What is a Nurse-Patient Relationship? (With Components, Phases, Importance, & How to Establish)
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
Are you a nurse who wants to find ways to make your patients feel secure, improve patient outcomes, promote patient satisfaction, and feel fulfilled with your job? When you learn to build strong nurse-patient relationships, you can accomplish that goal. Maybe you know how to communicate well with patients but wonder, “What is a nurse-patient relationship, exactly, and why is it so important?”
In this article, I will share some information about the nurse-patient relationship, its importance, and tips on how to develop strong relationships with your patients. I will also tell you some things to avoid that could result in violating professional boundaries when it comes to nurse-patient relationships to help safeguard your relationships, reputation, and career.
What Exactly Is A Nurse-Patient Relationship?
A nurse-patient relationship is the professional relationship between a nurse and a patient. It involves everything from communication, emotional, physical, and spiritual support, medication administration, and performing treatments to end-of-life care.
When Does The Nurse-Patient Relationship Begin?
The nurse-patient relationship begins with the initial meeting between the patient and the nurse. It is during this initial meeting that mutual trust and the foundation for all remaining interactions between the patient and nurse is built.
What Is The Role Of A Nurse In A Nurse-Patient Relationship?
The role of the nurse in a nurse-patient relationship is to create an atmosphere of support that fosters trust. Fulfilling this role is essential as patients who feel they can trust their nurses and believe they are in a supportive and safe environment are more likely to disclose critical information needed to develop effective care plans and are more compliant with recommended treatment plans.
What Is The Role Of A Patient In A Nurse-Patient Relationship?
The patient is the recipient of services in the nurse-patient relationship. However, for the relationship to be strong, there is a reasonable expectation that patients should be open and honest about their symptoms, concerns, and progress. There is also an expectation that patients will be compliant with the prescribed plan of care, so assessments and evaluations are based on true facts, not assumptions.
5 Reasons Why A Good Nurse-Patient Relationship Is Important
Building and nurturing a solid nurse-patient relationship has many advantages for nurses, patients, and the nursing profession. When you learn to build strong relationships with your patients, you can be instrumental in promoting a good work environment and positive patient outcomes, and you can have an increased sense of satisfaction with your job and career choice.
Reason #1: Good Nurse-Patient Relationships Make Patients Feel Safe and Supported
One of the main reasons good nurse-patient relationships are important is they make patients feel safe and supported. Being sick or injured leaves patients feeling afraid and often isolated. As nurses, we can alleviate some of the fears and frustrations they feel by developing a solid relationship based on trust and compassion.
Reason #2: Good Nurse-Patient Relationships Are Associated with Shorter Hospitals Stays
Because a good nurse-patient relationship leads to better communication and increased patient compliance with care, recovery times improve, resulting in shorter hospital stays. This reason for developing a strong nurse-patient relationship has a bit of a positive domino effect in that not only are hospital stays shorter, but it also reduces consumer and facility costs related to otherwise lengthy patient stays.
Reason #3: Good Nurse-Patient Relationships Result in Improved Patient Satisfaction Scores
When patients are happy with their nurses and the care they receive, it leads to improved patient satisfaction scores following care. Building good nurse-patient relationships is one way to ensure patient satisfaction. It is important for nurses to consider patient satisfaction because many healthcare organizations receive grants and other funding based on these scores. Some employers even pay bonuses or offer other incentives to nurses who receive accolades from patients for a job well done.
Reason #4: Good Nurse-Patient Relationships Make Nurses Happier
Good nurse-patient relationships benefit not only patients but also nurses. Knowing we have made healthy connections and provided the compassionate, effective care that our patients need makes us feel empowered and relevant, which leads to improved satisfaction with our jobs and professional role.
Reason #5: Strong Nurse-Patient Relationships Lead to Improved Patient Outcomes
The
American Nurses Association reports that when patients feel supported and confident in the care they receive, patient compliance is improved. Patient compliance leads to improved patient outcomes and reduced chances of exacerbation or relapse of symptoms.
5 Components Of The Nurse-Patient Relationship
Regardless of the context of the relationship, length of the interaction, and whether you are the primary or secondary source of contact with the patient, there are five components to the nurse-patient relationship: Trust, Respect, Professional Intimacy, Empathy, and Power. It is crucial that we understand our role in the nurse-patient relationship and act with professionalism, promoting dignity and respect for patients while implementing each component of the relationship.
Component #1: Trust
Because patients often feel vulnerable, trust is an essential component in the nurse-patient relationship. In the initial stages of the relationship, trust may seem difficult to establish or appear fragile. It is crucial for nurses to understand the importance of keeping promises and following through with care. Failure to establish trust could result in a poor nurse-patient relationship, which could negatively impact patient outcomes.
Component #2: Respect
According to the
American Nurses Association, "A fundamental principle that underlies all nursing practice is respect for the inherent worth, dignity, and human rights of every individual." We show respect to patients by recognizing their worth, uniqueness, and dignity despite their personal attributes, socio-economic status, or the type or extent of their health issues. Patients who feel their beliefs, wants, and needs are respected find it easier to build stronger relationships with their nurses.
Component #3: Professional Intimacy
Professional intimacy refers to the part of the therapeutic relationship between a patient and nurse that promotes closeness, reciprocity, trust, and self-disclosure. This component of the nurse-patient relationship may relate to physical care that nurses perform for patients, such as bathing or dressing, which promotes closeness. It may also involve intimate conversations when you provide emotional support to your patient. For example, if your patient receives a diagnosis or troubling news, or if they are distraught over their health status. Any care that involves spiritual, social, or psychological elements identified in the plan of care can be considered part of the professional intimacy component of the nurse-patient relationship.
Component #4: Empathy
Empathy in nursing is essential to building strong nurse-patient relationships. Empathy is one’s expression of understanding. Our expression of understanding validates our patient's feelings and resonates with genuine concern for what they are experiencing.
Component #5: Power
As a nurse and healthcare educator, I believe it is crucial for nurses to understand the power component of the nurse-patient relationship and to work carefully within professional boundaries. It is essential for us to be aware of this component and what it means because, in nurse-patient relationships, there seems to be an "unspoken rule" that power is unequal. Nurses have specialized knowledge, authority, and access to protected information, which means we must be vigilant to use our power and authority in the nurse-patient relationship to do good and advocate for our patients.
4 Phases Of A Nurse-Patient Relationship
Building a strong nurse-patient relationship occurs in steps or phases. Each phase builds upon the previous one and requires the participation of both the nurse and the patient. The following are the four phases of a nurse-patient relationship and an explanation of each.
Phase #1: Pre-Interaction Phase
The pre-interaction phase of the nurse-patient relationship is the initial phase during which the foundation for the relationship is formed. It is during this phase that a rapport between you and your patient is formed. The pre-interaction phase sets the atmosphere for the relationship from the first point of interaction until the patient is discharged from your care.
Phase #2: Orientation Phase
In the second stage of the nurse-patient relationship, the orientation phase, you and your patient become better acquainted. In this phase, you collaborate with your patient to determine health and treatment goals, establish patient expectations, and finalize a treatment plan. During the orientation phase, you will discuss privacy, confidentiality, professional boundaries, patient and nurse limitations, and expectations.
Phase #3: Working Phase
The working phase of the nurse-patient relationship is when the collaborative process begins to take on action. In this phase, you and the patient will work together to meet the goals that were established during the orientation phase. The working phase could last days, weeks, months, or even years, depending on your patient’s diagnoses and needs.
In the working phase, you may implement various therapeutic techniques to help your patients reach their goals, monitor their progress, or make adjustments to their treatment plans to promote positive outcomes. The more involved patients are during the working phase, the better their outcomes tend to be.
Phase #4: Termination Phase
The final stage of the nurse-patient relationship is the termination phase. In this phase, patients prepare to transition to independent, daily life or life outside of the need for our daily care. In this phase, nurses evaluate the patient's progress to determine whether they have met designated goals that were established and implemented in the orientation and working phases and address any outstanding questions or concerns the patient still has. During this phase, you will work with your patient to develop an action plan to maintain goals after discharge, including plans for follow-up care and instructions on what to do in case of the need for emergency or acute care services after discharge.
How To Develop A Good Nurse-Patient Relationship?
(The following are the 10 tips to develop a good nurse-patient relationship.)
Tip #1: Practice Active listening
About the Tip:
An effective and easy way to establish and strengthen the nurse-patient relationship is to practice
active listening. You can demonstrate active listening by paying close attention to what your patient says. Use body language, such as eye contact and a relaxed posture, to communicate your focus on the patient. Also, remember it is okay to allow moments of silence instead of feeling you must comment or push the conversation along. Moments of silence allow the patient time to think about what they want to say and may give them time to get the courage to talk about difficult subjects.
Why This Tip is Important:
It is essential to allow patients to express themselves, their needs, and their thoughts without fear of criticism or judgment. When we practice active listening, it shows patients we are genuinely concerned about the things that matter to them, strengthening our nurse-patient relationship.
Tip #2: Communicate Clearly
About the Tip:
Clear, therapeutic communication is an essential part of the nurse-patient relationship. Using various forms of verbal and nonverbal communication makes it possible to relate to patients on different levels. Nonverbal communication, such as making eye contact, holding your patient's hand, using gestures, having a relaxed posture, and making facial expressions, relays messages. Verbal communication using words and phrases your patient understands is effective in explaining conditions, treatments, or procedures.
Why This Tip is Important:
Clear communication is important in the nurse-patient relationship because both you and your patient can communicate thoughts, needs, and expectations. With clear communication, it is easier to establish plans and goals and assess the effectiveness of any treatment plans that were implemented.
Tip #3: Demonstrate Empathy
About the Tip:
Empathy is the action of being aware, understanding, or sensitive to the thoughts, feelings, and experiences of others. It involves imagining someone's ideas, attitudes, or feelings as if you experienced them yourself. Demonstrating empathy is an important step in developing a strong nurse-patient relationship.
Why This Tip is Important:
Empathetic nurses seem to have a better understanding of their patient’s needs. When you understand your patient’s needs, you can help put them at ease, making it easier for them to discuss concerns with you, which is necessary if you want to provide quality, individualized care.
Tip #4: Be Attentive
About the Tip:
I do not know about you, but one of my biggest pet peeves is to try and talk with someone who seems distracted by other things and inattentive to what I am saying. Imagine being sick or injured and anxious, only to have a nurse whose attention seems directed elsewhere. Developing a solid nurse-patient relationship requires being attentive to your patient. It is important to note that being attentive does not only mean listening to what your patient says. It also means being aware of what they do not say. Pay attention to their body language, which could indicate pain or discomfort that they are not yet sharing with you.
Why This Tip is Important:
This tip is important when it comes to building a strong nurse-patient relationship because being attentive shows genuine interest and concern. When patients believe you care for them and are truly interested in what matters to them, they are more likely to be open and honest with you, which makes it easier to gain important information needed to develop important treatment plans and assess patient progress.
Tip #5: Follow Through with Your Word
About the Tip:
One of the best ways to build a good nurse-patient relationship is to keep your word. If you tell your patient you will return to their room in an hour to check on them, you should keep your word. It is understandable that emergencies arise that could cause you to be delayed or something could happen that may cause you to be unable to follow through. However, you should make every effort to do everything you say you will. If the occasion happens when you cannot follow through with something you promised, it is crucial that you speak to your patient as soon as possible to explain why so they do not feel neglected or as if you intentionally misled them.
Why This Tip is Important:
Solid nurse-patient relationships are built on trust. When patients feel you are trustworthy, they are more apt to confide concerns about their health to you, which means you can address important issues, leading to improved patient outcomes.
Tip #6: Respect Cultural Diversity
About the Tip:
Of all the lessons I taught as a healthcare educator, one that I believe is most vital is the importance of demonstrating
cultural competence in nursing. Building a strong nurse-patient relationship requires us to acknowledge and respect the differences between ourselves and our patients, develop care plans, and implement patient care within the bounds of our patients' cultural beliefs and preferences.
Why This Tip is Important:
Being aware of and respecting cultural diversity is essential in meeting your patient and their family's needs, improving their experiences, and promoting positive outcomes. When patients feel true respect for their culture and beliefs, they are more responsive to healthcare providers, and compliance is increased, which improves outcomes.
Tip #7: Avoid Using Medical Jargon When Possible
About the Tip:
An important factor to remember when talking to patients is that not everyone understands medical terminology. It is easy for nurses to use medical jargon without giving it a second thought, but we must be careful to keep the conversation on the patient’s intellectual level.
Why This Tip is Important:
Although using medical terms may seem second nature to you or me, patients can feel overwhelmed or embarrassed when they do not understand the words we use. At times, instead of asking for clarification, patients may pretend to understand or say they have no questions when, in fact, they are confused but do not want to admit it. Unless you know your patient has a medical or nursing background, it is best to use layman’s terms with patients.
Tip #8: Include Your Patient in Important Decisions
About the Tip:
It is common for nurses to have several patients to care for each day. With heavy patient loads or complicated cases, it is easy to take it upon yourself to make decisions quickly without input from patients or their caregivers. However, unless you are dealing with an emergency that requires quick action, include your patient in decision-making about care.
Why This Tip is Important:
Patients have a
legal right to be involved in the development and implementation of their plan of care. While upholding their legal right to be involved is essential, including your patients in important decisions should go beyond legalities. Involving patients in care coordination gives them a sense of belonging and independence, which gives them meaning and often leads to better outcomes.
Tip #9: Respect Their Need for Privacy and Alone Time
About the Tip:
I am a “fixer” by nature. Even before I became a nurse, I was always the person who wanted to make everything better for everyone. If someone had a bad day, I wanted to make it better. If someone was alone, I wanted to keep them company. Because I love being around others and trying to encourage others, it was hard for me to understand that sometimes the best thing for people was to have alone time.
As nurses, we not only have to be present when our patients need us, but we also have to understand and respect the fact that there are times when our patients need to be alone. They may need time to process a new or shocking diagnosis or simply want to rest from having endless visitors and staff in and out of their rooms.
Why This Tip is Important:
It is important to understand and respect a patient’s need for privacy or alone time because it is during these times that patients can rest and take time to recover emotionally and mentally, as well as physically. When they are alone, they are not bombarded with endless questions or assessments and do not feel a constant need to entertain others. Understanding and respecting this need is an important part of building a healthy nurse-patient relationship.
Tip #10: Acknowledge Their Family and Loved Ones
About the Tip:
If patients have family, friends, or loved ones who stay with them or visit them during their stay in the hospital or while in your care, it is crucial that you acknowledge them and be respectful to them. Ask their name and relationship, find out if there is anything they need (lunch tray, a pillow or blanket, etc.), or if they have questions or concerns. Of course, remember you can only disclose information that the patient has authorized you to disclose and only to individuals on the patient’s Release of Information form, but you can answer general questions and provide facility information to make the visitor’s visit more comfortable.
Why This Tip is Important:
Following this tip is helpful in building the nurse-patient relationship because it shows your patients that you value the relationships they value. When you show respect to the people your patients care for, you are showing care and concern for your patients by extension. This is an excellent way to show genuine compassion and concern for your patients.
8 Common Boundary Violations Nurses Must Avoid In A Nurse-Patient Relationship
According to the
National Council of State Board of Nursing (NCSBN), Professional boundaries are "the spaces between the nurse's power and the patient's vulnerability." Professional boundaries are the lines that distinguish the space between a patient's need for care and the nurse's knowledge and ability to provide that care. Although boundaries may seem to some a restriction, they are designed to be guidelines to protect both nurses and patients. There are advantages to staying within professional boundaries and the consequences of violating them. Knowing what constitutes a professional boundary can help you protect yourself from the risk of violations and any potential consequences. The following are eight common boundary violations nurses must avoid in a nurse-patient relationship.
Boundary Violation #1: Sharing Too Much Information About Your Personal Life
I must admit, if anyone has the gift of gab, it is me. I love meeting new people and learning about them. While there is nothing wrong with chatting and getting to know our patients, it is crucial that we know where to draw the line and what information is appropriate to share. For example, if you are trying to build rapport with a patient, you may share that you have children or grandchildren or discuss hobbies. Sharing information that is intimate, such as problems with your marriage or finances, can teeter on the line of being too personal. It is best that nurses do not share information that is too personal for several reasons. One of the main reasons is that some patients may feel overwhelmed or uncomfortable and may even feel like they need to help you.
Boundary Violation #2: Acting As a Power of Attorney or Legal Representative for a Patient
When patients have no close or living relatives, they may ask a nurse to step in and be their legal representative. It is understandable, especially if the nurse-patient relationship is close or has existed for an extended period of time. However, although a person to whom the right to consent is delegated must be medically and legally competent to do so, the person designated to make those decisions should
never be a nurse or other healthcare provider directly involved in the patient’s care.
Boundary Violation #3: Flirting with Patients
I live in Louisiana. People often joke and say that most people here would rather call you "Darlin'," "Sweetheart," or "Honey" than by your real name. That is simply the southern way of doing things, I suppose. While that talk is fine in some situations, it is completely inappropriate in others. As nurses, we must be careful of the words we use and the way we conduct ourselves, even if what we say or the things we do are meant in the most innocent sense.
Avoid calling patients by pet names or making flirtatious remarks about their appearance. While a hand on their shoulder or holding their hand to comfort them in a time of grief or fear is appropriate, physical touch should be limited and never cross the line to appear flirtatious, which is a professional boundary violation.
Boundary Violation #4: Agreeing to Keep Secrets with a Patient
Protecting a patient's privacy and confidentiality is one of the nurse's main responsibilities. However, there is a difference between protecting the patient's right to confidentiality and privacy and keeping secrets for non-medical purposes. As nurses, we should never agree to keep secrets between our patients and ourselves. Doing so creates an illusion of intimacy between you and the patient outside the nurse-patient relationship that should not exist. Such intimacy could have dire consequences, especially if the patient reads more into the bond than you do. It is best to keep your relationship on a strictly professional level.
Boundary Violation #5: Performing Favors or Tasks Outside the Scope of the Patient’s Immediate Needs
The nurse-patient relationship is established because your patient has needs and you have the knowledge and clinical skills required to meet those needs. To remain within the ethical boundaries of the nurse-patient relationship, you should practice within the scope of your patient's needs. Therefore, performing favors or tasks unrelated to your patient's healthcare needs are considered boundary violations.
Boundary Violation #6: Showing Favoritism to One Patient More than Another
I have been a nurse long enough to know and admit that some patients are easier to care for than others. I am also professional enough to know that, despite the challenges some patients bring, it is our duty as nurses to treat patients equally. Showing favoritism to one patient over another can be considered a violation of professional boundaries in the nurse-patient relationship and is frowned upon by clients, peers, and employers alike.
Boundary Violation #7: Becoming Romantically or Sexually Involved with a Patient
Nurses should never become romantically involved with a patient who is currently in their care. The question as to whether nurses can ever become romantically involved with a former patient is one that is frequently asked, and, unfortunately, there is no simple answer. To err on the side of caution, experienced nurses would say it is usually best for a nurse not to become romantically involved, even if the person is considered a former patient.
According to the
NCSBN, there are several factors to consider, such as how long the nurse-patient relationship existed and whether the patient may need future care. For example, did the patient require mental health services, or do they have a chronic health condition such as cancer? In cases like this, the likelihood of the former patient being placed in the position of being an active patient and experiencing the vulnerabilities that come with that makes the nature of having a romantic relationship with the nurse seem like a gross boundary violation.
Boundary Violation #8: Accepting Financial Support or Gifts from Patients
As nurses, we care for patients at times when they are most vulnerable. At times, patients feel they want to repay nurses by giving gifts or money. Unfortunately, some nurses may also take advantage of a patient's generosity by talking about their own needs or financial hardships in hopes of being offered money. Any time a nurse accepts a financial gift from a patient, whether it be a gesture of kindness or a gift of financial support, it is considered a violation of professional boundaries that could have serious negative consequences on the nurse-patient relationship, the patient, and the nurse.
My Final Thoughts
As a nurse, you will meet people from many walks of life. From patients, their families, and friends to your peers and interdisciplinary team members, you will develop relationships with a diversity of people. One of the most important relationships you will develop is the nurse-patient relationship. This relationship is different from professional or social relationships. When you found this article, you may have wondered, “Exactly what is a nurse-patient relationship, and why is it important?”
In this article, I discussed the importance of this unique relationship and shared some tips on the importance of developing strong nurse-patient relationships. As you continue to grow and learn in your nursing career, you will discover that each patient is unique in their own way, which means each nurse-patient relationship is unique.
Frequently Asked Questions Answered By Our Experts
1. Why Is Trust Important In A Nurse-Patient Relationship?
Trust is important because it is the foundation upon which a nurse-patient relationship is built.
2. Can A Nurse Have A Romantic Relationship With A Patient?
Having a romantic relationship with a patient is considered unethical and considered a violation of professional boundaries.
3. How To Build A Good Nurse-Patient Relationship With A Family Member Or Friend?
For many nurses, professional boundaries often become blurred, especially when family members or friends become patients. In small communities where healthcare providers and facilities are limited, it is often inevitable that your friends or loved ones will eventually be your patients. You can build a good nurse-patient relationship with a friend or family member by establishing professional boundaries and adhering to them. Be respectful and always conduct yourself in a professional manner, remembering to save medical or health-related conversations for healthcare settings and appointments and personal conversations for social times.
4. How Is The Nurse-Patient Relationship Different From Social Relationships?
Nurse-patient relationships are patient-centered and health-focused and have defined professional boundaries. Social relationships take on more of a friendship perspective and center on meeting the needs of all parties involved.
5. How To Build A Good Nurse-Patient Relationship In Pediatrics And Neonatal Nursing?
Building a good nurse-patient relationship in pediatric and neonatal nursing is essential. Create a comfortable environment, get on their level (literally), and when appropriate, let them help. For example, you may let a pediatric patient listen to your heart before you listen to theirs. If parents or a caregiver are present, and it is feasible, allow the child to sit in their lap if it makes them more comfortable. Most of all, remember to stay calm and allow them to "warm up” to you.
6. In The Surgical Center, When Does The Nurse's Relationship With The Patient End?
Like any nurse-patient relationship, in the surgical center, the nurse’s relationship with the patient ends in the termination phase. During the termination phase in the surgical center, the patient will have had the surgical procedure, completed the recovery phase successfully, and been through discharge education and planning.
7. How Do You Build Trust In A Nurse-Patient Relationship?
Building trust in a nurse-patient relationship is an ongoing process that involves spending quality time with your patients, ensuring clear, judgment-free communication, demonstrating cultural competence, and practicing active listening.
8. How Important Is Empathy In Nurse-Patient Relationships?
Empathy is crucial in a nurse-patient relationship as it allows nurses to better understand patient needs, which makes patients feel more comfortable sharing problems or concerns, and this is essential in planning and implementing effective plans of care.
List Of Sources Used For This Article
1.
https://www.nursingworld.org/resources/individual/nurse-managers/nurse-patient-relationship-trust
2.
https://ojin.nursingworld.org/table-of-contents/volume-7-2002/number-3-september-2002/grounding-for-entry-into-practice
3.
https://www.linkedin.com/advice/0/how-can-active-listening-help-nurses-build-rapport-patients
4.
https://www.nursingprocess.org/cultural-competence-in-nursing.html
5.
https://www.law.cornell.edu/cfr/text/42/482.13
6.
https://www.lawhelp.org/dc/resource/frequently-asked-questions-about-durable-powe
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).