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When I first read "Violating Professional Boundaries" starting on page 52, I thought about how contradictory this familiar message can be: Stay within a "zone of helpfulness" to care for patients effectively-but beware of getting too close because that's unprofessional.
The difference between compassionate care and emotional overinvolvement may be clear-cut for experienced nurses, but most students and novice nurses have a hard time drawing the line. I speak from experience.
When I was a young nurse in a trauma ICU, I cared for a strong, handsome 16-year-old who'd been struck in the head by lightning while playing baseball. In a coma for weeks, he occasionally opened his eyes and moved a bit but remained in a persistent vegetative state. I sometimes volunteered to work double shifts and requested him as my patient.
My previous glimpses of death and severe trauma had involved older adults. Seeing someone so young clinging to life struck me as profoundly unnatural. I hung onto the idea that if I just worked harder, this patient would improve. But he didn't. Frustrated and disappointed, I lost sleep crying about him.
At the time, I was too inexperienced to recognize how deeply my involvement was affecting me-and it might have affected the quality of my patient care too. Only later did I realize that my attachment was unhealthy.
Nurses are compassionate people, and going the extra mile to help a patient is one of the joys of our profession. But overinvolvement not only takes a personal toll on the nurse; it also gets in the way of professional caregiving. Taken to an extreme, getting too close can even raise career-threatening ethical and legal dilemmas like the one described in our article.
Perhaps if one of my more experienced colleagues had taken me aside and talked with me about professional boundaries, I'd have had a better perspective on my attachment to my patient. But none of the nurses I worked with seemed to realize how involved I'd become.
If you're a seasoned nurse who mentors new nurses-whether formally or informally-don't be afraid to talk with them about the risks of emotional involvement. I also recommend including the issue in the new-graduate orientation process, perhaps as a group discussion.
Sooner or later, we all care for special patients who tempt us to cross the professional boundary. Let's be aware of this occupational hazard and look out for one another.
Cheryl L. Mee, RN, BC, CMSRN, MSN
Editor-in-Chief, Nursing 2005
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