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OPINION

Patient boundaries and my work/life balance

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Clinical nurse HIV specialist, Martin Jones, finds himself in hot water as he tries to maintain professional nurse-patient boundaries

Two things have happened to me recently that made me reflect. I’ve been canvassing for the local elections and a former patient asked me to be a facebook friend.

I’ve always been involved in local political activity, an active member of the labour party until Tony Blair was chosen as its leader, picketing my hospital during the cleaners’ strike in the 1980s and attending rallies with CND and people’s march  for jobs. More recently, although no longer a member of any political party, I’ve enjoyed knocking on doors on behalf of a friend who is a liberal democrat councillor.

I’ve been clinical nurse specialist for HIV in a small community for more than sixteen years. The  nature of this work includes home visiting and maintaining nurse-patient relationships over many years. I inevitably bump into some of my patients when I’m off duty and have always found my boundaries straightforward: if the patient acknowledges me then I’ll happily reciprocate but if a patient ignores my presence I’ll equally happily pass on. Neither approach affects my patient care in any way.

Canvassing a patient is a different. On the one hand I live in a democracy and as the NMC advises, have the right to engage in lawful political activity. However, as a clinical nurse specialist I am anxious that, because  of my professional role, it could be inappropriate to canvass the homes of  patients. I like to believe that health promotion and clinical advice dispensed during consultations carry some weight with patients. I would feel uncomfortable if I believed that patients gave extra credence to the political opinions of the lib dems simply because their clinical nurse specialist canvassed on their behalf.

I cannot ask my councillor friend to knock on certain doors for me, so I resolve the dilemma by not knocking but posting the ‘sorry you were out when we called’ leaflet.

Similarly, I have a right to enjoy social networking. I have a number of facebook friends whom I know through nursing: my only remaining contact from training in the mid-eighties, former and current colleagues, plus one or two other HIV specialists. However when a former patient requested a facebook friendship, I was confronted by a similar dilemma. I was delighted to see his picture on his profile and a little flattered that our nurse-patient relationship of a few years ago meant sufficient for him to send the invitation. But our relationship was just that: a nurse-patient relationship.

It would be inappropriate for me to have to explain how I know him to my family and other facebook friends. I am absolutely clear about my boundaries: work is work and I do not wish to be facebook friends with patients. I sent back a brief,  cheery message explaining that I was unable to accept because of professional boundaries. And received back a final, friendly, understanding message.

Whether it’s through nursing in a small community or because we can find other people so rapidly via the internet, maintaining appropriate nurse-patient boundaries is difficult but critical to my effectiveness as a clinical nurse specialist

Martin Jones is a clinical nurse specialist in HIV at East Sussex Downs & Weald.

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