Ep #150: Maintain Healthy Boundaries with Patients, Employers, and Preceptors

Welcome to the Real Deal Nurse Practitioner Club, the podcast for nurses who are ready to pass their boards and thrive in their careers as real deal nurse practitioners. I’m Anna and I’m the Director of Nursing Content at Blueprint Test Prep. Whether you’re deep in exam prep or stepping into practice, I’ve got you. It is time to become the confident, knowledgeable NP that you’re meant to be. Let’s dive in. 

Welcome back to another episode of the Real Deal Nurse Practitioner Club podcast. As always, it’s Anna here, and today I want to talk about professional boundaries. This is something you may have struggled with as a nurse, and it’s something that every NP student and new NP faces at some point in their careers. 

And there are so many layers to this, like how we say no. How can we care deeply for patients without crossing lines or burning ourselves out? How can we relate and empathize with patients while also maintaining professionalism? And this isn’t something that we figure out overnight.

But these tips can be used beyond the clinical role as well. It’s really easy to feel unsure about what’s too much when you’re in a new situation, be that a new practice, a new non-clinical role, or in a social situation. So, let’s break it all down. We’re going to talk about what professional boundaries actually mean, how we can maintain them without feeling cold, and some real-life examples of where things tend to get a little bit blurry and how to set boundaries with patients, employers, and even preceptors. And let’s be honest, each one of these is going to require a slightly different skill set.

When we talk about professional boundaries, we’re really talking about keeping a healthy balance between compassion and objectivity. As nurses, we care so deeply, and that is absolutely one of our greatest superpowers. But if we don’t put structure and boundaries around that care and compassion, it can very quickly turn into emotional exhaustion, blurred lines, unsafe care, and of course, burnout.

And boundaries with nurses tend to show up in a few main areas. Of course, there’s our time, and some of this too is not letting work or school, if you’re still in NP school, spill into every corner of your life. There’s that emotional involvement, and there’s also things like social media that’s around these days, right? In the world of technology, we have to be so mindful about interactions both with patients and interactions about patients outside of the clinic, especially online.

And really the goal of having healthy boundaries is to protect you, protect your patients, and to let you keep showing up as your best self. So, let’s walk through some examples here, and we’re going to start with examples of setting and maintaining boundaries with patients. A big one I see all the time is when a patient shares too much personal information. Right, sometimes patients open up because they trust you, which is great, and we definitely want to get their full story as it relates to their health and their current concerns.

But I have seen this shift into territory that’s not appropriate for your role, especially depending on the setting you’re working in. Let’s say you are seeing a patient for a sore throat, but suddenly you find yourself feeling like a therapist or a friend instead of a provider. Well, that’s your cue to gently redirect. 

You can say something like, “Thank you for being open and sharing with me. I want to make sure I’m addressing why you’re here. So let’s make sure we focus on your health goals or focus on your health concerns,” or whatever language makes sense to the appointment. Just a quick sentence or two can keep you caring and professional, but also help redirect you back to your role. Right, we’re not being cold or dismissive here, but we are being clear.

Another thing I have found so helpful to be clear on from the very beginning is the time allotted for the appointment. If you are working or you’re doing clinical rotations in primary care, well, you know that 15 minutes is just not enough sometimes, especially if patients have multiple additional concerns they want to bring up outside of whatever the appointment was scheduled for. I’ve had a lot of patients have an appointment for something like a standard medication follow-up, but then they bring up three additional new concerns that are completely unrelated, like a hurt knee.

I have found that setting the expectation up front that insurance is only approving the appointment for X amount of time, this is all we have time to address today, but please make sure you make an appointment before you leave to address your other concerns, helps a lot. It’s setting you up for success to not get super behind on your schedule, and it’s also showing the patient that you do care, you do want to address their other concerns, but you cannot do all of those things today. As much as we would want to, we cannot do all of those things every single appointment.

Now, another patient scenario. What happens if you see a patient outside of the clinic? Say you see them at the store or online. Well, first, I never say anything first. And of course, always, always remember HIPAA. But let’s say a patient tries to message you on social media, or they bring up their medical issues in a public space. Have a line, stick to it. A simple, “It’s great to see you. I can’t discuss clinical issues outside of the office, but I look forward to seeing you at your next visit,” is respectful, polite, but also firm.

Now, let’s say you have cared for somebody for a long time, say months or years. Naturally, you’re going to start to care deeply, and that’s okay, right? nurses at their core are very caring and very compassionate. When it comes to talking to those patients, though, focus on all of that therapeutic communication that we learned in nursing school. We want to practice reflective listening, remaining objective, and a very, very hard one here, but we need to try our hardest not to carry it home with us.

Redirect and reflect if you are ever finding yourself jumping straight to fix-it mode, or you’re being blinded by emotions and you can’t stay objective.

Okay, let’s switch here and let’s talk about the next large category, which will be boundaries with employers. Nurses and new NPs especially fall into this trap because you want to prove yourself, right? You are tempted to say yes to every extra shift, every quick favor. But that is how unrealistic expectations and burnout begins, my friends. And I want to be clear here, there is a big difference between being a team player and being taken advantage of.

We all want to be team players. I am not saying to never take an extra shift, to never stay late to help, and never do favors for our co-workers, right? Those are all good things, and they’re parts of having a really supportive team. 

But we need to think about the red flags here, and some red flags would be being expected to work off of the clock or skip your breaks, being pressured to do tasks outside of your scope without supervision, and this goes for NP students as well, and a big one, being made to feel guilty for having work-life balance.

A big lesson I had to learn here is that it is okay to say no sometimes. If you need to say no, and you will at times have to say no, keep it professional and calm. You could say, “I really want to give my best care to my patients, and to do that, I need to manage my workload safely. So I can’t take that on today, but I’d be happy to help problem-solve another solution.” 

Or you could say, “You know what, I haven’t been trained in that particular skill enough to be confident in doing it safely. Can we work on this together? And then I can do it by myself after we have checked off my competency,” or whatever it is.

And you don’t owe them an explanation if you can’t make things work with overtime or extra shifts. A simple, “I wish I could help the team today, but I have other obligations and I cannot make it in,” will suffice. Hold your boundary, stay polite and professional, and your team should understand. Remember, making you feel guilty about this is a red flag.

And keep in mind, you are supporting your team in maintaining healthy boundaries by setting this example.

Now, what about those of you who are in NP school? How do we set boundaries with preceptors? I hope that you will never need to use some of these. But sometimes preceptors, even unintentionally, can cross lines, like asking you to chart under their login, asking you to stay late outside of your allowed hours, or do patient care assessments or procedures that you haven’t been trained for. And remember, those are not learning experiences, those are boundary violations.

If something feels uncomfortable to you, trust your instinct. You can very respectfully and professionally say, “You know, I really appreciate the opportunity, and I really want to learn how to do whatever the skill is. I really want to learn how to document. I really want to learn how to do that assessment.” 

And then you say, “But I want to make sure I’m staying within my student scope.” Ask your preceptor to walk you through how to perform that skill or that assessment, or check in with your school if you think something is not allowed. Make sure any documentation is signed off on by your preceptor. You can still get these experiences, but you can do it in a way that protects you and your patients.

Now, this is rare, but I have heard stories of preceptors continuously crossing the line in unsafe ways. If this happens to you, reach out to your faculty or your clinical coordinator. Remember, you’re not being difficult here, you’re trying to be safe, ethical, and professional.

I remember when I was in clinical rotations and I had the opportunities to do skills that I hadn’t done in person yet. Like, I remember removing a toenail, for example. So rather than try to do that on my own, I just asked the preceptor to walk me through it. I wanted to make sure my landmarks were correct when it came to numbing. I needed to make sure the patient consented to me being a student and learning. That’s a big one. All of those things, right? Learning in your textbook, learning in simulation, learning on mannequins is very different from real life.

I also remember working as an RN at the hospital and getting calls constantly on my days off asking me to come in. And it’s tough because I knew the team was struggling being short-staffed, but I also know that I cannot work every day of the week safely. So, would I come in occasionally when I could? Yes, absolutely. But did I also say no sometimes? Absolutely.

So, let’s just reiterate here. Some of the big pitfalls include getting over-involved. Right, we need to re-center on our role and our scope. We want to avoid feeling guilty for saying no. Remember, these boundaries are being professional. They’re not trying to be difficult or rejecting. And lastly, remember to not let patient emotions or employer emotions impact your off hours. Use grounding, use debriefing after emotional visits, remember your why to saying no.

And really don’t think of these boundaries as barriers, right? They really are safety nets. They help us build trust, consistency, and they help us build longevity in our career by not getting burnt out or emotionally exhausted. You can care deeply. You can be a great team member. You can be that student who wants to learn everything, and you should. And you can still have limits. Right? We’re not being unkind, we are being sustainable. 

And remember, you’re not going to nail this right away. Finding the balance here takes time and practice and experience. And you’ll know that you’re growing when you start recognizing red flags early and responding with confidence instead of feeling guilty about it.

Keep yourself healthy, focus on your well-being so that you can also focus on your patients, right? When you respect your limits, you’re actually going to find that you have more energy and compassion to give. And that creates the kind of nurse practitioner we all strive to be and the kind of nurse practitioner that patients trust. 

I know this feels uncomfortable at first, especially when you’re new, and we want to help everyone. But remember, you can’t pour from an empty cup. So every no that you are giving is just making space for a stronger yes later.

So, take this as your little reminder, protect your peace, trust your instincts. Remember that being compassionate and being clear can absolutely coexist.

Now, that wraps up this podcast, but be sure to follow us along. For those of you who are still in school, join us in our next episode as we talk about creating a study plan for your board exam that works for you and how to adapt it to your life. And make sure you follow us on social media. Our Instagram is @smnpreviewsofficial. See you next time.

Thanks for listening to another episode of the Real Deal Nurse Practitioner Club. If you want more information about the different types of support that we offer to students and new nurse practitioners, you can visit npreviews, with an S, dot com. We’ll see you next week.