1. Friend Request Declined.. WHY?!? Samantha Leahy, MS, CCLS III Emily Steelman, BS, CCLS III Credit to Cynthia DeFrancesco, MS, CCLS II Inova Health System

2. Let ’ s Recap…Quickly! “An invisible line that provides limits to a professional’s behavior that allow for a safe relationship with a patient based on the patient’s needs” (Fisher, 2008). “Professional boundaries separate the therapeutic behavior of the nurse from any behavior, well intentioned or not, that could lessen the benefit of care to people…Boundaries give each person a sense of legitimate control in a relationship.” (ANMC, 2010)

3. Let ’ s Recap…Quickly! Child Life Operating Principle 10 -- Individuals shall use integrity to assess and amend any personal relationships or situations that may interfere with their professional effectiveness, objectivity or otherwise negatively impact the children and families they serve. A minimum of two years following the conclusion of a professional role shall lapse before any personal relationship is permitted to develop with children or the members of families they serve (childlife.org, 2000). Other Professions…no clear cut answers

4. Inova ’ s Advancements Policy - Must include written disclaimer on your Facebook page if you acknowledge that you work for the health system

5. When we left Florida in 2010… Came back and discussed implementation with our Child Life Director Identified and contacted Nursing Education Coordinator – THIS IS HUGE! Explored options Identify staff supporters Drafted a Professional Boundaries Policy Guidelines Implemented Professional Boundaries into Nursing Fellow Orientation Branched out to units

6. The Policy Process Administration support Success with presentations Gaining the support of administration Research and Contacts Adapting to your hospital environment Identifying the approval avenue Patience

7. Research to Support a Policy What is the research that’s out there and how does it help? Most research is around nursing Mostly international references New research is being conducted due to social media What are its effects? How are boundaries threatened?

8. Research to Support a Policy Best research found…. Joint Commission Registered Nurses Association of Ontario National Council of State Boards of Nursing Australian Nursing and Midwifery Council American Nurses Association’s Code of Ethics Cincinnati Children’s Hospital Social Workers Pediatric Nursing Journal. Rushton, Armstrong, McEnhill 1996

9. Key Themes of our Policy Include justification that will make your administrators take notice Joint Commission Define a therapeutic relationship and provide examples of potential boundary issues. Professionalism Receiving Gifts Instructions for gaining advice in potential boundary situations

10. Presentations Advanced Practice RN workshop Management Forum Nursing Fellow Orientation NICU Next steps and other areas

11. Struggles and Pushback General Management Hospital culture HCAHPS Population differences

12. Struggles and Pushback Specific Examples NICU Seasoned RNs Passive Aggressive Pushback Life experiences at work

13. Let ’ s Talk About It… Group Discussion…

14. References American Nurses Association’s Code of Ethics. (2001). Code of ethics for nurses with interpretive statements. Retrieved form: http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Cod e-of-Ethics.pdf http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Cod e-of-Ethics.pdf Australian Nursing & Midwifery Council. (2010, Feb). A nurse’s guide to professional boundaries Child Life. (2012). Operating principles of the child life profession. Retrieved from: http://www.childlife.org/The%20Child%20Life%20Profession/OperatingPrinciples.cfm http://www.childlife.org/The%20Child%20Life%20Profession/OperatingPrinciples.cfm Joint Commission. (2001). Essential issues for leaders emerging: Challenges in health care. Maas, A., Vargo, K., & Williams, S. (2011). Maintaining professional boundaries with families and tips for workings with staff who don’t. Presentation. National Council of State Boards of Nursing (2011). A nurse’s guide to professional boundaries. Retrieved from: https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf Registered Nurses Association of Ontario. (2006, March) Establishing therapeutic relations. Retrieved from: http://rnao.ca/bpg/guidelines/establishing-therapeutic- relationshipshttp://rnao.ca/bpg/guidelines/establishing-therapeutic- relationships Rushton, Armstrong, McEnhill (1996). Establishing therapeutic boundaries as patient advocates. Pediatric Nursing Journal, 22(3), 185-189.