Ethical Issues

As an RPN, you will encounter ethical dilemmas each day that you practice. It is important that you are able to manage these issues and resolve them in the client’s best interest. Below you will find scenarios to help you consider strategies and resources for addressing ethical issues.

Scenario # 1

Barb is an experienced RPN working in a complex care unit. One of her clients is a man with progressive dementia. His wife visits regularly and she has been experiencing a grieving process as she has watched his progressive decline and failing memory. Barb’s husband recently died from a similar dementia, so she has a firsthand understanding of what Rose is experiencing. Rose has approached Barb on several occasions at work to discuss her coping difficulties. Barb has suggested she might consider extra support at the local Mental Health Centre’s weekly Grief Support group, as it has been helpful for her. A couple of weeks later, by chance, they both attend the same Grief Support group meeting and at the end of the meeting Rose invites Barb for coffee at Starbucks.

Can Barb accept the invitation?

  1. Yes
  2. No
  3. It depends

Which practice standard(s) would guide Barb in helping her make this decision?

  1. Privacy and Confidentiality
  2. Appropriate Use Of Title
  3. Boundaries in the Nurse-Client Relationship
  4. All the Above

What are the some of the potential conflicts that could arise if Barb and Rose entered into a friendship?

What other resources can assist and guide RPNs facing nurse-client boundary issues?

Scenario # 2

You are a practising RPN and you and your friend Kathy go to a party. John, a former client of yours, is at the party and starts chatting with Kathy. They are instantly attracted to each other and have a lot in common. Over the evening they become very friendly and make plans to meet again soon. Although you know John well, he does not acknowledge you, nor does he tell Kathy about how you know each other. You know John’s psychiatric history includes a diagnosis of bipolar disorder, and that he experienced several manic episodes involving ruinous spending sprees and severe agitation and physically threatening behavior.

What would you do in this situation?

  1. Acknowledge to Kathy that you know him from somewhere, but give no details
  2. Avoid engaging in conversation with him
  3. Suggest to Kathy they leave the party before she can make plans with John
  4. Reveal to Kathy that he is a former client of yours but nothing else
  5. None of the above

A couple of weeks later, you are at another social function and Kathy and John are also there. Kathy approaches you and tells you she really likes John and has been on several dates with him. She says he has given her several expensive gifts and she wants your opinion about her new boyfriend.

Which is the best response?

  1. Say that you don’t know him well enough to comment
  2. Say that he seems nice based on this evening’s event
  3. Say that you do not like him
  4. Say he is a former client and therefore you can’t discuss him
  5. Say that you know him from work

Sometime later, Kathy tells you that John has been calling her in the middle of the night (sometimes as many as four times) to say that he is not able to sleep and wants her to talk or go for coffee. He has done this three times in the past 2 weeks. She knows you are a psychiatric nurse and asks you for advice on what could be going on and what she should do.

Which is the best response?

  1. “Do you think there is anything else going on? Have you noticed any other unusual behaviour?”
  2. “Based on my professional experience, it sounds like he might be having a manic episode.”
  3. “You have gotten to know him, what do you think is happening?”
  4. “Sure seems like there is something unusual going on – have you thought about getting him to see a doctor?”
  5. “I shouldn’t really say this, but he is a former client of mine but I can’t tell you any more than that.”

Under which of the following circumstances could you, as an RPN, disclose your knowledge about the client?

  1. Your friend Kathy says, “He’s beginning to act really strange; he has started yelling at me and is very controlling about what I do.”
  2. Kathy shows you a fabulous, expensive ring that John has given her. She says it was bought on his credit card, but he has told her that he is expecting a big bonus at work.
  3. Kathy calls you one night to say that he is pounding on the door, and she is afraid; she asks you what she should do.
  4. None of the above.

What resources can assist and guide RPNs facing privacy and confidentiality issues?


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