“Nursing ethics is relationship centered because when your friend, family member, or colleague becomes a patient, that relationship can’t be uninformed by how you know that person before they got sick. The first thing is to recognize you know them, and caring or them poses some fairly unique challenges in terms of, ‘How do I maintain professional boundaries?’” Lucia D. Wocial, PhD, RN, FAAN, HEC-C, senior clinical ethicist at the Lynch Center for Ethics at the MedStar Washington Hospital Center in Washington, DC, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, about the ethical considerations and implications of providing cancer care when people you know become the patient—whether they’re a friend, family member, or a colleague. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: The learner will report an increase in knowledge related to the ethical issues surrounding caring for personal acquaintances.

Episode Notes

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Learn more about the 988 suicide and crisis lifeline.
• Learn more about National Healthcare Decisions Day on April 16.
• Oncology Nursing Podcast episodes:
  • Episode 21: Normalizing the Use of Advance Directives in Cancer Care
  • Episode 78: Ethical Distress Impacts Nursing Practice
• ONS Voice resources:
  • Ethics in nursing topic tag
  • Advance care planning topic tag
  • My Practice video: Advance Care Planning
• Clinical Journal of Oncology Nursing articles:
  • Strategies to Mitigate Moral Distress in Oncology Nursing
  • Advance Care Planning: Having Goals-of-Care Conversations in Oncology Nursing
  • Advance Care Planning: Advanced Practice Provider–Initiated Discussions and Their Effects on Patient-Centered End-of-Life Care
• ONS Moral Resilience Huddle Card™
• ONS Nurse Well-Being Learning Library
• ONS Advance Care Planning Worksheet
• ONS Advance Care Planning Video
• National Council for State Boards of Nursing: Information on professional boundaries
• VitalTalk training program: IMPACT-ICU
• Nursing Code of Ethics
• The Conversation Project
• Conversation tools and games:
  • Hello
  • GoWish card game

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From Today’s Episode

“Nursing ethics is relationship centered because when your friend, family member, or colleague becomes a patient, that relationship can’t be uninformed by how you know that person before they got sick. The first thing is to recognize you know them, and caring or them poses some fairly unique challenges in terms of, ‘How do I maintain professional boundaries?’” Timestamp (TS) 02:55

“Many oncology nurses will see patients over years, so they develop relationships with them, and maybe you see those patients outside of the hospital. It’s hard to turn on and off the professional you from the personal you when those natural relationships form. So, how can you prepare yourself for that? One is: Think about it. If you’re in an environment like a small town or at an important cancer center even in a mid to large city, if you are the cancer center, people are going to come and want to be cared for. So, chances are pretty good that you will, one day, encounter someone that you know in this professional capacity.” TS 09:30

“It’s challenging because there’s this middle zone of helpfulness where on one end, there’s clearly a boundary violation, and on the other end is maybe a boundary crossing. And there’s no right line when we’re taking care of a family member or friend. It’s not like an alarm is going to go off when you cross a boundary and make a slip. So thinking about it in advance is really important, and talking with your colleagues about it openly.” TS 10:41

“Nurses are so well positioned to have conversations with patients about values and goals. If you can learn about patients’ values and goals, you can help them and physicians frame serious news they have to deliver. We’re the most trusted profession. People look to us and think they can have these conversations with us. . . . Some of these patients feel like your friends because you’ve cared for them for years. You have a deep relationship with them that’s been built over several years. Those are the times where you feel like somebody’s got to have this conversation, and I know the information. What is my role here? What does the code of ethics tell me I’m supposed to do?” TS 26:07

“People ask me all the time: ‘What would you do?’ Do I answer the question? When people ask me that question, I learned recently a really nice way to answer that question. ‘First of all, I’m not you, but I’d like to help you think about it. Can I help you think about this?’. . . And sometimes after all of that, patients will still press, ‘Well, what would you do?’ And as long as you’re clear and say, ‘I’m not you. If I tell you the decision I would make, I need to tell you why. And here’s the decision I would make and here’s why.’. . . What’s within your scope of practice? It is within everybody’s scope to ask permission to the patient and say, ‘Would it be okay if I shared something with you?’” TS 28:44