A registered nurse breached the Code of Health and Disability Services Consumer’s Rights for failing to maintain professional boundaries with a teenage mental health patient and could now face further legal action. Photo / Stock Image 123rf
A registered nurse breached the Code of Health and Disability Services Consumer’s Rights for failing to maintain professional boundaries with a teenage mental health patient and could now face further legal action. Photo / Stock Image 123rf
Legal action is being considered against a registered nurse who contacted a teenage former mental health patient through social media and text messages.
The patient, only identified as Mr B, complained to the Health and Disability Commissioner about the services provided by the nurse and an investigation was launched.
Aftercompleting his nursing degree, the nurse’s first job was with the mental health service, which he began in 2016. But in December 2020, his contract was terminated as a result of a separate complaint.
In August 2019, Mr B, aged in his teens at the time, was referred for a psychological assessment due to concerns about his low mood, ongoing thoughts of deliberate self-harm and suicidal ideation.
Following the assessment, he was referred to the Child and Adolescent Mental Health Service (CAMHS) for support and intervention.
The teenager was a community-based client, living at home with his parents. Throughout his care at the mental health service, his appointments occurred primarily at the clinic and on one occasion at his family home.
During 2019, he had eight appointments with the nurse, which included face-to-face intervention, psychoeducation, co-ordination of services including referral to a private psychologist, and ongoing risk assessment.
Mr B, his mother and his GP were all advised in December 2019 his file was being closed.
Shortly after, the nurse sent Mr B a text message on January 1, 2020, saying “Happy New Year, hope you have a good one.”
Then in February 2020, he again contacted the teenager on Facebook asking: “[H]ow you going.”
The following month, the former patient sent the nurse a text message asking if he was on Instagram, in case he would like to “keep up with all the cool shit [Mr B was] doing”.
Deputy Health and Disability Commissioner Dr Vanessa Caldwell said an inherent power imbalance exists between consumers and their healthcare providers.
The nurse replied by saying he could the app and the teenager then gave him his Instagram handle.
In his complaint to the HDC, the teenager said the nurse began to message him on Instagram around the time of the first Covid-19 lockdown.
He was unable to provide screenshots of the messages as they had been deleted but claimed the nurse commented on his muscles as he “always noticed and liked [his] muscles”.
The teen also claimed the nurse asked him for a picture of his muscles.
The nurse, on March 19, 2020, texted the teen saying: “[I]f you want to catch up in person, I can always make an appointment to see you at school and not let work know l[augh] o[ut] l[oud].”
He sent the boy a further text giving him his personal phone number “which is probably better than using my work phone now.” But the teenager did not respond.
Another two text messages, three days apart, were sent by the nurse in March but Mr B did not reply to those either.
In April 2020, the teen’s GP contacted CAMHS with concerns about his behaviour, but his file was closed again the same day. It was again reopened in August following a further GP referral and Mr B later attended an appointment with the nurse in September.
The nurse was also present at a psychiatrist’s clinical review in October before the file was again closed in December.
The nurse told the HDC investigation that the texts and Facebook and Instagram messages were the extents of his personal communications with Mr B.
He was found in breach of the Code of Health and Disability Services Consumer’s Rights for failing to maintain professional boundaries with a patient.
Deputy commissioner Dr Vanessa Caldwell concluded the nurse failed to adhere to the Nursing Council of New Zealand’s Code of Conduct and the Guidelines on Professional Boundaries.
“An inherent power imbalance exists between consumers and their healthcare providers and this involved a particularly vulnerable consumer who was a young person seeking help,” Dr Caldwell’s decision stated.
“By initiating contact with the patient outside of a professional setting, and sending messages of a personal nature, the nurse breached his professional and ethical obligations as a registered nurse and also breached the Code.”
The nurse has been referred to the Director of Proceedings to determine if legal proceedings should be taken.
Dr Caldwell recommended the Nursing Council of New Zealand consider the nurse’s fitness to practice and whether reviews of conduct and or competence were required. She also advised the nurse to undertake further training on identifying and maintaining professional boundaries if he was to remain employed as a nurse.
Since the complaint, the mental health service had developed social media guidelines and a training programme, as well as targeted guidelines for the use of mobile phones, laptops and other communication devices in professional practice.
It had also undertaken an audit and attempted to contact whānau involved with the nurse to ensure no other young persons have had similar experiences or need support.
