Warning signs of sexual boundary violations

Sexual boundary violations often are not overtly "wrong" until you put all the pieces together and see that the health care professional is no longer maintaining a professional distance from the patient, says Deborah S. Stephens, RN, BSN, JD, CPHRM, risk manager at Spectrum Health in Grand Rapids, MI.

Bridget Tucker Gonder, RN, BSN, JD, CPHRM, associate legal counsel for the health system, also cautions that the patient may not view these transgressions as unwelcome initially. But often, the extra attention or flirting from a physician eventually will make the patient uncomfortable and lead to sexual misconduct charges.

Stephens and Gonder offer these warning signs that a health care professional may be committing sexual boundary violations:

  • increased or inappropriate self-disclosure by the professional;
  • longer appointments or appointments at the end of the day;
  • meetings outside the office;
  • use of alcohol or misuse of drugs;
  • suggestive or seductive statements;
  • intrusion into the patient's personal life, such as calls to his or her home or attending social engagements when the provider knows the patient will be there;
  • requests for secrecy;
  • inappropriate physical or sexual contact;
  • sharing personal information with the patient.

The health care professional who commits sexual misconduct often is experiencing situational stress from difficulties at work or home, and some are addicted sex or drugs, Stephens says. Others have a personality disorder, but many have poor communication skills and an ignorance of boundaries that makes them think the patient wanted the behavior. That's no excuse when it comes to actual sexual misconduct, Gonder says.

What do patients think?

Stephens and Gonder offer additional examples of how staff are encouraged to consider the way patients may perceive misconduct. Staff are encouraged to discuss these scenarios and the potential ramifications. As these examples show, sometimes the caregiver's intention is clear and sometimes it is not:

  • As the physician is performing an assessment that involves touching the patient, he is discussing last night's date. This makes the patient uncomfortable, and she wonders why the doctor is sharing private information. Doing so while touching her heightens her discomfort. Was the doctor flirting with the woman, or was he just clueless that his comments were inappropriate?
  • A nurse is attending to a mentally disabled patient and does not take the time to explain what she is doing. As she tries to apply a monitor strap, he pulls away in fright and later reports that she touched him inappropriately. How could the nurse have prevented the problem?
  • A physician tells his attractive patient that he enjoys dating long-legged women like her and asks what kind of man she likes. Is there any doubt that the comment is inappropriate? What if she responds favorably? Does that make difference in whether it was wise to make the comment?


For more information on preventing and addressing sexual misconduct, contact:

  • Deborah S. Stephens and Bridget Tucker Gonder, Spectrum Health, 100 Michigan St. N.E., Grand Rapids, MI 49503. Telephone: (866) 989-7999.