As an RPN, you will encounter ethical dilemmas each day that you practice. It is important that you are able to manage these issues and resolve them in the client’s best interest. Below you will find scenarios to help you consider strategies and resources for addressing ethical issues.
Barb is an experienced RPN working in a complex care unit. One of her clients is a man with progressive dementia. His wife visits regularly and she has been experiencing a grieving process as she has watched his progressive decline and failing memory. Barb’s husband recently died from a similar dementia, so she has a firsthand understanding of what Rose is experiencing.
Rose has approached Barb on several occasions at work to discuss her coping difficulties. Barb has suggested she might consider extra support at the local Mental Health Centre’s weekly Grief Support group, as it has been helpful for her. A couple of weeks later, by chance, they both attend the same Grief Support group meeting and at the end of the meeting Rose invites Barb for coffee at Starbucks.
No. When a therapeutic relationship is established within an employment context it is not acceptable to extend it outside of that context.
Boundaries in the Nurse-Client Relationship practice standard provides guidance for these types of situations. The nurse-client relationship is the foundation of nursing practice across all populations and in all practice settings. It is based on trust, respect, and proper use of power/authority.
Professional intimacy is conducted within boundaries that separate professional and therapeutic behaviour from non-professional and non-therapeutic behaviour.
You are a practising RPN and you and your friend Kathy go to a party. John, a former client of yours, is at the party and starts chatting with Kathy. They are instantly attracted to each other and have a lot in common. Over the evening they become very friendly and make plans to meet again soon.
Although you know John well, he does not acknowledge you, nor does he tell Kathy about how you know each other. You know John’s psychiatric history includes a diagnosis of bipolar disorder, and that he experienced several manic episodes involving ruinous spending sprees and severe agitation and physically threatening behavior.
The correct answer is (e) none of the above. To use in your personal life any information gained about a client from your professional practice fails to meet your legal, ethical and professional responsibilities as an RPN. As John has not acknowledged you, you would treat him as any other person that you met for the first time.
The best response is a neutral response that isn’t influenced by any information that you may have gained about him from your professional practice. Consider (a) or (b), but (d) and (e) are incorrect as they would be a breach of confidentiality.
The best response is a neutral response that isn’t influenced by any information that you may have gained about him from your professional practice. Consider (a) or (c). Answer (a) responds to her request to draw on your experience as a psychiatric nurse, but does not suggest any prior knowledge of John. Answer (c) is an open question encouraging her to clarify her thoughts and feelings about the situation. Answer (e) is not appropriate because it is a breach of confidentiality. Answers (b) and (d) might lead you to reveal confidential information.
The correct answer is (d) none of the above. None of the situations described above demonstrate that compelling circumstances exist that affect the health or safety of anyone. It is only under these circumstances that the law allows disclosure. In situation (c), Kathy is not yet at risk, and you could suggest that she not open the door or call the police for assistance.
Other resources that support RPN practice and set out a framework for professional responsibility and accountability include:
RPNs should also review their organization’s privacy policies which often address topics such as:
For further information on the Standards of Practice or professional practice matters, contact us: