This is an important ethical question in the nursing profession. There are a few key factors to consider when determining whether it is appropriate for a nurse to date a current or former patient.
In general, it is not recommended for nurses to pursue romantic relationships with current or former patients due to the power imbalance inherent in the nurse-patient relationship. However, there are some exceptions and nuances to consider.
Power Imbalance
One of the main reasons nurses are advised against dating patients is the power imbalance. As a nurse, you have privileged medical knowledge about the patient and are in a position of authority over their care. This imbalance could lead to potential exploitation or the patient feeling coerced into an unwanted relationship. Even if the patient initiates a relationship, the nurse still holds more power in the dynamic.
Professional Boundaries
Dating a patient blurs the professional boundaries between nurse and patient. This boundary helps ensure objectivity in care and decision making. Blurring it risks dual relationships and conflicts of interest. The nurse may no longer be able to provide impartial care, jeopardizing patient safety.
Ethical Principles
Pursuing a romantic relationship with a patient goes against key ethical principles in nursing:
- Autonomy -overwrite’s the patient’s ability to make a fully consensual decision
- Beneficence – risks harming the therapeutic nurse-patient relationship
- Nonmaleficence – violates the oath to “do no harm”
- Justice – takes advantage of the power imbalance
Nursing Codes of Ethics
Most nursing codes of ethics, including the American Nurses Association (ANA) Code of Ethics, prohibit nurses from engaging in romantic relationships with current patients due to the threat to professional boundaries and trust.
For example, Provision 1.3 in the ANA Code states:
The nurse avoids conflicts of interest that interfere with the exercise of professional discretion and impartial judgment.
Entering a romantic relationship with a patient is considered one such conflict of interest.
State Regulations
Many states have laws or licensing board positions prohibiting sexual relationships between nurses and current patients. For example, in Texas this is considered unprofessional conduct that can result in disciplinary action from the Board of Nursing. Even if not explicitly prohibited, such relationships are generally still frowned upon across states.
Organization Policies
Most healthcare organizations have policies restricting or prohibiting intimate relationships between clinical staff and patients. This is to mitigate risks and reinforce ethical boundaries. Violating such policies can result in termination.
Former Patients
What about pursuing a relationship with a former patient after care has terminated? This may be less ethically problematic depending on the situation. However, many of the same concerns around power imbalance, boundaries, and ethics still apply in the immediate period after care.
Some best practices regarding former patients include:
- Allowing at least 12 months between care termination and initiating a relationship
- Obtaining explicit consent from the patient prior to initiating a relationship
- Seeking counsel from a nursing ethics board or committee
- Disclosing to management to avoid perceptions of impropriety
Exceptions
There are some exceptional situations where a nurse-patient relationship may be ethically permissible, such as:
- The patient and nurse had an established relationship prior to the provision of care
- Incidental contact in a social setting that organically leads to dating
- The patient is no longer dependent on the nurse’s care and sufficient time has passed since termination of clinical contact
However, these exceptions should generally be approached with abundance of caution and transparency.
Key Considerations
When determining the ethics of pursuing a nurse-patient relationship, some key considerations include:
- Nature of original nurse-patient contact
- Length of professional relationship
- Time elapsed since care provided
- Policies of employing institution
- Power dynamics – was there informed consent?
- Patient’s capacity for decision making
- Potential for harm to therapeutic relationship
Conclusion
In summary, it is generally not advisable for nurses to date current or recent former patients due to professional ethics, power differentials, regulations, and organizational policies. However, in limited exceptions involving consenting adults and passage of time, such relationships may be permissible.
Nurses should reflect carefully on context, seek counsel, and disclose any relationships to avoid impropriety. The priorities should be upholding ethical boundaries, protecting the therapeutic nurse-patient alliance, and preventing any exploitation.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Publishing.
National Council of State Boards of Nursing. (2011). White paper: A nurse’s guide to professional boundaries. Chicago, IL: Author.
Texas Board of Nursing. (2021). Texas Administrative Code: Rule 217.11 Standards of Professional Nursing Practice. Austin, TX: Author.
Thacker, K. (2008). Nurses’ advocacy behaviors in end-of-life nursing care. Nursing Ethics, 15(2), 174-185. https://doi.org/10.1177/0969733007086015
| State | Regulation on Nurse-Patient Relationships |
|---|---|
| California | Sexual relationship prohibited with current patients and within 2 years after termination of care per Board of Registered Nursing |
| Florida | Sexual misconduct prohibited per Florida Nurse Practice Act |
| New York | Sexual conduct prohibited with current patients per Office of Professional Discipline |
| Texas | Sexual contact prohibited under the Nursing Practice Act |
Organizational Policies on Nurse-Patient Relationships
Most healthcare organizations have internal policies regarding intimate relationships between clinical staff and patients. Some examples include:
- Prohibiting relationships with current and former patients within 1 year after care
- Requiring relationship disclosure and transfer of care if relationship predated treatment
- Restricting any relationship that could impair judgment or risk exploitation
- Permitting termination for policy violation
While the specifics vary across healthcare settings, the overarching theme is avoiding inappropriate relationships that could compromise care and ethics. Violating policies can result in disciplinary action.
Risks of Nurse-Patient Relationships
Some risks and consequences associated with nurses dating current or former patients include:
- Compromised patient care and safety
- Breaches of patient privacy and confidentiality
- Loss of public trust in the nursing profession
- Disciplinary action by state licensing boards
- Termination from healthcare organizations
- Civil liability for exploitation or harm
- Criminal charges in some cases
These relationships can seriously impact the nurse’s career and reputation, and undermine ethical standards in healthcare. The risks apply even after the professional relationship has ended.
Maintaining Appropriate Boundaries
To avoid inappropriate intimacy and maintain professionalism, nurses should:
- Keep relationship purely therapeutic
- Avoid overly personal self-disclosure
- Prevent isolation with patients
- Document boundaries clearly in chart
- Disclose any gifts or requests for relationships
- Transfer care if existing relationship discovered
- Consult peers or ethics committees if concerns arise
Preserving boundaries protects all parties and upholds the highest ethical standards.
Seeking Support for Boundary Issues
If struggling with intimate feelings, attraction, or boundary dilemmas with patients, nurses should:
- Be self-aware and acknowledge feelings
- Avoid rationalizing or justifying actions
- Disclose to supervisor to facilitate transfer of care
- Seek counseling from confidential sources
- Review organizational policies and professional codes
- Consult with colleagues or mentor
- Pursue additional ethics training if needed
- Document steps taken and any advice received
Seeking help early can prevent minor boundary issues from becoming major transgressions.
Conclusion
Romantic relationships between nurses and patients are rife with ethical concerns and strongly discouraged in most cases. Exceptions may exist in certain circumstances but require careful thought and full consent. Nurses should uphold the highest professional standards by maintaining appropriate boundaries and seeking help if struggles emerge. This protects the therapeutic alliance, patient wellbeing, and integrity of the nursing profession.