The key issue
What is the appropriate disciplinary sanction for a transgression of professional boundaries not involving intimate relations?
The respondent was employed as an agency nurse and worked four shifts at a nursing home where the patient (Patient) resided. The respondent provided nursing care to the Patient on three days between October 2017 and November 2017.
Between November 2017 and December 2017, the respondent, among other things:
- stayed overnight with the Patient at the nursing home;
- attended consultations with the Patient;
- took the Patient out on social visits; and
- allowed the Patient to stay overnight with her.
In March 2018, the respondent inspected a property for sale with the Patient and the Patient subsequently entered into a contract of sale for the property. The contract was brought to an end after the Patient’s son had expressed concerns.
In July 2018, the Patient entered into a further contact of sale, which was completed in August 2018 and the property was transferred to the Patient. The Patient moved into the property with the respondent.
The Patient appointed the respondent as his guardian under an enduring power of guardianship.
In May 2019, the relationship between the two parties broke down, the respondent was hospitalised and moved out of the property.
While being investigated by Ahpra, the respondent redacted a letter from the Patient’s treating neurologist that she provided to Ahpra by removing information describing her as the patient’s ‘partner of nine months’. She did not bring this to the attention of Ahpra.
In mitigation, the Respondent did not financially gain from her relationship with the Patient. Further, the Patient sought the respondent’s assistance to live independently in order to have more effective management of his pain. Prior to the respondent’s engagement at the nursing him, she had suffered a significant period of ill health and clinical depression and naïvely felt she could make a difference to the Patient’s care and ongoing pain.
The tribunal approved orders that the respondent behaved in a way that constitutes professional misconduct, reprimanded her, disqualified her from applying for registration for a period of 12 months, and ordered her to pay the Board’s costs.
The case confirms that health practitioners must not transgress professional boundaries with patients, whether those transgressions be intentional or innocent. Further, “helping” patients, while well-intentioned, can lead to circumstances where the power imbalance that exists between a health practitioner and patient can lead to a vulnerable patient being exploited.
The decision Nursing & Midwifery Board of Australia v Bouwer  VR 46 can be read here.