Podcast: Asserting professional boundaries with Dr Wendy McIntosh

Episode: 33
Guests: Special guest co-host Tessa Moriarty, Georgie Southam and Kat Evans
Duration: 49:58
Tags: professional boundaries, assertiveness training, communication
Soundcloud: Listen to Episode 33

Understanding professional boundaries is vital for nurses and midwives to practise safely and adhere to our registration requirements and protect ourselves and the public from harm. Unfortunately, asserting professional boundaries isn’t always easy.

At Nurse & Midwife Support we often hear from nurses and midwives that navigating professional boundaries can be complex. We support nurses and midwives impacted by boundary transgressions or with questions about boundary management. We know that managing professional boundaries may not always be black and white and we are here to support you.

The Nursing and Midwifery Board of Australia (NMBA) also recognise that managing professional boundaries can sometimes be difficult, particularly identifying and differentiating the boundaries between professional relationships and personal relationships. That’s why they provide guidance on professional boundaries in the respective Code of conduct that aim to protect the community by helping to prevent distress, confusion, harm, or abuse of people being cared for by nurses and midwives.

But professional boundaries aren’t just important for protecting the people we care for — they’re vital for protecting clinicians too. Understanding professional boundaries is important for your professional wellbeing. That’s why we asked Dr Wendy McIntosh to join us on the Your Health Matters podcast to provide you with the facts, information, resources, and support you need to confidently assert your own boundaries.

Wendy has spent many years studying professional boundaries. She has 30 years’ experience as a registered nurse in clinical, education and research settings, including twenty-five years in mental health. She takes a special interest in professional supervision, professional boundaries, professional identity, links between childhood trauma and mental illness and workplace bullying. We are so grateful that Wendy has joined us to explain what she has learned about professional boundaries and how they will support your professional health and wellbeing.

Wendy has also written a blog for us on the topic: “That’s enough now”— professional boundaries fortify self-care.

She writes:

“That's enough now” is a phrase I developed while supporting professionals to identify and address factors that led to their boundary transgressions. “That's enough taking work home”, “that's enough workplace bullying”, “that's enough working long hours”, “that's enough unpaid overtime”. That's enough now.

Wendy believes “That's enough now” is a crucial phrase to help nurses and midwives create and reinforce boundaries, and that we should start practicing it at the undergraduate level. Check out the blog to learn more about how you can practice saying “That’s enough now.”

Check out the blog

Talk to us about it

Professional boundaries matter! If you need help figuring out how to build and maintain your boundaries, we’re here to chat about it. Give us a call on 1800 667 877 or email us.

Dr. Wendy McIntosh PhD RGN, RMHN, Grad.Dip MH, MN, Cert IV Workplace Assessment & Training, Group Leadership Cert, MRCNA, MANZCMHN, AMANZSPA.

Dr Wendy McIntosh currently works with the Davaar Consultancy to promote the importance of psychologically well employees to the delivery of safe and competent health care. Wendy has more than 30 years as a health professional (clinical, education and research), twenty-five of those years in mental health. Areas of specific interest and passion for Wendy include: professional supervision, professional boundaries, professional identity, links between childhood trauma and mental illness and workplace bullying. Wendy has more than 20 years as a psychodrama trainee – a life long learning. She is committed to using experiential learning in the work she does with individuals and groups. Regularly presenting workshops at national & international conferences, Wendy consistently receives feedback on her passion, knowledge and creativity as a presenter & facilitator.

Email Wendy

Mark Aitken [0:09] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Mark Aitken, the podcast host. I'm the Stakeholder Engagement Manager with Nurse & Midwife Support, and I'm a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free, and you can call us anytime you need support. 1800-667-877, or contact us via the website: nmsupport.org.au.

Hello, and welcome to Your Health Matters podcast. The podcast title today is 'How Professional Boundaries Can Be Integral to Your Self-Care', and the theme of this podcast which will become clear throughout our conversation is: 'That’s Enough Now?' So hopefully, that's hooked you right from the beginning, because it certainly hooked me when I read it.

I'm really pleased to welcome my guest today, Dr. Wendy McIntosh, PhD, registered nurse and consultant with Davaar Consultancy, training and development. So hello, and welcome, Wendy. Please tell us a bit about yourself and your background.

Wendy McIntosh  [1:32] Thanks very much Mark. I am so delighted to be here and to have a conversation with you. Mark, I'm from Scotland, some of the listeners may already have picked that up, from the west coast of Scotland, from an area that Paul McCartney sang about, actually, the Mull of Kintyre. I did my nurse training, general nursing initially, and then psychiatric nursing, as it was called in those days, in hospitals in Glasgow, in Scotland. And then about 1986, I moved to Australia, initially Perth in WA, and then Queensland, and that's where I've been since 1994. So despite the accent, I am now more Australian than Scottish. 

Once I finished my general training and found psychiatric nursing that really was where my heart was. I loved being able to be with patients, to sit with them, to walk with them, to engage with them in different activities that we did. I really learned so much from just being in that professional relationship with patients. As I've been reflecting and doing my work on professional boundaries, I can see that they were my teachers in so many ways about professional boundaries. 

Then, in a job as an educator, I was invited by the director of the hospital to do some education on professional boundaries and I got really hooked into the topic. I think at that time, which would have been about 2003, 2004, I probably knew as much about professional boundaries as anyone else, which was: do not have a personal relationship with your patients under any circumstances. I had no idea at the time what that meant. I mean, I had some idea, obviously. But this has been an incredible journey for me, Mark, and it has become a life's work. So really, since 2005 professional boundaries has been my focus. Every time I do a workshop, every time I do one-on-one work with a person, I learn so much more. So I'm really grateful. I think [with] this conversation I'll probably learn some more again. 

I do one-on-one work. I do a lot of workshops, where I'm invited by organisations to do workshops on professional boundaries, or working with mental wellbeing in the workplace or how to develop depth and connection within teams that are newly forming or where there's been disunity and they want to look at how to bring unity back to the team. I've had a great privilege of being able to develop Internet tools, one of them being on professional boundaries, to develop a series of podcasts on professional boundaries, and that was a huge learning for me. I learned a lot more about what drew me into this area. I've developed a podcast [and] workbook that goes with that. I've developed some flashcards. So when I go to workshops, put them out on the table and ask people to choose a letter and each card, each letter has three words connected to professional boundaries, and I give them those three words as a gift to take away. Professional boundary markers is an ongoing process. It's something that once we start the journey, we should never close the door to learning. 

So that's a bit about me!

Mark Aitken [6:02] Thanks, Wendy. Well, I think today we're speaking to exactly the right person about this very important topic. I think that nurses and midwives broadly know what professional boundaries mean, as you say. I always thought I had a broad understanding, but it was only when I worked with you, Wendy, and you did some training for our group of clinicians at Nurse & Midwife Support that I came to realise that professional boundaries is multilayered, and there's many facets to it. 

I think it's really important that nurses and midwives have conversations about professional boundaries, and are actually given permission to speak about those boundaries and to be skilled in relation to them and boundary transgressions and how to manage boundary transgressions, which we'll talk about today. 

So Wendy, given that, I think it's really useful if we start with your definition of professional boundaries.

Wendy McIntosh [7:05] The definition that I use in workshops and training is one that appears frequently in most literature around professional boundaries, and that's that professional boundaries are the limits that protect the space between a professional's power and the client's vulnerability. That in itself says a lot. but if you don't actually understand what it really means, it means nothing. 

So I then add some other bits that go something like, professional boundaries is about your safety. When you are safe with your boundaries, your professional relationship with your patient will be safe. Professional boundaries is also about your wellbeing. If you establish and maintain good boundaries, your wellbeing will be sustained for much longer in this profession, which asks a lot, be that of a nurse or a midwife. But the most common definition [is that they] are the limits that protect the space and that space is really important. That's the psychological, emotional, physical space between two people. In this case, the professional's power and the client's vulnerability.

Mark Aitken  [8:39] Thanks, Wendy, that's a really great and comprehensive definition. Why are professional boundaries important, do you think, for nurses and midwives to have?

Wendy McIntosh  [8:50] I think they're really important, Mark, because when we really understand them, we understand that professional boundaries start and end with us. So we need to have a really good sense and awareness of who we are when we go to work each day, who we are when we interact with each patient that we interact with, and indeed collegially as well. By that I mean, the nurse that I am to Patient A could be quite different to the nurse I am to Patient B. That might be based on gender, age, tone of voice, how they address me, how I address them. So the 'who' in me is not just Wendy the nurse when I go to work. What age is Wendy operating from when she talks to Patient A, compared to what age is Wendy when she talks to Patient B?

I think it's really important because every day preparing to go to work, we prepare to meet with patients that will potentially trigger different internal role systems for us. We understand ourselves, we understand boundaries better, we understand what's going on for us in response to the relationships we're having with our patients.

Mark Aitken [10:26] That's a really important point too, Wendy. Could you talk a bit more about that concept of what age is the nurse when she or he might be interacting with Patient A, as opposed to Patient B? What does that exactly mean?

Wendy McIntosh  [10:42] I can talk from my experience, Mark, there've been some patients that I've worked with...maybe they'd be age respective with my parents. There would be a tone of voice like, "Oh, for goodness sake, nurse," and I'd go, internally...it wasn't totally conscious, but internally, something was triggered for me, it's like I was in relationship with my mother. Quite often, I would then respond from the role of a child, you know, like, "Well, it's none of your business," or, you know. 

This kind of relationship that can be triggered really quickly, that takes us out of that professional role into a much younger role response. Other patients might say things like, "Oh, goodness, you're just like my granddaughter!" and if I'm not going to work fully prepared with boundaries, and say, for example, I've just lost my grandmother, and I'm still grieving for her, for a patient to say that in such a loving way, "Oh my goodness, you're so like my granddaughter," then that could be a trigger that takes me into a relationship with her where it's granddaughter/grandmother, rather than nurse/patient, so I potentially will lose my objectivity. I will potentially slip out of my professional role, and maybe I give that patient a bit more attention, a bit more care, a bit more kindness. 

So who we are when we're relating in a moment with all patients is very important, Mark.

Mark Aitken  [12:43] Absolutely, Wendy. What I hear from this is despite the fact that we're nurses and midwives, and we're trained, hopefully, to an extent around awareness and knowledge around professional boundaries, at the end of the day, we're all human, with our past, our upbringing, trauma, perhaps, significant things that have happened in our life that we packed away. And because we're human, we may be triggered by an interaction with the patient. We may not necessarily notice that. 

What I'm hearing here, Wendy, is that it's really useful if nurses and midwives have an awareness of this, and that they will inevitably be triggered by an interaction with a patient or a client, or that person they're caring for, to actually then not bury that trigger or response, but to note it and their reaction. To give themselves some space and time to reflect on that and perhaps get some support around how they're feeling and why they're feeling that way, and to explore that a bit so they can better understand it. 

Would you say that's a reasonable summation of some of what you talked about there?

Wendy McIntosh [14:09] Yeah, I think that you're absolutely correct there, Mark. There are a couple of questions that I'll pose to people I see. One of those questions will be, what age was the other person in the moment of that interaction you had? What was the drama? It might be nurse/patient, but is it an earlier drama that's now been drawn out? What age were you and what role were you in? 

Professional boundaries for me, Mark, does invite us to engage in self-inquiry and self-reflection, and sometimes, Mark, it's not until we're driving home or walking home and we go, "Gosh, that was really interesting. I've never said that to a patient before, or I've never agreed to that with a patient before." That's just because when we're at work, we're busy. Most nurses and midwives work in highly emotive, reactive circumstances, so we just do, do, do, do. It's not until we're away from the doing that we have time--unconsciously, most of us--to process it. But those are really good red flags. Why this patient? Why now?

Mark Aitken [15:47] Yes. I think this goes to the importance, Wendy, of clinical supervision for nurses and midwives. We had a whole podcast on the importance of clinical supervision. I'll put the link to that podcast with Julie Sharrock in the show notes for this episode. 

I also think it [shows] the importance of...if you are triggered by an interaction or a reaction to somebody you're caring for and you feel uncomfortable, feel like you need to talk about it, and you need support in a confidential way, that's a reason you can call Nurse & Midwife Support. Our registered nurses and midwives understand the world you live and work in, we've all potentially and probably been where you are at. You can contact the service on 1800-667-877, or via our website, nmsupport.org.au. 

Now, as we identified, Wendy, at the beginning of this podcast, this subject is multilayered and multifaceted. I'm interested in how you became interested in this subject.

Wendy McIntosh [17:00] Yeah, that's such a good question, Mark. As I said earlier, I was an educator at a psychiatric hospital, mental health hospital, when the Director of Nursing asked me to do some education on professional boundaries. I did get interested in it because I had to read, I had to research, I ran a hypothetical as part of the workshop. That was really interesting, because I had people in different roles. The role of a patient, the role of a nurse, the role of a family member, the role of a representative from a regulatory board, and I just asked them to respond as though they were those people. That was one of those lightbulb moments for me about, "Oh, my goodness, there can be this interaction between two people, and everybody in the room sees something different, or hears something different, or interprets it differently." So that got me really interested. 

Then I went along to a two day seminar on professional boundaries, and one of the keynote speakers was Dr. Glen Gabbard, who was considered at the time and possibly still is [considered] to be a bit of a guru in the area of professional boundaries. Of course, they asked if there were any questions from the audience. I stood up and I said, "I really like what you're saying about professional boundaries and I'm on board. However, I'm a nurse, and you're talking about receptionists who make appointments about saying goodbye to one client, and then having time to write your notes before the next client comes in (this is in the therapeutic, or the psychiatrist domain)." 

I said that as much as we don't have that privilege of time, I might see a patient walk out and another patient asks me for their medication, I don't have time to do the processing. In all seriousness, he looked at me and he said, "Well, I think that's something that nurses have to sort out then." I went "Challenge accepted," and that's what got me going back. I thought, yeah, I'm gonna really work at this and really figure out how do we do professional boundaries as nurses and midwives? How can we do them better? How can we ensure that we look after that relationship that we have with our patients in a safe and respectful way?

Mark Aitken  [19:59] I think that's really interesting, Wendy. I imagine every nurse and midwife listening to this podcast, would've had that moment in their career, where they hear a great speaker, and they feel a call to action to engage in a particular area, or further their curiosity around exploring it. For many people I think that results in further study or a career passion and a life passion. It sounds like that's been your experience here. Now, I know you've got a PhD, Wendy, we said that at the beginning of the podcast. Can you share a bit about what you did your PhD on? Was it related to this topic?

Wendy McIntosh [20:47] Not at the time. But I refer to it frequently in training that I do, or one-to-one work that I do, Mark. 

I was working in a specialised trauma unit, and I noticed the interactions that patients had with us, with other patients, and in fact, the relationship that they had with themselves, which resulted in lots of self-harm behaviours. At the time, I was thinking I wanted to do research on workplace bullying, because I'd experienced workplace bullying. As I started to research the literature on workplace bullying, I realised I'd also been a perpetrator of workplace bullying in my life. I [wondered], how can I do something different? It's an area that's been well-researched. As good supervisors do, they said, "See if you can find a gap." 

I worked in this environment with patients where every boundary had been violated in childhood: sexual, physical, emotional, psychological. Then I'd go into the nursing tearoom, and I would watch and be part of conversations or interactions, and I'd go, "Oh, my goodness. It feels like I've just walked out of one ward into another ward. I wonder if shame--because shame was the overriding emotional experience of patients who've experienced trauma--I wonder if shame is a missing link in workplace bullying."

That became the topic of my PhD, shame in the nursing culture. What I wanted to look at was did that exist, and if it did, could that be a bit of a missing link in terms of the literature on workplace bullying? Unless we owned shame that might be there in the nursing profession, for whatever reason, unless we explored it, had robust discussions about it, then my concern was that we would continue to perpetrate shame on other people.

Mark Aitken  [23:35] I think that's a fascinating area to explore, Wendy, and no doubt people will be very interested to connect with your work. They can do that via your website. Can you share those website details again with us, please, Wendy?

Wendy McIntosh [23:52] So it's www dot dash dash, 'davaar'. D for donkey, A for apple, V for Victor, A for apple, A for apple, R for Robert, com.au. [www.davaar.com.au]

Mark Aitken [24:10] Thanks, Wendy. There's some wonderful resources on that website and I'd encourage you to have a look at those if you want more information, or to explore this important topic more. Now, as part of this podcast, we've also got a blog that Wendy wrote and the blog is titled 'That's Enough Now: How Professional Boundaries Can Be Integral to Your Self-Care.' Self-care is something that we champion and promote a lot of [at] Nurse & Midwife Support, and it's vitally important for nurses and midwives that they remember that when you're in the care and service of others, you really need to care for yourself and pay some attention to your own self-care. 

Wendy, how does this important subject of professional boundaries connect with self-care for nurses and midwives? 

Wendy McIntosh [25:06] Mark, I think it's a very important relationship, and very integral. I know from my own experience, I know from the work that I do with health professionals, that without good professional boundaries in place, there can be significant psychological and emotional damage. I don't think that's too strong a word to use for both the health professional and the patient. In some cases, [there's a] physical concern, and in some cases, where there's been sexual mistreatment, sexual abuse, sexual harassment, then of course, that's a really deep level of concern, in terms of wellbeing. 

As I said earlier on Mark, I think, when we understand professional boundaries...and this is not something that people learn overnight, or in a one day workshop with me, in fact at the beginning [inaudible] not sure what to say, we're going to scratch the surface. Being in this workshop is really easy for me, the hard part is when you go back to work tomorrow, and you now start to try and integrate some of this stuff into your work. I advocate, absolutely, for mandatory training yearly, because we always need to top up, we always need to revisit. I absolutely believe that without good boundaries in place, our wellbeing will be affected, you have spoken several times, Mark, about the care that we give. 

We give a lot, and nurses and midwives have given so much during COVID-19 at great cost, and for multiple reasons. The cost when we keep giving and giving--for any human being, but especially in nursing and midwifery--we keep giving and giving but we don't fill up for ourselves, [the cost] is we experience burnout. We experience compassion fatigue, we may even experience some psychiatric illness such as depression or anxiety, perhaps even Post-Traumatic Stress Disorder because of the work environment and the trauma that we have to deal with from patients' experiences. 

Good professional boundaries in place mean that we go to work each day, and we know what we have to do. We're really clear about what we have to do and what we've been paid to do, rather than what we want to do, which is a really important element in professional boundaries. If I want to go in and make everybody feel good, if I want to go in and make people feel better, that is just beyond my capacity. But can I go in and provide really good care? Yes, I can. Can I go in and ensure that the medication I'm about to administer is the correct medication? Yes, I can do that. So good boundaries means I am really clear on what is expected of me as a nurse as opposed to what do I, Wendy, want to be able to do today for the patients that I provide care to?

Mark Aitken [29:13] Thanks, Wendy, I think they're important points and going to the issue that we've spoken to quite a bit in this podcast, that there's so many layers to this important discussion. Communication is a key element, I believe, in establishing professional boundaries. It's something nurses and midwives often contact us about: how they can effectively communicate with their patients or the people they care for, their colleagues and indeed people outside of work. So how can nurses and midwives communicate more effectively, do you think, Wendy, to establish and maintain professional boundaries?

Wendy McIntosh [29:53] Mark, again, it comes back to when you understand and integrate boundaries into a professional role, that's an important first step. To really understand the nuances and complexities and they are multilayered, as you say. When I see someone because a complaint has been put in against them, for example, via a regulatory body, then part of what is confronting for them is how little they knew about professional boundaries in terms of those nuances and the complexities, so it's important that we understand that.

I believe we need to develop the courage and the professional authority to be able to establish and maintain boundaries. Now I want to be really clear, Mark. To me, there's a big difference between professional authority and being authoritarian. In professional authority, I mean that I have a really good understanding of my professional codes, my Code of Ethics, my Code of Conduct. I've been through the criterias, I've discussed the criterias with trusted colleagues, I've really got to understand what am I being asked of as a professional, so that I'm not just saying to Patient A, "Okay, we're not going to go there anymore. That's not a topic that I'm prepared to talk to you about." 

I'm not only doing that to protect my personal life, and perhaps my family, but I'm talking from the authority of my professional codes, that say be really careful around self-disclosure. Because you're there to provide care, you're not there to talk about yourself, and you're certainly not there to talk about issues that are going on for you in your life. 

I'm really strong on this, Mark, no nurse or midwife should be going in and talking to any client about how awful the workplace is, how awful their life is, because patients worry about us. We should never walk out of a room and have that patient concerned about our wellbeing. We need to develop the courage to be able to say, "Thank you so much for inviting me to your birthday party, I am not able to do that. Thank you for asking me what my mobile number is, however, I will not be giving you my mobile number." A large part of that, Mark, which is going a bit deeper, is that we have to understand that saying no, setting limits, is not something to be guilty about. It's actually a responsibility, and a duty of care. 

Many people that have worked with us over the years have said, "Oh, I feel really guilty. I think I should be giving this patient more. This patient is very lonely, and I just want to decrease their sense of loneliness. I don't want to upset them. I don't want to offend them." I will work with them on that role development to move them beyond feeling guilty to really appreciating that certain boundaries, in some cases, can be life saving.

Mark Aitken  [34:22] They're very important points, Wendy, and thank you for raising those. If you want to read more about what Wendy's talking about here, once again, I'd encourage you to check out Wendy's website and her excellent blog: 'That's Enough Now: How Professional Boundaries Can Be Integral to Your Self-Care', and those are available on our website. I think what I've really connected with here, Wendy, is once again, check in with yourself regularly, and if you feel uncomfortable about an interaction with somebody you're caring for, talk to somebody about it. You can call Nurse & Midwife Support to do that. 1800-667-877, or contact us via the website, nmsupport.org.au. 

Wendy, if a nurse or midwife finds themselves in a situation where boundaries are transgressed, what is the best way for them to communicate this? Is 'that's enough now' a statement they could use?

Wendy McIntosh [35:28] It is a statement to use internally, it's like a red flag. Sometimes our body responds quicker than our brain. So our body would put a hand up, or we cross our arms, or we move back. In a way, that's our body setting a boundary. If we can capture our body giving us a message, then internally we go, that's enough [inaudible], and then that starts an internal line of inquiry. Like, what is 'enough now'? Is that too [many] personal questions a patient's asking me? Are they asking me questions that would take me beyond my scope of practice? 'That's enough now' is an internal red flag for us to pay heed to and then start an internal line of inquiry. 

Mark, I think when we recognize that a transgression has occurred, and again, we might not get it in the moment, it might be driving home, it might be reading something, it might be listening to one of my blogs, for example, it because again, if we don't actually understand what professional boundaries are, then how do we know we're about to transgress them? The first thing to do would be a series of questions, which is, what was the purpose of what I said and did? (This is internally.) Whose needs were being met? Was there another option I could have used, and what stopped me using another option? I'm just going to revisit those questions and tease them out a little bit more, Mark. 

So the first question, what was the purpose of what I said or did? If in the moment, for example, a patient says, "I'd really like you to come to my 21st birthday party," and I've really enjoyed the relationship that I've had with the patient. I've only ever seen it as professional. It's been complimentary, reciprocal so it doesn't come as a surprise to me that I've been asked to their 21st birthday. I don't really think it through and I say, "Oh, okay." 

So if we go to that first question, what was the purpose of me accepting that? Initially, I would say, "Well, the purpose was the patient asked me so of course, I just said yes." But we have to go deeper and go, yeah, but what was the main purpose? Well, I quite liked the patient and I didn't want to offend them. It was such a nice invite. So then we go to the next question whose needs were being met, first base again. Well, the patient invited me. So I just thought it was a reasonable thing to do to say "Yes." Dig deeper, whose needs were being met? Again, there's a part of me that really wanted to go to that 21st party. So I said, "Yes." Were there any other options I could have used? 

Mark, in the work I've done, I've been able to identify there will always be at least five options to that initial response. But we can only develop those five options through really understanding professional boundaries. So were there other options? Absolutely. I could have laughed it off. I could have said "No way José!" I could have said, "Wow, that's a really nice invite. Sorry, I can't go." There will always be at least five options. What stopped me using another option will generally take me back to question two: whose needs were being met? Mine. I actually really wanted to go and celebrate this person's 21st birthday. I've been travelling with them over a number of months. I've watched them recover from serious injury.

I've watched the love that this young person's family gave them. I was very grateful and appreciative that I was a nurse who was able to attend to this patient and my heart was very big for this patient. So whose needs were being met? Mine. I really wanted to celebrate this person's 21st birthday, because they made it through. We ask those questions, and then we go, I accepted the invite. Yes, that is a transgression. What do I do now? 

Well, as you've already said, I think it's good to find a trusted colleague to run this by. By a trusted colleague, I don't mean someone who will say, "Don't worry about it. Off you go. Don't tell anybody. I won't tell anybody." That's not useful. I mean, a trusted colleague, who can say, Wendy, what was going on for you at the time, when you accepted that invite? The fact that you're bringing this to me...what concerns do you have that you've accepted the invite. A trusted colleague who, with my professional being in their interest really takes me on again, another journey of self-awareness and self-discovery. 

Talk it [through] with a trusted colleague, come up with a strategy. That strategy would be to go back to that young person and say, "You know what, I really do want to thank you for your 21st birthday invitation. However I really thought about this, and this is a time for you to enjoy being with your family, and not to have someone from the hospital there to remind you of being in hospital." I mean, you don't have to be that elaborate, but you would have to go back...well, you would, that's a very strong statement. By resetting the professional boundaries, the professional thing would be to go back and say, "I'm really sorry. I've reconsidered and I cannot come to your 21st birthday."

Mark Aitken [42:28] Good advice, Wendy. Do you think managers have a role to play here? Can they support a nurse or a midwife who may feel they've transgressed a boundary to explore that issue?

Wendy McIntosh  [42:43] Absolutely, I think not only to explore, but to role model it. Professional boundaries need to be role-modelled at all levels in an organisation. I mean, that collegially as well, Mark. In places where I've worked, or in the work that I've done with people, where collegial boundaries have been blurry, then generally, we will see higher incidence of transgressions with patients because nobody's holding the line. So many people that I've seen over the years, I've said to them, "Who did you check this out with?" and they said, "Oh, yeah, I went to my manager, and he or she said that it was okay to do that." "Okay. Did you go and check it out with someone else? No? Okay. Well, it's always good to check out a few people and get a bit of a barometer, or go to the literature and read it." Do not just accept one person's idea, or a reinforcement that it's okay. 

I think what works best, Mark, is where managers really explore. What do you think was going on for you? What do you think happened? What makes you think this was a boundary transgression? Because the more curious a manager is with a staff member, the more curious that staff member will be with themselves and their actions, and that's what we want. We want people to be curious around professional boundaries. Why now? Why this time of day? Why this patient? I've never said this. I've been nursing for 25 years. I've never said this. I've never done that with any other patient. 'Why now' is a really important question. Mark, that requires then, that nursing managers, supervisors also need to have good knowledge and good understanding of the nuances. and the complexities of professional boundaries. It's more than just holding the line. It's understanding who am I when I go to work? Who am I, when I'm engaging with Patient A and in what way is that different from when I'm in engaging with Patient B?

Mark Aitken  [45:23] Thanks, Wendy. Oh, goodness, there's so much I want to ask you about this, but we're really coming to the end of the podcast, so we may have to have you back for Part 2. What I love to do, Wendy, as part of the podcast is ask your advice for students and early career nurses and midwives around these important issues. If you were talking to a group of students and/or early career nurses and midwives, what would you say to them about professional boundaries?

Wendy McIntosh  [45:55] I'd say professional boundaries is about your safety. When you're safe in your boundaries, then the relationship that you have with your patient will be much safer. Explore what professional boundaries is and what it means for you. Understand the context that you work in. [For] a nurse working in mental health, the context around professional boundaries will be somewhat different to the nurse working in accident emergency, there will still be Code of Ethics, Code of Conduct ideals to work towards, principles to work towards around professional boundaries. But the context that you work in, will change that somewhat. 

And really understand your job description. If there's something in your job description criteria, that you just do not understand, please clarify it, because if you don't really understand it, you will make it up and you will make it up from the familial, from the cultural, from perhaps a spiritual basis from which you come. From your moral compass, your family, community moral compass, and most of the time, it may be okay, but sometimes that may be the transgression. Don't go to work [and] make things up around professional boundaries, really understand the role that you've being paid to do, and if you have any concerns at all about what you see or what you do with a patient, seek out a trusted colleague.

Mark Aitken  [47:58] Great advice, Wendy. Thank you. We really are at the end of the podcast. So thank you, but any final words of wisdom?

Wendy McIntosh  [48:08] I think professional boundaries is about your wellbeing. Think about how to establish and maintain professional boundaries to sustain you in the career that you've chosen to be in, and probably love.

Mark Aitken  [48:29] Wonderful, wonderful wisdom Wendy, thank you so much. We really appreciate your expertise, your passion for this really important subject, your time, and your willingness to share all of your wisdom and learnings. Thanks very much, Wendy. It's been a great conversation. I know our listeners will benefit from it, and if you want more information, check out Wendy's website. Those details again, Wendy?

Wendy McIntosh [49:00] www.davaar.com.au. D for Donald, A for apple, V for Victor, A for apple, A for apple, R for robert, .com.au.

Mark Aitken  [49:15] Thank you very much. Remember, if this podcast has raised any issues for you, or concerns, please contact Nurse & Midwife Support for support. We're ready, willing and able to speak to you and support you. 1800-667-877, or via the website nmsupport.org.au. Look after yourselves and each other, and I'll speak to you next time. Bye for now.