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Policies and Procedures

Professional boundaries

  • 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.

    2. Scope

    This 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 listed above.

    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 and patient/family.   

    Boundaries are  the lines that separate the professional from non-professional relationships

    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.

    Therapeutic relationship 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)
    • Judgemental attitudes (leading to withholding of support, criticism, or abuse towards the person)

    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 boundaries. 

    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 money, etc.)

    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. 

    4.6 Confidentiality

    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.

    4.7 Reporting

    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.

    4.8 Support

    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 the Performance Management and Management of Misconduct procedure for further information about the disciplinary process that will be facilitated.

    5. Reference

    AHPRA Professional Codes & Guidelines

    Nurses Professional Standards - Australian Nursing & Midwifery Board

    Code of Conduct - Pharmacy Board of Australia

    Code of Conduct - Physiotherapy Board of Australia

    Code of Ethics - The Australian Psychological Society

    Code of Conduct for Victorian Public Sector Employees

    OVIC Information Sharing and Privacy – Guidance for Sharing Personal Information

    6. Related RCH Policy/Procedures

    Code of Conduct

    Conflict of Interest Policy

    Conflict of Interest Procedure

    RCH Patient's Rights and Responsibilities

    Consent – Informed Procedure

    Gifts, Benefits and Hospitality

    Performance Management and Management of Misconduct

    Culturally Appropriate Healthcare Delivery to Aboriginal Patients and their Families

    Social Media

    Safe & Positive Workplace Behaviours

    7. Contacts

    Executive Director, People & Culture