John is a nurse working for an intercity Visiting Nurses Association (VNA). Recently he admitted Susan to home care following her discharge from the hospital status post a total colectomy with a resulting colostomy. Susan is a 28 year old, college graduate who is employed as an events manager for a national pharmaceutical company. She lives alone, has family in the areas and several close friends including Brad, who Susan has started dating before her surgery.

Upon admission, John noted that Susan was demonstrating an ineffective coping mechanism when they were discussing the steps associated with caring for the colostomy on her own. Susan became so upset that John decided that he would bring it up again on his follow-up visit in two days.

Two days later when John visited Susan he learned that Susan and Brad were no longer seeing each other. Susan was adamant that she would "never take care of this bag!". John was becoming increasingly concerned with Susan's ineffective coping and while driving to his next patient John decided on a plan of care to make Susan feel better about herself.

John based his new care plan on the facts that Susan was a young woman who was experiencing significant loss in her self-esteem, body-imagine and self-worth. His goal was to improve Susan's self-esteem and to get her to recognize that she is still a bright, smart, attractive, and desirable young woman.

The next day on his way to the office, John made an unscheduled visit on Susan and offered to take her for a drive. Susan was appeared depressed and refused.

That afternoon, John stopped by and offered to take Susan for a walk along the shore, and again she refused to go out of the house because, "this damn bag might leak."

Two days later John sent Susan a cute little teddy bear dressed in Scubs with an invitation to dinner. Impressed by his persistence, Susan agreed. While at dinner, Susan and John were seen by another nurse at the VNA. The next morning John was terminated from the VNA for violating professional boundaries.

  1. What boundary did John cross? And why?
  2. Was it fair for John to lose his job for only trying to make the patient feel better?
  3. Did Susan have any responsibility in John losing his job?
  4. If you were John's supervisor, what would you do the same, or differently? And why?


Watch NCSBN’s video, Professional Boundaries in Nursing, in which explains the continuum of professional behavior and the consequences of boundary crossings, boundary violations and professional sexual misconduct.


This information is provided by the Division of Health Professions Licensure within the Department of Public Health.