Sex is always a boundary crossed

Intimate relationships with patients are never acceptable. 

A cornerstone of nursing is the therapeutic relationship. It is a privileged relationship, which nurses should at all times protect and respect. The profession is conscious of this; hence any suspected transgressions are strenuously investigated and if substantiated can result in serious consequences. Sexual relations with patients are an extremely serious breach of that relationship. A recent disciplinary hearing found an RN guilty of professional misconduct with two patients in this way.

The tribunal in its findings firstly reiterated what professional boundaries are. It highlighted their importance by reinforcing that society trusts nurses to act in the best interest of those in their care. The power imbalance present in a professional relationship places the patient in a position of vulnerability and exposure to exploitation or abuse if that trust is not respected. Professional nursing boundaries protect the space between the nurse’s professional power and the patient’s vulnerability. Nurses have a responsibility to ensure that a relationship is therapeutic and not predatory for self-gratification. The tribunal stated, “No matter the patient, it is solely the nurse’s responsibility to maintain the professional (and personal) boundaries.”

The tribunal then addressed sexual misconduct, explaining it as an extreme form of boundary violation and includes any behaviour that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by a patient. Sexual misconduct is sexual assault. Even if the person (or their legal representative) consents, or the person initiates the sexual conduct, it is still the nurse’s responsibility to ensure relationships do not develop.

Patient A (female aged 48), was voluntarily admitted to a mental health unit for treatment of post-traumatic stress disorder following a car accident and workplace bullying. On admission, patient A was suffering from anxiety, depression and suicidal ideation and felt fearful of authority figures. She was heavily medicated.

The facts of the case make it clear that the nurse was predatory. He used his position of power and trust with both patients for his own benefit. The behaviour is outlined in the decision as follows.

On an evening whilst patient A was an inpatient, the nurse entered patient A’s room, sat on her bed and stroked her shoulder and neck whilst talking to her.

On a subsequent evening, the nurse entered patient A’s room, closed the door, kissed patient A, pushed his crotch against her and forced her to touch his genitals.

On another occasion whilst patient A was an inpatient at the unit, the nurse entered patient A’s room carrying towels and closed the door to the room. Whilst in patient A’s room, the nurse instructed Patient A to lie down on the bed, covered her mouth with his hand, and commenced to have sex.

On several occasions following this event, the nurse entered patient A’s room on the pretense of delivering towels and touched and kissed patient A.

Following patient A’s discharge from the unit, the nurse telephoned patient A and asked her how she was, whether she was taking the same medication and said words to the effect of it was boring not seeing her.

Later the nurse telephoned patient A’s mobile phone on multiple occasions, including once from the landline at the unit where patient A had been admitted.

On two occasions following patient A’s discharge, the nurse attended at patient A’s home and had sex with patient A.

On other occasions, the nurse requested patient A meet him in the car park near where he was working, instructing Patient A as to where she should park her car. On each occasion, the nurse and Patient A were sexually intimate.

During various conversations between the nurse and patient A following her discharge from the unit, the nurse disclosed confidential patient information, including information related to the death of a young female patient at the unit, to patient A.

The tribunal asked patient A why she had not reported the incidents whilst she was in the unit. She stated words to the effect that she was on her own, and that the practitioner had said, I know you’ve got a son. If you say anything, your son can be taken away. Patient A was concerned that no one would ever believe her.

Patient B (female, aged 55) was admitted to the unit due to ongoing depression. She had a 30-year history of recurrent depression.

On a day shortly after her admission to the unit, patient B cried. The following day, the nurse went into patient B’s bedroom and stated that he was concerned that she had been so upset the previous day and he wished to give her a hug. The nurse then hugged patient B.

From that day, the nurse would regularly attend at patient B’s room on the unit and close the door, following which he and patient B would kiss and hug each other.

On several occasions during patient B’s admission at the unit, the nurse would leave his rostered shift and attend the unit where patient B was admitted, enter her room and kiss her.

The nurse did not attend the disciplinary hearing. The tribunal was understandably scathing about the behaviour of the nurse, stating that his conduct would reasonably be regarded by his professional brethren of good repute and competency as dishonourable. The nurse’s conduct would incur strong criticism from them. It was an egregious departure from the elementary and generally acceptable standards of nurses. His conduct and comments portrayed indifference to his patients and to their vulnerable state and were an abuse of the privileges that accompany registration as a nurse. His registration was cancelled, and he was disqualified from re-registering for a period of seven years. This substantial penalty reflects the seriousness of such conduct and should act as a reminder not to be neglectful of your professional responsibilities.

Scott Trueman is a lecturer in the School of Nursing, Midwifery and Nutrition at James Cook University.

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