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Ethical issues


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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.

Scenario # 1​

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.​

Should Barb accept the invitation?

No. ​​When a therapeutic relationship is established within an employment context it is not acceptable to extend it outside of that context.​

Which practice standard would help Barb make this decision?

The 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.

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What are some of the potential issues if Barb and Rose enter into a friendship?
  • If Barb and Rose entered into a friendship, thereby violating the nurse-client relationship, other clients and relatives of those clients could perceive that Rose and her husband are receiving preferential treatment.
  • Rose might also inadvertently use their friendship as an opportunity to ask for extra care.
  • Another potential conflict could occur if there is a falling out of that friendship, resulting in Rose fearing that her husband might now receive less or inadequate care from Barb.
  • Another potential risk is that Barb might disclose information to Rose about other clients or staff in the facility, which would constitute a breach of confidentiality or violation of the Privacy & Confidentiality Standard.
What other resources support RPN practice and set out a framework for professional responsibility and accountability?
​​​​​Scenario # 2

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.​

What would you do in this situation?
  1. Acknowledge to Kathy that you know him from somewhere, but give no details
  2. Avoid engaging in conversation with him
  3. Suggest to Kathy they leave the party before she can make plans with John
  4. Reveal to Kathy that he is a former client of yours but nothing else
  5. None of the above

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.

​​A couple of weeks later, you are at another social function and Kathy and John are also there. Kathy approaches you and tells you she really likes John and has been on several dates with him. She says he has given her several expensive gifts and she wants your opinion about her new boyfriend.​
What is the best response?
  1. Say that you don’t know him well enough to comment
  2. Say that he seems nice based on this evening’s event
  3. Say that you do not like him
  4. Say he is a former client and therefore you can’t discuss him
  5. Say that you know him from work

The best response is a neutral response that isn’t influenced by any information that you may have gain​ed about him from your professional practice. Consider (a) or (b), but (d) and (e) are incorrect as they would be a breach of confidentiality.

​​​​Sometime later, Kathy tells you that John has been calling her in the middle of the night (sometimes as many as four times) to say that he is not able to sleep and wants her to talk or go for coffee. He has done this three times in the past 2 weeks. She knows you are a psychiatric nurse and asks you for advice on what could be going on and what she should do.​
Which is the best response?
  1. “Do you think there is anything else going on? Have you noticed any other unusual behaviour?”
  2. “Based on my professional experience, it sounds like he might be having a manic episode.”
  3. “You have gotten to know him, what do you think is happening?”
  4. “Sure seems like there is something unusual going on – have you thought about getting him to see a doctor?”
  5. “I shouldn’t really say this, but he is a former client of mine but I can’t tell you any more than that.”

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.​

Under which of the following circumstances could you, as an RPN, disclose your knowledge about the client?
  1. Your friend Kathy says, “He’s beginning to act really strange; he has started yelling at me and is very controlling about what I do.”
  2. Kathy shows you a fabulous, expensive ring that John has given her. She says it was bought on his credit card, but he has told her that he is expecting a big bonus at work.
  3. Kathy calls you one night to say that he is pounding on the door, and she is afraid; she asks you what she should do.
  4. None of the above.

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.

What resources can assist and guide RPNs facing privacy and confidentiality issues?

Other resources that support RPN practice and set out a framework for professional responsibility and accountability include:

  • The Privacy and Confidentiality practice standard
  • The Code of Ethics and Professional Standards for Psychiatric Nursing require RPNs to protect the confidentiality of all information gathered in the context of the professional relationship and to practice within relevant legislation that governs the privacy, access, use, and disclosure of personal information.
  • BCCNP bylaws provide additional direction for self-employed registrants, particularly around the safe and secure storage of client’s files and information.
  • The BCCNP Practice Consultant.
  • Resources available throug​h your employer.

RPNs should also review their organization’s privacy policies which often address topics such as:

  • Confidentiality
  • Collection, use and disclosure of personal information and relevant consent
  • Access to records
  • Documentation of disclosure of information
  • Use of social media
  • Use of mobile communications and computing devices
  • Storage, retention and disposal of records​

 Need help or advice?

​For further information on the Standards of Practice or professional practice matters, contact us:

  • Email practice@bccnp.ca
  • 604.742.6200 x8803 (Metro Vancouver)
  • Toll-free 1.866.880.7101 x8803 (within Canada only)