A nurse witnesses a mental health worker kissing a patient in the patient's room. The patient tells the nurse, "Please don't tell anyone about this. It just happened. I care so much about him, but we have agreed not to date until I'm discharged." Which of the following is an appropriate response?

"I have to report this situation to the authorities."


•Patient safety must be the first priority. As a mandated reporter, the nurse must document and report this situation to the hospital and to the required authorities in their jurisdiction. Professional sexual misconduct is a criminal offense.

•Overinvolvement with a patient can include milder boundary issues (like personal disclosures) to more serious boundary violations like sexual involvement or assault. Any sexual activity with a client constitutes sexual misconduct. This includes any behavior that is reasonably interpreted as sexual by the patient. For this reason, careful boundaries should always be maintained.

•Even if a patient consents or initiates the sexual conduct, it is still sexual misconduct. Due to the power dynamic between a patient and a nurse, and especially with patients with a mental illness, there cannot be true consent because the patient is in a vulnerable position. It is always the responsibility of a health care professional to maintain appropriate boundaries with current and former patients.

Incorrect options:

•"You should know better than to get involved with each other. It's inappropriate." It is the responsibility of the mental health care worker to maintain boundaries with patients. The patient is not to blame.

•"I will have to make a note about this and reassign him to work on another unit while you are here." While the situation should be documented, reassigning the mental health care worker is not adequate. A report needs to be filed and disciplinary actions taken to prevent further abuse of patients.

•"I can't tell you what is appropriate outside the hospital, but while you are here you cannot engage in any physical contact with each other." This situation would constitute sexual misconduct whether it happened during the patient's stay or after discharge.

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