Maintaining Professional Boundaries

As a healthcare professional you will often be in knowledge of intimate personal details about your patient or the service user. You might therefore develop a close relationship with each other. However, you must be careful not to find yourself in an improper emotional relationship. It might not always be obvious when treating a patient or service user whether you are crossing professional boundaries.

In this article we look at a real life case involving a social worker who thought they were doing their best to support a service user but instead found themselves investigated by Social Work England for crossing professional boundaries.

Case study
The social worker was allocated to work with a service user in crisis. They helped admit the service user into psychiatric care. The service user explained their problems had begun with work related stress. When providing support, the social worker liaised with the service user’s professional regulator; the NMC, the RCN and their employer. They submitted a report about the service user’s mental health along with recommendations. The social worker’s contract came to an end with the community team and the service user’s care was passed to another social worker.

The service user however contacted the social worker on Facebook, sending a friend request, which the social worker accepted. They formed a friendship and socialised together. The service user wanted the social worker to act as a witness in their regulatory and employment investigations. The social worker agreed and had some ongoing limited contact with the service user’s employer. The service user’s employer complained and the social worker was suspended from practising by Social Work England pending their full investigation.

The social worker contacted us when we helped them undertake a significant amount of reflective work on their code of practice and their actions. Through a period of reflective work they came to realise, amongst other things, that they’d not considered the service user might now have different expectations of other professionals involved in their care which could impact their therapeutic relationship. They accepted their ongoing involvement, although well intentioned, constituted work outside of their scope of practice, and although the service user had wanted their relationship to continue, they had crossed professional boundaries. They also reflected that they had overidentified with the struggles of the service user, which lead to this situation occurring in the first place.

Social Work England accepted the social worker had demonstrated sufficient insight, remorse and remediation and so decided not to refer their case to a fitness to practise hearing. They lifted the interim suspension but issued a warning, warning them to ensure they maintained clear professional boundaries in the future.

Conclusion
You might be treating someone who is emotionally or physically vulnerable. The balance of power is therefore often tipped in your favour. It is your responsibility to ensure that your patients/service users know you are not their friend, partner or family member. If a patient relationship looks or starts to feel uncomfortable, seek advice from your colleagues or others as soon as possible.