Research demonstrates that the faculty-student relationship is a special one. Faculty members have an important influence on students’ academic success and personal growth (Endo & Harpel, 1982; Gaines & Baldwin, 1996; Gardiner & Nazari-Robati, 1983; Lamport, 1993; Pascarella, 1980; Terenzini et al., 1996; Tinto, 1975, 1987). The nursing education literature has emphasized the need for faculty to establish caring relationships with students (Bevis & Watson, 1989). The importance of the relationship between faculty and students is clear, yet the appropriate boundaries of that relationship are not.
Professionals, including educators, are held to high ethical standards. In recognition of their special knowledge and ability, society grants professionals status and privilege but also relies on them to place society’s needs above their own needs (Peterson, 1992). As a result of this social exchange, professionals are expected to perform ethically and with excellence, while minimizing self-serving actions (Hamilton, 2002).
Gabbard and Nadelson (1995) defined professional boundaries as “the parameters that describe the limits of a fiduciary relationship” (p. 1445). A fiduciary relationship is one in which the client is entitled to trust and have confidence in the fiduciary, who is obligated to act with candor and in good faith on behalf of the client (Garner, 2004). Although the term fiduciary is most often applied to relationships involving financial matters, some identify any relationship involving a professional and a client as a fiduciary one. Therapists (Kutchins, 1991; Strasburger, Jorgenson, & Sutherland, 1992), physicians, and social workers (Kutchins, 1991) have been mentioned as examples of professionals with a fiduciary responsibility for clients.
Building on the notion that professionals who have power over clients have a fiduciary responsibility to the clients, Plaut (1993) stated that teachers have a fiduciary relationship with students. Although he focused on graduate students, he noted that teachers ultimately retain the responsibility for evaluating students and that students are dependent on teachers’ guidance. These factors form the basis for the definition of a fiduciary relationship.
Friedman and Boumil (1995) described the fiduciary nature of professional-client relationships and included the teacher-student relationship in the discussion. Again noting that teachers have influence over students and that students rely on teachers for their professional services, Friedman and Boumil stated that this creates a fiduciary responsibility on the part of the teacher. Elements in the teacher-student relationship that contribute to its being fiduciary are the difference in professional status between the teacher and the student and the age difference common between teachers and students. The age difference varies among educational institutions and level of educational program.
Feldman-Summers (1989) also noted that the teacher-student relationship falls under the rubric of a fiduciary relationship. She stated that students seek guidance from teachers and place their trust and confidence in teachers—behaviors that are hallmarks of a fiduciary relationship.
In fiduciary relationships with an inherent imbalance of power, it is always the responsibility of the professional (teacher) to not take advantage of that power and to not exploit the client (student) (Jacobs, 1991; Kagle & Giebelhausen, 1994; Kutchins, 1991). Boundaries are necessary, at least in part, because of that difference in power between the professional and the client (Peterson, 1992). One risk of the power differential between professional and client is the potential for the abuse of power (Gallop, 1998). The professional’s abuse of power emerges as exploitation of the client to meet the professional’s needs (Jacobs, 1991). When applied to the teacher-student relationship, such exploitation may range from teachers who seek admiration from students (Kagan, 1983) to those who engage in sexual relationships with students (Nadelson, 1989).
Each kind of professional has a particular role with a client, and each role has its own rules of engagement that reflect the professional services provided to the client (Webb, 1997). Most boundary issues involve mixing roles (Corey, Corey, & Callanan, 1997). A range of issues may be addressed in discussing boundaries, from whether clients and professionals should be addressed by first names to whether professionals should engage in sexual relationships with clients.
In any professional relationship, including that between teachers and students, the professional is obligated to create an environment where the stated purpose of the relationship is predominant and where the client’s needs are considered before the professional’s needs (Pope, Schover, & Levenson, 1980). Boundaries outline the appropriate behaviors for the professional’s relationship with a client. Boundaries separate the professional relationship from a personal or social one (Plaut, 1993). Behaviors outside the boundaries of the professional relationship are boundary violations (Gutheil & Gabbard, 1993; Peterson, 1992). In all professional settings, boundaries are necessary to define the appropriate behavior of the professional and the limits of that behavior (Gallop, 1998).
In addition, boundaries are the necessary tool used to manage the power differential between the client and the professional. Professionals use boundaries to identify how power is to be exercised and the limits of that power (Peterson, 1992). Boundaries are necessary to protect vulnerable clients from professionals’ power (Peterson, 1992). Attempts to equalize the power between professional and client do not mean that the power differential is eliminated (Peterson, 1992).
Professionals must always subjugate their needs for the needs of their clients (Gallop, 1998; Hazler & Carney, 1993; Peach, 1999; Pope, 1989b; Sheets, 1996). Failure to do so impairs the professional’s ability to function in the professional role, whether that role is effectively caring for a sick client (Totka, 1996) or objectively evaluating a student (Kitchener, 1988; National Education Association [NEA], 1975; Pope et al., 1980).
Authors across the professions have agreed that it is the professional’s responsibility to maintain the appropriate boundaries in the relationship (Hermansson, 1997; Jacobs, 1991; Peach, 1999; Salladay, 1996; Simon, 1989; Webb, 1997). The professional, as the individual with the power in the relationship, needs to accept that authority and set the tone for the relationship (Peterson, 1992). The establishment of clear boundaries and explicit expectations creates a safe environment for the client to be honest in sharing personal information with the professional, toward the end of meeting the client’s goals and needs (Peterson, 1992).
Boundaries in the therapist-client relationship have been clearly studied and articulated (American Counseling Association, 1997; Borys & Pope, 1989; Coleman & Schaefer, 1986; Gutheil & Gabbard, 1993; Gutheil & Weisstub, 1996; Pope, 1988, 1989b; Pope, Keith-Spiegel, & Tabachnick, 1986; Pope, Tabachnick, & Keith-Spiegel, 1987; Simon, 1989, 1995; Smith & Fitzpatrick, 1995). Because of the fiduciary nature of the teacher-student relationship, many of the same concerns about boundaries apply (Feldman-Summers, 1989; Friedman & Boumil, 1995; Peterson, 1992; Pope, 1989a).
The nursing profession has clearly prohibited sexual relations between nurses and clients (Stevens, 1998). The Washington State Nursing Care Quality Assurance Commission has extended that prohibition to sexual relationships between nursing faculty and nursing students (Washington State Department of Health, 1999). However, other boundary issues have not been addressed in nursing education. The purpose of this study was to identify nursing faculty beliefs and behaviors regarding boundary issues between associate degree nursing faculty and students.
A questionnaire was prepared using the tool developed by Pope et al. (1987) in a survey of psychologists in clinical practice and further used by Tabachnick, Keith-Spiegel, and Pope (1991) in a study of psychologists who were primarily teachers. The 16 items related to the teacher-student relationship were chosen for the questionnaire developed for this study, along with 2 additional items from a different study (Borys & Pope, 1989) and 1 item from the author’s personal experience as an educator (prescribing medications for a student). A test-retest trial of the new 19-item questionnaire revealed a reliability of 0.73. Questionnaires were mailed to all associate degree nursing faculty (n = 180) in a western state, identified via e-mail contact with the program deans or directors.
In the first section of the questionnaire, faculty were asked to identify how appropriate each of the 19 behaviors was on a scale of 1 to 5, from never appropriate to always appropriate (Table 1 displays a portion of the questionnaire). In the second section, faculty were asked to identify whether they had engaged in any of the 19 behaviors and whether they had seen colleagues engage in any of the behaviors. Next, faculty were asked about the source of their beliefs about boundaries, if their perceptions about boundaries had changed over time, if they were aware of campus standards about teacher-student relationships, and if they believed nursing faculty would support a code of conduct regarding boundaries. Finally, faculty were asked demographic questions. At the time of the survey, the author knew many of the faculty included in the sample. Because of the few numbers of male faculty and ethnically diverse faculty, and to promote anonymity of responses, participants were not asked to identify gender or ethnicity.
Table 1: Selected Portions of the Survey Instrument
Included with the mailed questionnaire was a call for volunteers to participate in an interview. Four interviews were conducted to acquire additional information on faculty’s knowledge of and experiences with boundary issues. This article focuses on the questionnaire results.
Questionnaire results were analyzed using the statistical analysis software StatView 4.5 (Adept Scientific, Inc., Acton, MA). The study was approved following the Human Subjects Review Policy of the university in which the author was enrolled as a doctoral student at the time of the study.
Of the 180 questionnaires mailed, 1 was returned as undeliverable. Of the 179 delivered, 140 were returned, for a 78.2% response rate. Most (70.7%) of the respondents were employed full time (Table 2). Most (45.7%) were ages 50 to 59; 35% were between ages 40 and 49 (Table 2). Although 73.6% of respondents had 20 years or more of nursing experience, only 24.3% had 20 years or more of teaching experience (Table 3). Nearly half (48.6%) of the respondents had a bachelor’s degree as their initial degree in nursing; 79.3% had earned a master’s degree in nursing (Table 4).
Table 2: Faculty Age and Employment Status (N = 140)
Table 3: Faculty Experience (N = 140)
Table 4: Faculty Educational Preparation (N = 140)
Seven of the 19 items on the questionnaire were considered appropriate, at least under rare conditions, by more than 50% of respondents (Table 5). Hugging a student (98.6%), accepting a gift worth under $10 (90.2%), and asking small favors such as a ride home (72.2%) were widely considered appropriate teacher behaviors.
Table 5: Faculty Beliefs About Appropriateness of Teacher Behaviors (N = 140)
On the other hand, 12 of the 19 items were regarded as appropriate by fewer than 50% of the respondents. Three items were considered never appropriate by 100% of the respondents: telling a student of the teacher’s sexual attraction; sexual involvement with a current student; and making deliberate or repeated sexual comments, gestures, or physical contact that are unwanted by the student.
For most of the items, a smaller percentage of faculty had engaged in the behavior than thought the behavior was appropriate. For example, although 98.6% of faculty thought it was appropriate to hug a student, at least under rare conditions, only 86% had done so. For four behaviors, a larger percentage of faculty had engaged in the behavior than the percentage of faculty who thought the behavior was appropriate. Those four behaviors were talking about a student’s performance with another student (19% engaged in, versus 15.7% thought appropriate), insulting an absent student (21% engaged in, versus 5% thought appropriate), insulting a present student (4% engaged in, versus 2.1% thought appropriate), and telling a student of the teacher’s sexual attraction to the student (0.7% engaged in, versus 0% thought appropriate).
A larger percentage of faculty identified colleague engagement in the behaviors than identified their own engagement in the behaviors. This was true for all but three of the behaviors. Eighty-six percent of faculty reported that they had hugged a student, and 84% reported seeing a colleague do so; 88% of faculty reported accepting a gift worth under $10 from a student, and 87% reported seeing a colleague do so; and 28% reported lending money to a student, and 21% reported seeing a colleague do so.
Of the three items identified as never appropriate (telling a student of a sexual attraction, being sexually involved with a current student, and making unwanted sexual comments or advances toward a student), only one faculty member (0.7%) reported engaging in any of the three behaviors (telling a student of a sexual attraction). On the other hand, faculty reported seeing colleagues engage in all three of the behaviors. One percent of faculty reported seeing a colleague tell a student of a sexual attraction; 3% reported seeing colleagues become sexually involved with a current student; and 4% reported observing colleagues engage in sexual harassment of a student.
Most faculty were fairly conservative in their beliefs, with a majority of faculty believing that only 7 of the 19 behaviors were appropriate at least under rare conditions. Three behaviors were seen as never appropriate by 100% of respondents: telling a student of a sexual attraction, being sexually involved with a current student, and engaging in sexual harassment. Sexual relations between nurses and clients are seen as inappropriate by the National Council of State Boards of Nursing; this prohibition has been enacted into legislation in some states (Washington State Department of Health, 1999). In one state, that prohibition has been extended to include sexual relations between teachers and nursing students. Faculty beliefs in this study aligned with that viewpoint (Washington State Department of Health, 1999).
For the most part, faculty were more conservative regarding behaviors than beliefs. For example, although 72.2% of faculty believed it was appropriate, under at least rare conditions, to ask small favors from a student, such as a ride home, only 17% had done so. In only four instances had a larger percentage of faculty engaged in a behavior than thought the behavior was appropriate. Responses to two of these four items were disturbing. Although 5% of faculty believed that insulting an absent student was appropriate under at least rare conditions, 21% reported having done so. A number of respondents wrote notes on the surveys regarding this item, indicating that they made such comments in the form of venting frustrations with other faculty members, not in front of other students. However, it is of concern that even 5% believed this behavior was ever appropriate.
A second item of concern was the related item of insulting a student in his or her presence. Whereas 2.1% believed this was appropriate, 4% reported having engaged in this behavior. Again, it is of concern that any faculty believed that insulting a student in her or his presence was appropriate under any conditions.
Of note, faculty reported that colleagues had engaged in the behaviors more often than faculty reported engaging in the behaviors themselves. Faculty reported seeing colleagues engage even in the three behaviors that faculty agreed were never appropriate.
Chi-square analysis was used to examine the differences among respondents on the basis of age, employment status, years of nursing experience, years of teaching experience, basic educational preparation, and highest degree achieved. However, there was little spread in the respondents’ beliefs about the behaviors, with most identifying the behaviors as never or rarely appropriate. In addition, few of the respondents had engaged in most of the behaviors. This resulted in small differences based on demographic characteristics, and few of the differences were statistically significant. In a few instances, older faculty were more conservative than expected in their beliefs about the appropriateness of the behaviors, whereas full-time faculty and those with more teaching experience were more likely than expected to engage in the behaviors. No clear patterns of behavior emerged.
Tabachnick et al. (1991) studied boundaries between psychology educators and students. Questionnaires were sent to 1,000 psychologists; 482 (48.2%) usable responses were analyzed. Validity and reliability of the questionnaire were not discussed in this report, nor in a previous report of a study of psychologists in clinical practice using the same questionnaire (Pope et al., 1987). In the study reported by Tabachnick et al. (1991), respondents were provided with a list of 63 teacher behaviors and asked to identify on a scale of 1 to 5 whether the behaviors were ethical, ethical under rare conditions, ethical under some conditions, ethical under many conditions, or unethical. Some of the items related to teacher-student behaviors; many had to do with teacher behaviors apart from their relationships with students (e.g., using school resources to produce a popular trade book or selling complimentary copies of textbooks to vendors).
Nursing faculty in the current study were generally more conservative in their beliefs and actions than were the psychology faculty surveyed by Tabachnick et al. (1991). Two exceptions were noted. First, more nursing faculty than psychology faculty thought hugging a student was appropriate, at least under rare conditions (98.6% versus 83.2%). Likewise, more nursing faculty than psychology faculty reported they had actually engaged in the behavior (86.4% versus 71.1%). Second, more nursing faculty than psychology faculty thought accepting a student’s gift worth under $10 was appropriate, at least under rare conditions (88.8% versus 85%). The percentage who had actually engaged in the behavior was similar for both groups: 87.9% for nursing faculty and 86.5% for psychology faculty.
Implications for Nurse Educators
When asked to indicate what had contributed to their beliefs about the appropriateness of teacher behaviors, 55.5% of survey respondents reported having received specific training about appropriate and inappropriate behaviors of educators. Other contributors to respondents’ beliefs included ethical or conduct codes at the respondent’s school or department (62.4%), religious training (69.7%), education preparation (75.6%), knowledge of professional standards for educators (77.5%), teaching experience (87%), and knowledge of professional standards for nurses (90.5%).
When asked whether written behavior standards existed at the respondent’s school, 58.6% indicated such standards exist. Respondents were asked to describe the nature of the standards. Most of the comments indicated that the standards had to do with sexual harassment. Sexual harassment is illegal (Dziech & Weiner, 1990), whereas the other behaviors studied in this research are not. More variation in beliefs regarding the appropriateness of the other behaviors exists and may lead to potential problems in teacher-student relationships.
The nursing education literature is silent on these issues. With rapid turnover of nursing faculty, guidelines are needed to support new faculty in their transition into the teaching role. However, equally important is the need for experienced faculty to consider ethical issues in their interactions with students. With sexual harassment rates in higher education estimated to be 20% to 30% (Dziech & Weiner, 1990), current faculty need education about proper relationships with students.
The National Council of State Boards of Nursing (1998) has published guidelines for nurses’ behavior with clients. Although national guidelines exist for faculty behavior with students (American Association of University Professors, 2007; NEA, 1975), the nursing education community has not provided explicit guidelines for interactions between nursing faculty and students. In keeping with the fiduciary nature of the teacher-student relationship, it is the responsibility of the teacher to maintain appropriate behavior with students. Without guidelines, faculty may be unsure about what behavior is considered appropriate and what is not. As many as 75% of respondents in this survey believed that nursing faculty would support a code of conduct regarding boundaries. Perhaps it is time to consider adoption of such a code.
Conclusion and Suggestions for Further Research
This study focused on associate degree nursing faculty in a western state. Research should be expanded to include baccalaureate and higher degree faculty, as well as faculty across the country. A larger sample would allow investigation into possible differences in responses on the basis of gender or ethnicity. Additional studies should investigate how expectations may differ in graduate education.
Gender and ethnicity of respondents was not asked in this research. Future research should include these variables to determine whether gender and ethnicity affect faculty perceptions about boundary issues. Absent from this study were the voices of students. Questions could include:
- Are students aware of incidents of boundary violations?
- How do students define boundary violations?
- What are students’ views on appropriate faculty behaviors?
- How are students affected by boundary violations, and what suggestions do they have for faculty in terms of making decisions about whether to engage in particular behaviors?
Research into students’ beliefs about and experiences with boundaries needs to be conducted.
More work needs to be done in determining what faculty already know about boundary issues. What are their sources of information? Are faculty instructed on boundary issues in their educational programs? Although there is much literature about boundaries between nurses and clients, little discussion was found in the literature about boundaries between faculty and students. Although some participants in the study used nurse-client relationship information in guiding faculty-student behavior, is that appropriate? What are the similarities and differences between the two relationships?
What does the emphasis in nursing education on caring for students and developing relationships with students mean for maintaining appropriate boundaries (Bevis & Watson, 1989)? In trying to connect with students outside the classroom and in promoting more egalitarian relationships between faculty and students, where do the boundaries fall? This study was only a beginning step in exploring this topic and provides insight into nursing faculty beliefs and behaviors in the area of faculty-student boundaries.
- American Association of University Professors. 2007. Statement on professional ethics. Retrieved August 1, 2008, from the Illinois Institute of Technology Web site: http://ethics.iit.edu/codes/coe/amer.assoc.univ.prof.pro.ethics.1987.html
- American Counseling Association. 1997. Code of ethics and standards of practice. Alexandria, VA: Author.
- Bevis, EO & Watson, J1989. Toward a caring curriculum: A new pedagogy for nursing New York: National League for Nursing.
- Borys, DS & Pope, KS1989. Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers. Professional Psychology: Research and Practice, 20, 283–293. doi:10.1037/0735-7028.20.5.283 [CrossRef]
- Coleman, E & Schaefer, S1986. Boundaries of sex and intimacy between client and counselor. Journal of Counseling and Development, 64, 341–344.
- Corey, G, Corey, MS & Callanan, P1997. Issues and ethics in the helping professions (5th ed.). Pacific Grove, CA: Brooks/Cole.
- Dziech, BW & Weiner, L1990. The lecherous professor: Sexual harassment on campus (2nd ed.). Baltimore: University of Illinois Press.
- Endo, JJ & Harpel, RL1982. The effect of student-faculty interaction on students’ educational outcomes. Research in Higher Education, 16, 115–138. doi:10.1007/BF00973505 [CrossRef]
- Feldman-Summers, S1989. Sexual contact in fiduciary relationships. In Gabbard, GO (Ed.), Sexual exploitation in professional relationships (pp. 193–209). Washington, DC: American Psychiatric Press.
- Friedman, J & Boumil, MM1995. Betrayal of trust: Sex and power in professional relationships Westport, CT: Praeger.
- Gabbard, GO & Nadelson, C1995. Professional boundaries in the physician-patient relationship. Journal of the American Medical Association, 273, 1445–1449. doi:10.1001/jama.273.18.1445 [CrossRef]
- Gaines, S & Baldwin, D1996. Guiding dialogue in the transformation of teacher-student relationships. Nursing Outlook, 44, 124–128. doi:10.1016/S0029-6554(06)80004-7 [CrossRef]
- Gallop, R1998. Abuse of power in the nurse-client relationship. Nursing Standard, 1237, 43–47.
- Gardiner, JJ & Nazari-Robati, A1983. Student attrition research: Implications for retention strategies. NASPA Journal, 203, 25–33.
- Garner, BA (Ed.). 2004. Black’s law dictionary (8th ed.). St. Paul, MN: Thomson.
- Gutheil, TG & Gabbard, GO1993. The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. American Journal of Psychiatry, 150, 188–196.
- Gutheil, TG & Weisstub, DN1996. Sexuality in the mental health system: Patients and practitioners. International Journal of Law and Psychiatry, 19, 183–190. doi:10.1016/0160-2527(96)00004-0 [CrossRef]
- Hamilton, NW2002. Academic ethics: Problems and materials on professional conduct and shared governance Westport, CT: Praeger.
- Hazler, RJ & Carney, J1993. Student-faculty interactions: An underemphasized dimension of counselor education. Counselor Education and Supervision, 33, 80–88.
- Hermansson, G1997. Boundaries and boundary management in counselling: The never-ending story. British Journal of Guidance & Counselling, 25, 133–146.
- Jacobs, C1991. Violations of the supervisory relationship: An ethical and educational blind spot. Social Work, 36, 130–135.
- Kagan, N1983. Classroom to client: Issues in supervision. The Counseling Psychologist, 111, 69–72. doi:10.1177/0011000083111011 [CrossRef]
- Kagle, JD & Giebelhausen, PN1994. Dual relationships and professional boundaries. Social Work, 39, 213–220.
- Kitchener, KS1988. Dual role relationships: What makes them so problematic?Journal of Counseling and Development, 67, 217–221.
- Kutchins, H1991. The fiduciary relationship: The legal basis for social workers’ responsibilities to clients. Social Work, 36, 106–113.
- Lamport, MA1993. Student-faculty informal interaction and the effect on college student outcomes: A review of the literature. Adolescence, 28, 971–990.
- Nadelson, CC1989. Afterword. In Gabbard, GO (Ed.), Sexual exploitation in professional relationships (pp. 229–231). Washington, DC: American Psychiatric Press.
- National Council of State Boards of Nursing. 1998. Crossing the line: When professional boundaries are violated. Chicago: Author.
- National Education Association. 1975. Code of ethics of the education profession. Retrieved August 1, 2008, from http://www.nea.org/aboutnea/code.html
- Pascarella, ET1980. Student-faculty informal contact and college outcomes. Review of Educational Research, 50, 545–595.
- Peach, J1999. Managing professional boundaries. Kai Tiaki: Nursing New Zealand, 58, 20–21.
- Peterson, MR1992. At personal risk: Boundary violations in professional-client relationships New York: WW Norton.
- Plaut, SM1993. Boundary issues in teacher-student relationships. Journal of Sex & Marital Therapy, 19, 210–219.
- Pope, KS1988. How clients are harmed by sexual contact with mental health professionals: The syndrome and its prevalence. Journal of Counseling and Development, 67, 222–226.
- Pope, KS1989a. Teacher-student sexual intimacy. In Gabbard, GO (Ed.), Sexual exploitation in professional relationships (pp. 163–176). Washington, DC: American Psychiatric Press.
- Pope, KS1989b. Therapist-patient sex syndrome: A guide for attorneys and subsequent therapists to assessing damage. In Gabbard, GO (Ed.), Sexual exploitation in professional relationships (pp. 39–55). Washington, DC: American Psychiatric Press.
- Pope, KS, Keith-Spiegel, P & Tabachnick, BG1986. Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41, 147–158. doi:10.1037/0003-066X.41.2.147 [CrossRef]
- Pope, KS, Schover, LR & Levenson, H1980. Sexual behavior between clinical supervisors and trainees: Implications for professional standards. Professional Psychology, 11, 157–162. doi:10.1037/0735-7028.11.1.157 [CrossRef]
- Pope, KS, Tabachnick, BG & Keith-Spiegel, P1987. Ethics of practice: The beliefs and behaviors of psychologists as therapists. American Psychologist, 42, 993–1006. doi:10.1037/0003-066X.42.11.993 [CrossRef]
- Salladay, SA1996. Professional boundaries: In love with a patient. Nursing96, 262, 18.
- Sheets, VR1996. Raising awareness regarding the phenomenon of professional sexual misconduct. Part two: Implications of professional sexual misconduct for nursing faculty. Dean’s Notes, 182, 1–3.
- Simon, RI1989. Sexual exploitation of patients: How it begins before it happens. Psychiatric Annals, 19, 104–112.
- Simon, RI1995. The natural history of therapist sexual misconduct: Identification and prevention. Psychiatric Annals, 25, 90–94.
- Smith, D & Fitzpatrick, M1995. Patient-therapist boundary issues: An integrative review of theory and research. Professional Psychology: Research and Practice, 26, 499–506. doi:10.1037/0735-7028.26.5.499 [CrossRef]
- Stevens, J1998, November). When patient care gets too personal. RN, 61, 67–70, 72.
- Strasburger, LH, Jorgenson, L & Sutherland, P1992. The prevention of psychotherapist sexual misconduct: Avoiding the slippery slope. American Journal of Psychotherapy, 46, 544–555.
- Tabachnick, BG, Keith-Spiegel, P & Pope, KS1991. Ethics of teaching: Beliefs and behaviors of psychologists as educators. American Psychologist, 46, 506–515. doi:10.1037/0003-066X.46.5.506 [CrossRef]
- Terenzini, PT, Rendon, LI, Millar, SB, Upcraft, ML, Gregg, PL & Jalomo, R Jr. et al. 1996. Making the transition to college. In Menges, RJ & Weimer, M (Eds.), Teaching on solid ground: Using scholarship to improve practice (pp. 43–73). San Francisco: Jossey-Bass.
- Tinto, V1975. Dropout from higher education: A theoretical synthesis of recent research. Review of Educational Research, 45, 89–125.
- Tinto, V1987. Leaving college: Rethinking the causes and cures of student attrition Chicago: University of Chicago Press.
- Totka, JP1996. Exploring the boundaries of pediatric practice: Nurse stories related to relationships. Pediatric Nursing, 22, 191–196.
- Washington State Department of Health. 1999. Rules update. The Nursing Commission Newsletter, 51, 6–8.
- Webb, SB1997. Training for maintaining appropriate boundaries in counselling. British Journal of Guidance & Counselling, 25, 175–188.
Selected Portions of the Survey Instrument
|In thinking about behaviors of nursing instructors, please answer the following question: How appropriate or inappropriate is each of the following behaviors? Using the descriptors below, circle the number that best corresponds to your response for each item. For this survey, “student” is defined as a student enrolled in a course you are teaching at the time of the behavior.|
|Never Appropriate||Appropriate Under Rare Conditions||Appropriate Under Some Conditions||Appropriate Under Many Conditions||Always Appropriate|
|Asking small favors, such as a ride home, from students.||1||2||3||4||5|
|Hugging a student.||1||2||3||4||5|
|Telling a student “I’m sexually attracted to you.”||1||2||3||4||5|
|Accepting a student’s gift worth under $10.||1||2||3||4||5|
|Becoming sexually involved with a current student.||1||2||3||4||5|
|Next, please identify if you have observed colleagues engage in any of these behaviors. Indicate also if you have engaged in any of these behaviors. Please note that there are two questions and two responses for each item. Y = Yes, N = No.|
|I Have Observed Colleagues Engage in This Behavior||I Have Engaged in This Behavior|
|Asking small favors, such as a ride home, from students.||Y / N||Y / N|
|Hugging a student.||Y / N||Y / N|
|Telling a student, “I’m sexually attracted to you.”||Y / N||Y / N|
|Accepting a student’s gift worth under $10.||Y / N||Y / N|
|Becoming sexually involved with a current student.||Y / N||Y / N|
Faculty Age and Employment Status (N = 140)
| ≤29||0 (0%)|
| 30–39||17 (12.1%)|
| 40–49||49 (35%)|
| 50–59||64 (45.7%)|
| ≥60||7 (5%)|
| Missing data||3 (2.1%)|
| Full time||99 (70.7%)|
| Part time||38 (27.1%)|
| Missing data||3 (2.1%)|
Faculty Experience (N = 140)
|Experience (y)||Kind of Experience|
|≤5||2 (1.4%)||37 (26.4%)|
|6–9||7 (5%)||29 (20.7%)|
|10–19||25 (17.9%)||38 (27.1%)|
|20–29||54 (38.6%)||25 (17.9%)|
|30–39||43 (30.7%)||9 (6.4%)|
|≥40||6 (4.3%)||0 (0%)|
|Missing data||3 (2.1%)||2 (1.4%)|
Faculty Educational Preparation (N = 140)
|Basic preparation in nursing|
| Licensed practical nurse||4 (2.9%)|
| Associate’s degree||38 (27.1%)|
| Diploma||25 (17.9%)|
| Bachelor’s degree||68 (48.6%)|
| Other||3 (2.1%)|
| Missing data||2 (1.4%)|
|Highest degree earned|
| Bachelor’s degree in nursing||16 (11.4%)|
| Master’s degree in nursing||111 (79.3%)|
| Master’s degree in another field||5 (3.6%)|
| Doctorate in nursing||2 (1.4%)|
| Doctorate in another field||4 (2.9%)|
| Missing data||2 (1.4%)|
Faculty Beliefs About Appropriateness of Teacher Behaviors (N = 140)
|1. Asking small favors, such as a ride home, from students.a||27.9||59.3||10||2.9||0||0|
|2. Hugging a student.||1.4||29.3||55.7||13.6||0||0|
|3. Telling a student “I’m sexually attracted to you.”||100||0||0||0||0||0|
|4. Accepting a student’s gift worth under $10.a||10||25.7||46.4||12.9||3.8||1.4|
|5. Becoming sexually involved with a current student.||100||0||0||0||0||0|
|6. Lending money to a student.a||33.6||52.9||12.9||0.7||0||0|
|7. Accepting a student’s invitation to a party not related to class activities.a||44.3||37.9||14.3||2.9||0||0.7|
|8. Selling goods, such as your car, to a student.a||60||27.1||9.3||0.7||0.7||2.1|
|9. Being sexually attracted to a student.||84.3||5||4.3||0||0||6.4|
|10. Accepting a student’s gift worth more than $50.||89.3||8.6||1.4||0||0||0.7|
|11. Making deliberate or repeated sexual comments, gestures, or physical contacts that are unwanted by the student.||100||0||0||0||0||0|
|12. Taking advantage of a student’s offer, such as wholesale prices at the parents’ store.a||77.9||17.9||3.6||0||0||0.7|
|13. Insulting or ridiculing a student in the student’s presence.||97.9||2.1||0||0||0||0|
|14. Insulting or ridiculing a student in the student’s absence.||95||2.9||2.1||0||0||0|
|15. Becoming sexually involved with a student only after the student has completed your course and the grade has been filed.||69.3||22.9||4.3||2.1||0||1.4|
|16. Hiring a student to work for you outside of school, such as to house-sit.||44.3||33.6||17.1||3.6||0.7||0.7|
|17. Talking about a student’s performance to another student.||84.3||12.9||2.1||0||0||0.7|
|18. Sharing details about your personal stresses with students.||45.7||40.7||13.6||0||0||0|
|19. Prescribing medications to a student by a nursing faculty member who is a nurse practitioner.||68.6||24.3||6.4||0||0.7||0|