When Caring Crosses the Line - Understanding Professional Boundaries in Healthcare

Celeste:  Welcome to the Nursing and Midwifery Health Program Victoria podcast series, where we will be diving into issues that impact the way nurses and midwives navigate today's ever-changing world. I'm Celeste Pinney, a Registered Midwife and senior clinician at the Nursing and Midwifery Health Program Victoria, and host of this podcast series. The Nursing and Midwifery Health Program is a support service which provides care and assistance to nurses, midwives, and students by experienced nurses and midwives.

NMHPV provides a space where our colleagues can bring with them any sensitive health issues impacting their well-being. It is free to access, confidential, and independent. Joining me today on the podcast to discuss professional boundaries is Wendy McIntosh, a registered nurse. Wendy runs her own company called Devaar Consultancy Training and Development and has worked for over 40 years in clinical education and research, with 25 of those years in mental health. Her areas of interest and passion include professional boundaries, professional supervision, professional identity, trauma-informed approaches to care, and links between childhood trauma and boundary transgressions. Welcome, Wendy. Thanks so much for joining us today.

Wendy: Yeah. Thanks, Celeste. It's great to be here. Thank you very much.

Celeste: Yeah. Thank you. Is there anything else you would like to tell us about yourself or the work that you do that we haven't already mentioned?

Wendy: This will probably come out in the podcast, Celeste, but I guess one thing I'd like to say is that professional boundaries have become my life's passion. So the more I delve into it, the more I understand I need to delve further. And so for any of your listeners, if this is the first time they've been really thoughtful about boundaries, keep delving in, keep investigating, because this is such a vast area for us to explore individually, but also as a profession. Yeah.

Celeste:  Great. Yeah. Sounds like really important work that you're doing there. Could you tell us a little bit more about the work that you do with nurses and midwives and boundaries? What are you seeing in your practice? What are people coming to you for?

Wendy: Yeah. Look, I've been providing one to one education plans or supervision or mentoring for nurses, midwives, and in fact, a broad range of health professionals for over 20 years now. And I fell into the work, I think by accident. I was working as an educator in a private psychiatric hospital, and our director of nursing asked me to do a workshop on professional boundaries. And that really opened up my eyes to how little I knew about how poor the education was about professional boundaries. And I'd invited, what was at that time, a representative from the QNC, Queensland Nursing Council—so this is pre-establishment of Ahpra—and also a lawyer from Queensland Nurses' Union. 

And there must have been something I was doing, saying, presenting, that they started to kind of refer nurses and midwives to me who transgressed boundaries. Look, I see a broad range of reasons, Celeste. I certainly see people who have been reported for sexual misconduct, that's for sure. But I would say the majority of the cases are for what's referred to as non-sexualized boundary transgressions. And in some cases, I refer to them as acts of kindness, which means acts of kindness as perceived by the health professional, but a misuse of power as perceived by someone else who looks in on that professional relationship. So it could be over-disclosing information about themselves to establish rapport. It could be lending clients some money, buying clients some food, preparing meals for clients, and home delivering. It could be having those incidental kind of—what would we call them? We can't call them clinical meetings because it's not happening within a clinical setting, but a nurse might be walking down the road, a person in the community who's also been a patient says, "Oh, Nurse so-and-so, I'm just wanting to talk to you about those antibiotics that the doctor started me on." And the nurse thinking they're doing an okay thing starts to talk about the antibiotics. Completely inappropriate, I get. They just want to ease the person's distress. But right there and then is a major breach because they're not in a clinical role. So I think people acting from what they believe is a good place in their heart: good intentions, bad outcome. Yeah.

Celeste: That's really interesting to hear specific examples, and you can see how perhaps easily that could happen to anyone, especially if they're caught off guard or in the moment and someone asks them something, and they maybe don't have time to think it through. But I think it's good that we're talking about it so that we can help people better understand what is a boundary transgression, which is probably a good place to start. Could you maybe tell us a little bit more about what you see as a definition of a boundary? And also, we'd love to hear what you consider—some people may not be familiar with the term boundary transgression.

Wendy: Yeah. So the definition of professional boundaries that I like, which is quite old now, but it is simply this: for professional boundaries to the health professional, it's a space—sorry, it's the limits that protect the space between the nurse's power and the patient's vulnerability. And the keywords there are power and vulnerability, but also creating a space, a physical space, a psychological space, an emotional space where the vibes of the two people don't kind of intersect and cross over each other, but the nurse can maintain their position and stay objective, which is required of the clinicians, critical analytical thinkers, nurses and midwives. So it doesn't mean that we close our heart off. In fact, professional boundaries, when we really understand it and when we adhere to professional boundaries, our heart actually gets bigger because we're not overcompensating, we're not being overwhelmed, we're actually doing the job that we're required to do regulatory-wise. 

So for me, professional boundaries, the limits that protect the space between the professional's power and the clinician's and the patient's vulnerabilities, is key. And then we have to go to our specific code of conduct, the Nurse and Midwifery Board of Australia, domain four: Professional Integrity. And there's a good amount of information there about professional boundaries. It doesn't provide specific scenarios, but it gives information. It says, "These are the things we need to attend to as nurses and midwives. We need to be thoughtful, and we need to take our time. It's important to be considered in the professional boundary world." Yeah.

Celeste: Yeah. Okay. Great. That's really interesting to hear a little bit more about that and delve in. So how do healthy boundaries protect the health and well-being of nurses and midwives? I think you touched on that a little bit there, but it'd be good to explore that some more.

Wendy: It's interesting. I was actually just reading an article yesterday, and it was actually written for doctors. But the author in that has talked about—actually, I like the word they use. They talk about boundary blubbering. We used to call it the slippery slope. Sorry, I forgot the question, Celeste.

Celeste: Oh, that's okay. How can healthy boundaries help protect the health and well-being of nurses and midwives?

Wendy: Fantastic. Okay. So in the work I've been doing, Celeste, over the 20 years, I see quite a strong connection between poor boundaries and burnout and also vicarious trauma and compassion fatigue, which we know there is a high incidence, for example, in mental health, accident emergency, especially. So when I'm going to work and I've stepped out of what I'm being paid to do and what my regulatory body wants me to do, I'm following my heart. And so that means I'm not paying attention to other clues or what we call the red flags that might say, "Hold on a minute. You've just stepped out of your nursing role into a sister role or a mother role or an uncle role." And so when we become emotionally drawn into that relationship, we give more and we give more and we give more. We overcompensate. There's quite a link between overtime and boundary transgressions because when we get tired and fatigued, we're not thinking rationally. We're reacting. We just want things to settle and be okay, but we're not actually thinking it through. So we say yes when we should be saying no, or, "Let me think about that." 

So yeah, this author, Lambie Etal, in a paper published in 2023 for Doctors, drew quite a clear line between poor boundaries and burnout. And I would say that conversely, when I'm working with people and they talk about being burnt out and they list the signs and symptoms, and I say, "Well, tell me now about your relationship with your patients," and they say, "Oh, yeah, give them a bit more because my other colleagues, I don't think they're giving them enough care, so I give them more care." So a person who's got burnout, we can look through that lens and go, "Hmm, I can see a trail of boundary transgressions there." And when people are not attended to their boundaries well, it can lead to burnout. Yeah.

Celeste: So you see that often, do you, where people are coming to you because they've had an issue with boundaries and there might be burnout or there has been burnout? They sort of coincide together?

Wendy: Absolutely. Yeah.

Celeste:  So that could be a red flag as well if someone's perhaps—because we see a lot of burnout generally in the nursing midwifery profession. That could be a red flag or a clue that perhaps there might also be some boundary issues.

Wendy: Yeah. And I think what goes along with that is some self-thinking that by doing more, that proves their worth, the individual's worth. So it's also quite intricately linked to a person's self-esteem. If I do this, I'll be seen as a good nurse or a good midwife, and that makes me feel better. Generally, it's not actually the outcome, but when they're on this kind of path of doing more and giving more and being more, then there's usually something in there about self-image, self-worth, wanting to be perceived as the best nurse.

Celeste:  So it's coming from a place of maybe lacking in confidence or insecurity or low self-esteem and wanting to improve that in oneself. But from what you said, it doesn't really get you to that place. In fact, it can cause more problems.

Wendy: Yeah. And over the years, I'd say that most of the people that I've supported, Celeste, I would assess them just to be good people with good hearts and good intention. There's very few health professionals, certainly that I've worked with, that I'd say where their intent has been bad, clearly a bad intent to get their own needs met. But in fact, when we're looking at boundary transgressions, which means we've stepped out of the professional role that we're paid to do, it's usually related to self-worth and self-value. Yeah.

Celeste: That's really good to think about it in that way. Maybe we can all reflect on more, "How do I feel about myself, and where am I trying to gain value and self-esteem from?" And thinking about what that can mean if we're looking outside ourselves to our patients and perhaps blurring the boundaries.

Wendy: Yes. And I think I experience quite a lot of anger initially in the people that I see, enragement, in fact, that they've dedicated so much of their life to the profession, to an organisation, and then they've clearly been transgressing boundaries, which they don't see that they have. And then the organisation takes steps to suspend that person, perhaps even terminate them. And so there's this kind of enragement, "How could they do this to me? I'm a valuable member of staff. I've given more than other nurses." So it's not always a good outcome. No.

Celeste: Yes. Yes. And I think perhaps the nursing midwifery profession attracts people who are caring because you probably wouldn't go into the role if you weren't. And so people have their caring nature, and they want to give and make a difference and help people, but it can sometimes fall over into something that's not healthy for them or the patient.

Wendy: Yeah. There's a trauma kind of guru by the name of Colin Ross. And every time I've heard Colin speak over the last couple of decades, he will always insert a line like this, which is, "Sometimes it's just luck when we become if we become the patient or the health professional." And he draws on health professionals having experiences of childhood trauma, whatever that was for the individual, lack of caring or inappropriate caring. So they come into caring professions to, at one level, obviously, look after another person and provide care, but really seeking that care that they never got as a child. And it's unconscious. Yeah.

Celeste: That's really interesting. So playing out maybe some old role that they've been in or they haven't learned healthy boundaries in their family that they grow up in, and that's the way that they're relating to people is perhaps similar.

Wendy: Yeah. Certainly, if the boundaries have been blooded in the family of origin, then that little child grows up kind of thinking, whatever the thinking, whatever the boundaries were. And then that's compounded more when they then work in a team, and the boundaries are blooded. The team leaders get very poor boundaries. The team leader hugs the staff if they come in on a morning shift. The team leader is self-disclosing information, really, that belongs to intimate family, friends. And so someone who's already got blooded boundaries goes, "Oh, well, this is obviously what you have to do." And part of that is survival. You've got to be in it to win it. You've got to be part of the tribe. 

So I've also worked with individuals who've got really clear boundaries, and then they find themselves in a team where the boundaries are really blooded. And that kind of moral choice, "Do I join the bandwagon, or do I hold my boundaries, which might also mean that I'm ostracized?" And individually, people just have to make that choice or leave if it's too compromising for them to leave. So blooded boundaries in childhood, blooded boundaries in the team that they work in, we're just probably going to be looking at some disaster that's about to happen.

Celeste: And especially difficult if there is a culture of the workplace of, "Well, this is just how we are. We cross boundaries at times. We don't maybe respect other people's boundaries." And it's very challenging, especially if you're a student or a grad or a junior nurse or midwife, to speak up because you're new and you feel like other people are more experienced, that you might accept that. So I can see that that would be really challenging for some people.

Wendy: Yes. I think so. Because if that's the norm and you don't know anything different, then you're just going to go with it. I've also had cases, Celeste, where clinicians have had that intuitive uncomfortable knowing, "Maybe I'm transgressing a boundary here. Maybe I shouldn't be saying or doing this. Maybe I shouldn't be catching up with the patient in my own time once they're discharged from hospital." So there's something that's saying, "Be very, very cautious here." And so they've gone to their team leader or they've gone to the person next up the line, and that person has not advised them correctly. "Yeah, of course, you can see them. The patient's discharged now. It's not a problem." And so they've had the intuitive, "Something here's not right. Let me check it out with a senior person." And the senior person says, "Yeah, I don't see any problems with that. That's okay." Person goes ahead, transgresses the boundary. A complaint comes in. "Well, that senior person's not going to be called to account because the complaint's not about them. The complaint's about that nurse that checked it out, thought the advice was sound." So I always say to health professionals, "Please read your codes. Please read your policies. Check out with a few people. Just because you've asked a senior person doesn't necessarily mean that senior person has a good in-depth understanding of what professional boundaries is."

Celeste: That's a really good piece of advice. And even accessing our service, calling nurse midwife support, speaking to an educator or another more experienced nurse or midwife, like you said, so that you're not relying on one person. Because even though we want to be able to trust people, they may not have that awareness or understanding. So in order to protect ourselves and our registration, we do need to be aware. And I think it's good that we're having this conversation so that people can start to develop that awareness. And speaking of developing boundaries, I imagine it does require a certain level of skill, particularly if you come from a background and upbringing where that wasn't taught to you in a healthy way. What do you think it takes for an individual? What does an individual require to develop these skills?

Wendy: So I just identify, assess that this should be a core competency within undergraduate, postgraduate degrees, enrolled nurses, diplomas. We maybe do a one-hour PowerPoint, which is really just words. This stuff requires us to really investigate very thoroughly who we are, how we make the decisions we make, clearly looking at our childhood experiences and how we've adapted, survived, and how that might come out to play as a nurse or a midwife in relationship with colleagues, in relationships with the people we serve. And I just think this needs to be given as many hours as medication administration in my books. Because the risk, if we get this wrong, in extreme cases, health professionals have suicided. And in some cases, especially if the transgression happened to a patient within mental health, and then they figure out that that relationship was not real. They thought the nurse was a friend. They thought the nurse was a lover. They thought their midwife was fully invested in them. 

And then they find out that that person transgressed the line. Then they feel an enormous sense of betrayal. And that can kind of really destabilize them and make them unwell again. So I think it's highly skilled. It's a highly skilled area. We need to understand the language. There's quite an intricate language in professional boundaries. We need to understand what has actually been asked of us rather than our own interpretation of what's been asked of us. We need to find speech that is professional. 

We need to look after our own emotions as we might get triggered into old responses. So a lot of people, when I talk to them, say that they struggled with setting limits with patients because they don't want to disappoint them or let them down. And when we track back to when that role first developed, it's family of origin. If I said no to mum, then she would slap me. Or if I said no to dad, I'd be punished. And then they go through older nurses and midwives who went through schools which were quite rigid and strict, where they were punished standing up for themselves and saying no. So they developed this survival role of never having good boundaries but always being the good person, the go-to person. And so part of the skill development is understanding that there's quite a difference between the personal self and the professional self. And it's the professional self that must always turn up for work and that boundaries are healthy, that we can develop a tone of voice that's specific for boundaries, that we can develop specific scripts for boundaries. It's not common sense. There's nothing about boundaries that's common sense. I think it's just a highly skilled area of being a midwife.

Celeste: And you can see how if you haven't had an education or understanding, or you haven't maybe got the insight into your own behaviour, how that can have huge implications, like you mentioned, for nurses and midwives and patients. And it can result in some fairly dire outcomes. So I think it sounds like what you're saying is the profession needs to devote more time and energy to nurses and midwives understanding boundaries. And I think one place people can learn about that is supervision. That's a good place for that. But we know supervision isn't offered wildly across the board, unfortunately. People can access it themselves. They have to pay for it. But I think anyone listening, if you feel like you might have some issues with boundaries, that it, like Wendy's saying, it's really important to protect yourself and the people you're working with and to learn more about yourself and how you are in that space. So I'd be curious to know, Wendy, what more could nurses and midwives need to be aware of at work when relating to patients in terms of professional boundaries and keeping themselves and patients safe? Is there anything else we haven't discussed that you think is important for people to know?

Wendy: There's a term that I use, a professional boundary crossroad. And that's where I ask clinicians to consider, "You're in this interaction with a patient or indeed a colleague. And you notice within yourself that something has been triggered, whatever that is. What's really important is that you stop at that crossroad. You pause. You consider, 'What do you want to say and do here?' Don't just rush in.'" Victor Frankl, who survived one of the concentration camps, Man's Search for Survival, I think, was the book he wrote. Or I might have got that wrong. But he uses this phrase, which I think's intricate to boundaries, which is, "Between the stimulus and the response, there has to be a pause. We have to stop and consider and consider all the data so that the patient is inviting me to go and visit them once they're discharged." And maybe the patient has used a term such as, "Oh, gosh, you just remind me of my granddaughter or my grandson. I just feel really comfortable when I'm with you."

So all that kind of emotional buy-in that might pull a health professional in. So rather than being pulled in, to be able to go, "Well, Mary, thank you, however, I cannot visit you at home." That takes a lot of guts. The person has always been, "Of course, Mary. Yes, Mary. I'll do that, Mary." So for someone within that kind of nurse and midwifery role to take a completely different stance, their body's still, their tone of voice is highly respectful and full of dignity, and they're not in role conflict. So when a nurse or a midwife's in role conflict, that means the professional part knows that they should be saying no, but the personal part is really struggling because of that old memory of being punished. And so when we're in conflict, when we've got a push me, pull me, "I should set a boundary. Oh, I might be disrespectful. It's important that I set a boundary. Oh, they might not like me anymore." 

Then that's where they're incongruent. So they deliver a message, but the rest of their body's saying, "Sure, I'd love to come for lunch." And so the patient will hear that hesitancy. It's not a clear message. It's not a clear boundary. So they'll just push, "Oh, you know I'd love to see you. I get so lonely at home." So they'll just pull out all the tricks. Not in any manipulative way. It's just one person who's spotted this other individual that is fulfilling needs in them. And yeah, anyway, I've got kind of times gentle there.

Celeste: No, that's okay. That's good. I think what you're saying is it's important to pause and consider certain requests or conversations that might lead to a boundary transgression. And also, like you said, I think becoming aware of our gut instinct. And sometimes we just get that little whisper. If something doesn't feel right and I think some nurses and midwives have difficulty trusting themselves, which makes sense if there's childhood trauma and maybe their boundaries were not respected. But really important to start listening to those little feelings because often that can be the one thing that can tell us, "Oh, hold on a minute. Something's not feeling right here."

Wendy: Yes. Listen to yourself. As a child, your intuitive self would have been giving you a message that whatever happened was not okay. But you had to kind of hide that. You had to squash down that instinct, really, in order to survive what was about to happen and what was happening. So as a nurse and a midwife, as an adult in the here and now, we really have to coach ourselves around the fact that it's okay that we have good boundaries in place. In fact, the professional relationship that we value, the professional role that we've worked very hard to get to, will be much more robust when we have good boundaries in place.

Celeste: And in terms of learning to communicate in a way that effectively establishes and maintains boundaries, do you have any advice for nurses and midwives? Like you said before, it can be difficult to say no. You feel bad. What are some tips in that area?

Wendy: So I really like the idea that we listen to learn and to understand and that we're not listening and forming the next six questions in our brain. So we're actually disconnected. So we slow down, and we listen to learn, not to provide answers, not to provide reassurance. Because when we are clear in our head about the messaging that the patient's given us, then we can respond from a much more kind of coherent place. And I think we had a great lesson from a supervisor that myself and colleagues used to see on a regular basis. And he came from a psychoanalytical background. So he was very quiet. Well, we were all, "Nee." And then occasionally, he would say something profound. And one of the most profound things that I remember was he said, "Just carry a bag of mintis and self-assess who's talking the most in the relationship. And if you're talking more than the patient, chew a minty." 

Because it's very hard to talk when you're chewing a minty without saliva dribbling. And really, what he was saying was just learn the fine art of silence. Because in silence, that's where a lot of the work comes in. I think when people are anxious, when they're uncertain, when they don't know what the boundary is, then individuals will rush in with a response and start to disclose too much information. And then patients go, "Hold on. How come I'm learning all about how horrible your marriage is and what's happening? Where am I in this space?" And that's where the complaints will come in. Because patients will say, "In that half hour " it won't be as specific as this, but "In that half hour, the nurse spoke for 15 minutes about themselves. What do you want to know about the nurse? Because I've got a list here." 

And when I say to people who have had complaints against them because of self-disclosure, they'll say, "Oh, I thought it was a good way to build rapport." I'm still to be convinced on that one, me myself. I'm uncomfortable with silence. I just thought I've got a lot of good experience that I can share with them. Well, okay, but you're not employed as a peer support person. You're employed as a nurse. So getting clear slow down, pause, again, consider. However, it is actually learning different communication styles. So when I'm working with an individual, we'll do some role-play, and I'll have them in the role of a nurse or a patient. And if I notice that their boundaries aren't very good, I'll say, "Stop. Let's replay that. Try this. See what you notice." 

Because we have to kind of get some different wiring going in the neural pathway. You know that phrase, neurons that wire neurons that fire together, wire together? So we want to fire up some neurons on boundary communication so that they'll wire together. I'll say to people, "Get a full-length mirror and really look at yourself. Imagine that you're setting a boundary with a colleague or a patient. Notice if your body's moving. Still it. Notice if you're putting three sentences into one." Boundaries are short, crisp sentences, usually about five words. That's enough. Because when we do more than five, we start dropping in little bits of meat. And the patient will go, "Oh, she doesn't really mean it." Or, "Yeah, he's saying one thing, but he means the other." So short, crisp sentencing, but done with a tone of voice that's respectful and full of dignity.

Celeste: No. That's really good to hear a little bit more about how that might look and what people can start thinking about for themselves. Just changing direction a bit, I'd love to hear in terms of trauma-informed care, I'd love to hear your point of view about how having an understanding of this could help people develop healthier boundaries.

Wendy: Yeah. So there's a lot more coming out about trauma-informed care, certainly in the last 10 years. I was working in a specialised trauma unit in Queensland over 25 years ago. And it was great because it was a great experience to learn about the importance of boundaries when we're working with people where every boundary was violated in their childhood. And in fact, some of the patients became the teachers. They'd come to the nursing station and say, "Wendy, you've gone on about boundaries, and you just transgressed one there. Oops. Okay. Tell me about it. What did you see? What did you hear?" And so they would because we were teaching them about boundaries, so they were really onto us. And it was fantastic kind of talk about 360-degree feedback. So certainly, in my experience, and especially not especially. Well, certainly, where the boundary transgression has been sexual misconduct, then I ask the clinician about their childhood, their experiences growing up. 

Then there's been enough evidence for me in my work that there's a clear correlation between childhood sexual abuse and that being acted out in some way as a health professional. I have seen some link between domestic violence and non-sexualised transgressions because the experience of domestic violence has been so harrowing, so frightening, life-threatening in some cases, causing a major disruption. So people come to work for a break. People come to work for safety. And so they start kind of acting out their trauma by being overkind, overcompensating, or in some cases, withdrawing care, especially if a patient reminds them of the person who's caused them trauma. 

So again, that work of really understanding that this person in front of us, while they might resemble someone from our past, they're not. This is a completely different individual. But if our limbic system is triggered because we see this person or they're wearing same perfume or aftershave as someone that caused us harm, then that smell can trigger our limbic system. And before we know it, we're no longer in 2026. We're a child. And so that's where the boundary transgressions will happen because the clinician's not available because there are other roles back to protect.

Celeste: Wow, it's so complex, isn't it, the more you talk about it and you realise how deep it can go in people in terms of their history and what's going on in their lives and their own experiences of trauma?

Wendy: Yeah. And that's why in my books, this integral area to recognising midwives do requires more respect, requires more in-depth and reflective education content. Let's look at different scenarios. Let's look at the multiple influencing factors. Let's look at the upbringing of the clinician. And it's so important for me to hear an individual's story before we want to go yet. Okay. I get it. Click, click, click, click, click. Okay. It's happened. We cannot change that. Are you prepared? Really, the work I do is very much about changing habits of a lifetime that were really habits of a lifeline.

Celeste: That's great. I like that.

Wendy: So that's the work that I think's important because rightly so, the boards want to make sure that this clinician, this midwife, this doctor, this dentist is safe enough to practice. And in my books, the best way to assess that is the person has to understand how they got here and have to understand, as uncomfortable and as confronting as it is and it is, all these deepening layers that have actually been influencing factors that got them to here. They're not a bad person. They made bad decisions. Their actions weren't so good. They completely stepped out of the professional role. But are you willing to now do the hard work? Because that's what's required.

Celeste: Yes, that deeper personal work that can be really very challenging, especially if someone has not maybe had counselling or therapy before, but necessary, really essential in terms of going forward and working in the profession in a healthy way.

Wendy: Yes. And I'll say to some people if I assess that they're in kind of psychological, emotional trouble, "Are you seeing someone? Have you got a mental health plan?" And some of them do, and that's good. So they're getting this other kind of psychological support on top of the work that I'm doing with them as well.

Celeste: Yes. I think very important that people seek help if they find themselves in this place. It's like you can't really do it alone.

Wendy: No. And that's where your service comes in. It is really important, that confidential space where nurses and midwives can come in and talk to some, who's there to listen, to validate, offer strategies. It's such important work that you're doing.

Celeste: Yes. Yes. Thank you. And just lastly, before we wrap up, I'd be curious to know we've talked a lot today about the importance of having healthy boundaries with patients. What about collegial boundaries? So what about boundaries between other staff members, whether that be your manager or other nurses and midwives? Do you see those boundaries being crossed in those ways? And I guess what can people is it the same in terms of the boundary transgressions and why that occurs? Or just love to hear your thoughts on that.

Wendy: Yeah. Look, I would say in the last few years, I've worked with an increasing number of nurses who don't and nurses who've been reported by colleagues because they've made what they've assessed to be offending comments, offending jokes. They've self-disclosed too much information about themselves. They've shown them things that they've been looking at in social media that the other person finds offensive. I can't say why there's been an increase, but I would say post-COVID, there's certainly been an increase. So saying things that are inappropriate, thinking that something that they find funny lands badly with someone else. And I remember working with one clinician who was reported for offensive storytelling, and colleagues just found the comments of a complaint went in. 

So I was working with a clinician and go, "What's going on? When are you going to work every day? What's your warm-up to going to work?" And the clinician went, "Ah, click." And this clinician would be listening to a radio programme, which was pretty offensive, this batter between commentators, crude, rude. And so that was the warm-up to going to work. So by the time the clinician got to work, they were ready to share all this bantering, completely inappropriate. So then it was something around, "You have to have a different warm-up. Listen to audiobooks. Listen to another radio station. But this is a bad warm-up because you're already enrolled when you go to work. And you're not a radio host. You're a nurse." 

So it's these little things that we have to pay attention to, inappropriate touch. So the person that has had a complaint made against them might reach out to console a colleague, and the colleague finds that offensive and may register that as sexual harassment. So the person doing the hugging thinks they're doing the right thing by consoling, but it lands inappropriately for the other person. So again, poor understanding of boundaries, poor understanding of collegial relationships, and getting friendship mixed up with professional friendship. It's quite a difference. So with my friends, I have a good time. We have a banter. I share intimate aspects of my life if I choose to do that. 

When I'm at work, really, we should be focused on the patient. That's who we should be, not what we were doing at the weekend, not what the neighbour was doing at the weekend. Go to work. Do the job you're paid to do. Do it with full heart. And when you're in relationship with colleagues, if we're role modelling blood boundaries with each other, I can pretty much guarantee the boundaries with patients are going to be blood because that's just the role that we're in. So turn up, be respectful, be professional, friendly, but always keep the focus on the patient. That's why we're there. That's what we'll sign down to do.

Celeste: So again, it's just bringing awareness to how we're interacting with and relating to others and trying to learn more about ourselves if we do find that maybe we think we're crossing boundaries or that they've exceeded a little.

Wendy: Yeah. And I think for people who are nursing or midwifery, it's their life. So they're very focused. So when they come to work, they're engaging with people as if it's family members because maybe they're focused so much on work, they haven't created an external world, or the external world isn't the one they want to be in, an unhappy relationship. That would be a major influencing factor. So people come to work again for that relief. So they're talking to people as they wish their family would talk to them. Work's not the place to build our families.

Celeste: Yeah. Great. Yes. Thank you for that. Well, thanks. That's great, Wendy. We've come to the end of our time together. Thanks so much for joining us on the podcast today. It's been a real pleasure and a very enlightening conversation. For people who'd like to learn more about you and what you do, where can they find you?

Wendy: Well, they can find me on my website, which is Daavar Consultancy. Yeah, Daavar Consultancy. I've done a podcast series on professional boundaries, and that's accessible through Apple, Google, or on our website. And that podcast series introduces boundaries through a different set of professionals. So there's a story about a teacher, a police officer, support worker, as well as a clinician. And so that's usually a good place to start. If your listeners are interested, if they're curious to know more, then that podcast series, as challenging as it can be at times, will also give them lots of information about what professional boundaries are and are not.

Celeste: Sounds like a really good resource. And we'll pop the link to your website in the show notes so people can access it if they'd like. But yeah, thanks so much, Wendy.

Wendy: No worries, Celeste. Thank you for the invite. I really appreciated it.

Celeste: You're welcome. For any nurse or midwife who might need support after today's podcast, you can access our service on 03 9415 7551. Thank you for listening.