I’m often asked about a “typical” board investigation. I’ll get this out of the way directly: there is no such thing as a typical board investigation. Board investigations, whether initiated by the Board of Social Work, the Board of Medical Practice, the Board of Nursing, the Board of Psychology, or any of Minnesota’s other licensing boards are as varied as those individuals who hold a license to practice before them. While there is no typical board case, there are frequently arising themes of Board investigations. I will be exploring those themes one at a time over the weeks ahead.
Repeated Boundary Violations: With the advent of approximately 225 ways for people to reach out and touch someone comes a whole host of new problems regarding professional boundaries. Whether it is text messaging, sending emails using one's personal email address, or connecting with individuals through Facebook or Instagram, the accessibility of electronic communication can be inversely correlated to the maintenance of professional boundaries. To avoid becoming ensnared in this boundary problem, professional license holders should be aware of the following:
1. Personal text messages should be avoided: Simply put, do not get involved in a texting relationship with a patient or client using your personal cell phone. Your patients or clients have to have your personal cell phone number in order to text you on it. It seems simple, but don't give them this number. Maintaining a record of patient or client text communications that were exchanged on your personal cell phone is a charting/record-keeping nightmare. If you have a bright-line rule that you religiously follow, you will entirely avoid this potential boundary pitfall and your patients and clients will respect this clearly drawn line.
Please note that I am talking about a personal cell phone. Some facilities have policies which permit care providers to text patients or clients with appointment or medication reminders or similar information in order to improve patient outcomes. If your facility policy allows it, by all means use your work phone to transmit permissible information. Outside of this exception, however, texting patients and clients should be avoided.
2. Avoid social message board relationships: Your current patients and client should not be your Facebook friends in most instances. It is wise not to put yourself in a position where you are explaining to the Board why you are posting your patient about her weekend plans or commenting on his kid's photographs on Facebook. You also run the risk of inadvertently exposing the nature of your relationship or confidential information by commenting or responding to a post. In this area, it is better to be overly cautious in my opinion.
3. Email very sparingly and only use a work email: We stop and give a moment of thanks for the Patient Portal. It has given a way for our medical professionals to quickly and efficiently respond to patient questions while creating a record of the communication. Having said that, email is fraught with potential problems of which we are all certainly aware. There are miscommunications. Tone is lost. Advice is imperfectly transmitted. Use it very carefully, in accordance with any facility policy and make it a part of your record keeping.
Of course, the potential for boundary violations is much broader than just the use of electronic communication. Its prevalence, however, has led to increase concerns by Minnesota's licensing boards in the administration of ethical rules they promulgate.
The Minnesota Board of Nursing makes resources regarding professional boundaries available on their website. You can access them HERE There are also continuing education courses that address the maintenance of professional boundaries. These materials address a wide range of potential boundary violations.
Next week, we'll move onto Board inquiries into dishonesty in a multitude of forms.
