1. Procedure Statement
The Royal Children’s Hospital (RCH)
is committed to always setting and maintaining a high standard of professional
conduct for its staff, who are responsible for maintaining professional
boundaries in their day-to-day work with patients and families.
Professional boundaries enable staff and patient/family to engage safely and
effectively in a therapeutic relationship.
The RCH strives to create a safe
and supportive environment for all patients, their families or carers who
access the services. In the process of
providing patient care, the RCH recognises the value and importance of staff
building rapport and appropriate professional relationships with the patient/family.
Accordingly, this procedure assists staff to focus on professional patient-centred
care to deliver Great Care, Everywhere.
Procedure applies to all RCH employees, students and volunteers, contractors,
honorary employees and, Board Members of the RCH. For the
purpose of this procedure, reference to staff is inclusive of all persons
3. Definition of Terms
Professional boundaries are the limits to the
relationship of a member of staff and a person in their care which allow for a
safe, therapeutic connection between the staff member and that patient (and their
nominated family, carers and friends), protecting both staff
Boundaries are the lines that separate the professional from
Power imbalance is the
difference in power relations between a staff member and the patients we care
for. This can be due to the vulnerability of the person, the sensitive
information staff have access to, or the role of the staff member in providing
or giving access to the care the patient needs.
is the relationship between staff and the patient that promotes the latter’s
safety, wellbeing, independence, and resilience, and prioritises their
interests above those of the employee.
Our patients are those
that seek access to and/or receive the RCH services. This can be expanded to
include their relatives and carers where appropriate in this procedure.
4. Procedure details
This procedure provides guidance
for appropriate behaviour to maintain professional relationships between staff
and our patients/families, where the focus will be on always managing a
professional, therapeutic relationship in patient care. Due to the limitations
of the procedure to provide recommended behaviour that covers all role related scenarios,
the RCH Code of Conduct and Compact should be reviewed and adhered to. It is expected that anyone who falls under
the scope of this procedure will always exercise good professional judgement
and ask for assistance from their manager when unsure.
4.1 Professional Boundaries
Health care workers have a duty
of care to treat patients with respect and provide patient-centred support that
meets their needs without judgment or bias. Staff must always remember that
they play a role to support the patient with their healthcare needs, whilst understanding
that professional boundaries require the recognition of potential conflicts,
risks and complexities of providing care to patients. This can occur for example in patients who
have had lengthy, or frequent episodes of care. It can be challenging,
and staff can raise any concerns or training needs with their manager.
Early in patient care, staff should
always inform the patinet and families we treat about their role, what can be
expected in the professional relationship to avoid misunderstandings. Despite
best efforts to maintain professional relationships, boundaries may be crossed
and may lead to strains or a break down in relationships. In situations where
the professional relationship has been compromised, staff will work towards
making repairs where possible and desired by the patients we care for. For
guidance in these situations, workers should consult with their manager, refer
to the RCH Code of Conduct and Compact.
Some signs of compromised boundaries are:
Setting aside time outside of work to assist a patient/family
Possessive or secretive behaviour (e.g. becoming defensive in matters relating
to a patient/family or not sharing information with managers)
attitudes (leading to withholding of support, criticism, or abuse towards the
Social relationship between RCH
staff, patients and their family members are inappropriate, including friendship,
socialising, social relationships via social networking sites or electronic
means, or entering any other relationships apart from a professional one. To do this is a breach of professional
Staff must never give advice that
is outside of their training and expertise, e.g., a non-health professional
advising someone to stop taking medication.
Staff who visit patients at home must
do this for work related purposes which is agreed by the team and documented in
the EMR. Requests by patients and families for staff to visit at home
outside of these arrangements will be declined by staff, documented in the EMR,
and discussed with their manager.
An employee is encouraged to
declare to their manager if there is a pre-existing personal/social
relationship (acquaintance, friend, relative connection etc.) with a patient or
their family as soon as they are aware of the patient receiving services at RCH
in an area that may impact on their work sphere. The manager will manage
any declaration sensitively, always maintain confidentiality and only inform
others on a need-to-know basis.
Any breach to a professional
boundary will be managed in line with relevant RCH procedures to ensure the
safety of staff and patients/families is managed accordingly.
4.2. Therapeutic Relationships
RCH staff need to be aware that
they are responsible for providing therapeutic support that is goal-oriented
and planned to meet specific medical needs. Further, employees must be mindful
of the power imbalance that exists which may make the patient/family more
vulnerable in the professional relationship. As such, support must always be patient-centred
and inclusive. Staff must behave and make decisions with the best interests of
the person in mind and refrain from crossing the boundaries of the professional
relationship that can lead to potential harm. Staff should avoid having non-clinically
related physical contact with those we provide care for as some may not welcome
physical contact. It is always the responsibility of staff to act
professionally and inform our patients/families about the professional nature
of the relationship.
4.3. Request and Disclosure of Information
Staff will avoid requesting
information that is not necessary for the purposes of providing patient care. Further,
staff shall not disclose any unnecessary personal information relating to
themselves or others at the RCH. This is important, especially when the
disclosed information has potential to affect the professional relationship. Before making any voluntary disclosures, employees
should always question the motive behind the disclosure, whether the
information would help the person and consider the unintended consequences that
can arise from the disclosure.
4.4 Accepting and Giving of Gifts
In general, gifts should not be
exchanged between staff and patients/families, and this should be clearly
communicated early in the professional relationship. However, it is understood
that in certain situations, cultures, and contexts, refusing of gifts could
appear as offensive and may damage the established good working relationship.
In these cases, in accordance with the Gifts,
Benefits and Hospitality procedure, gifts may be accepted to the
appropriate dollar limit, not conditional upon any action or services being
rendered, and nothing is expected in return.
As some gifts may bear more meaning than its monetary value to the patients
we care for or their families, staff are always encouraged to dissuade gift
giving practice. When it is necessary to accept gifts, workers should state
they are accepting on behalf of the team/ward to remove the personal element. All
gifts received should be declared. Refer to the Gifts,
Benefits and Hospitality procedure for further information.
4.5 Prohibited Relationships
While providing care, staff may
develop feelings for patients, their relatives, or carers and vice versa. Employees
must remember it is their responsibility to conduct themselves professionally
and maintain professional boundaries with the patients we care for. If a staff
member notices a change in the relationship or signs they or another party seeks
a change in the relationship, they must inform their manager and discuss ways
to continue to maintain the professional nature of the relationship.
Some examples of relationships
that are prohibited are:
Personal relationship (being friends, assuming the role of a parent/guardian)
Any sexual relationship
Financial or business relationship (entering contracts, giving, or lending
Staff must never seek out
relationships with former or current patient/family/carer’s and will use caution
with exchanging messages and making connections on social networking sites and
other electronic means with those we care for, as this can blur the safe zones
of professional boundaries. If staff have concerns or questions about
appropriate behaviour, they should consult their manager.
All staff must familiarise
themselves, be vigilant, and adhere to all the RCH privacy and confidentiality procedures
in securing and protecting information obtained in the course of their work. Patient
confidentiality must never be breached except in cases where it concerns the
safety of a patient, their family, or carer.
If this is the case, staff will approach their manager for guidance and
recommended course of action(s). Refer to the OVIC
Information Sharing and Privacy – Guidance for Sharing Personal Information.
An accurate and detailed record
of meeting with a patient regarding a concern about possible breach of
professional boundaries relating to them or other workers must be reported to the
employee’s manager, for a prompt response.
The EMR should only be accessed
to support the provision of clinical care or authorised research. Accessing any
person’s information from EMR for any other reason is not appropriate. This
includes EMR data concerning patients across the Parkville Precinct.
Where a staff member has a
concern or question about professional boundaries, they should seek guidance
from their manager. This is especially
where an employee has a personal relationship that may impact their ability to
perform their role and breaches the definition of a “professional
boundary”. If this is not possible then
the employee will need to discuss this with their HR Partner.
Where appropriate, the manager will
support a staff member to obtain professional support for any distress
experienced while providing patient care.
Staff are encouraged to utilise the RCH Employee
Assistance Program (Converge International) which offers confidential
counselling services or the Peer Support program. Manager support can be provided to staff,
including the potential to extract them from instances where professional
boundaries may be challenged. A manager
and employee discussion may occur to discuss and develop a strategy to support
staff to feel safe to perform their role, subject to the circumstances.
Managers may consider discussing
any concerns and questions about professional boundaries in team meetings where
appropriate, to explore best practices and effective ways to maintain
professional boundaries. Managers and employees can also consult with the
Organisational Development department for relevant training, to ensure they are
up to date and consistent with best practice.
4.9 Disciplinary Action
Where there has been a report of
a possible professional boundary breach the matter will be investigated and may
result in disciplinary action. The severity of the disciplinary outcome will depend
on the seriousness of the breach. A
manager should contact their HR Partner for further advice on this matter. Refer to the relevant Enterprise Agreement and
Management and Management of Misconduct procedure for further information
about the disciplinary process that will be facilitated.
Professional Codes & Guidelines
Professional Standards - Australian Nursing & Midwifery Board
of Conduct - Pharmacy Board of Australia
of Conduct - Physiotherapy Board of Australia
of Ethics - The Australian Psychological Society
of Conduct for Victorian Public Sector Employees
Information Sharing and Privacy – Guidance for Sharing Personal Information
6. Related RCH Policy/Procedures
Code of Conduct
of Interest Policy
of Interest Procedure
RCH Patient's Rights and Responsibilities
Consent – Informed Procedure
Benefits and Hospitality
Management and Management of Misconduct
Appropriate Healthcare Delivery to Aboriginal Patients and their Families
& Positive Workplace Behaviours
Executive Director, People & Culture