…when the girl is sitting in front of me in the office and has not one iota of an idea just how good she has it and is deliberately being stubborn, how do I keep from wanting to jerk her off the table and slap the mess out of her and make her behave.
Before you all go into a tizzy… No, I wouldn’t ever really do that, but you would be lying to yourselves if you didn’t have situations where you felt like becoming “a real person again” and not restricted by our professional boundaries. Even being a real person is much more worrisome when it comes to being physical. You can’t spank a child or even really yell for fear of DCF coming to call and removing the kids for child abuse. I think the good old days need to come back. I never believed in beating a child, but a good old fashioned spanking in a controlled manner never hurt me. It sure made me think twice about making poor decisions.

In order to try to help people make better choices, what does a health care provider say that really make a difference? How much is too much information from either side of the spectrum? Patients will often tell me things that I cannot change for them and it gets frustrating. How much information about one’s own background is too much when trying to help others maintain the right road in life? Physicians are trained that one must always keep a very strict line between the patients and themselves. Nurses are supposed to do that too. I believe that nurses are more holistic and will be more apt to disclose more personal background than physicians. Why? I personally think it’s because we are mostly women, wives and mothers who “have been there and done that” a few times in their lives. Sorry about being a little sexist but men don’t really share themselves with strangers. I wonder what female physicians do in these cases and are they any different in their disclosures than male docs or male nurses?

What say you?

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