Setting Boundaries for a Healthier Nursing Career

• Setting boundaries is crucial in many areas of life, and it is essential in nursing as well.  
• There are two types of boundaries – internal and external – and it is vital to understand the differences.  
• The concept of setting boundaries is an imperative aspect of self-care, and it’s important to understand the subtle ways one can become overextended. 

Welcome to a discussion that’s essential not just for nursing professionals but anyone seeking a balance between their professional duties and personal well-being. Today, I want to discuss the profound impact of setting boundaries — a crucial skill in a nursing career.  

What is a boundary, exactly? Boundaries are the rules or guidelines we choose to live by to have good relationships and live a healthy, well-balanced life. They include what we say yes to, what we say no to, and where we draw a line in the sand.  

Types of Boundaries

There are two types of boundaries, internal and external: 

• Internal boundaries — those we make ourselves do (like showing up to work on time) or that we won’t allow ourselves to do (say yes to things at the expense of our own well-being). They help us manage our actions, feelings, and behaviors, ensuring we maintain our personal integrity and well-being and don’t overextend ourselves. 
• External boundaries — those we set with others (see the story below about the scrotum incident). These boundaries govern what we will and won’t allow others to do to us, ensuring that our interactions with others are respectful and don’t impinge on our personal or professional well-being.  

As I reflect on my career, I realize I did not utilize boundaries while at work; I just gave, gave, gave. But once I started realizing my needs also mattered, that I did not have to say yes to everyone, and that my worth was not connected to how hard I worked or how many “yeses” I could deliver in a 12-hour shift, I actually started to enjoy giving.  

A Defining Moment: The Scrotum Incident

Early in my nursing career, I encountered a situation that became a defining moment. A patient, capable of personal hygiene, asked me to apply lotion to his scrotum. Yes, you heard that right. It was one of those moments where you do a double-take and wonder if you’ve suddenly become the unwitting star of a hidden camera show.  

This request was uncomfortable, to say the least, and it raised a crucial question: “Is this part of my job?” If I say no, does that mean I am providing poor customer service? After a bit of internal debate, during which I flipped through the mental handbook of “Nursing Duties I Never Expected,” I decided to refuse. Thankfully!   

It was an early lesson in understanding my professional limits and personal comfort zone. This incident taught me that not every patient request is reasonable or appropriate, and it’s perfectly okay to say no. If there’s a fast track to burnout, not setting boundaries is undoubtedly it.  

This episode was a clear example of setting an external boundary with a patient. I’ve drawn a line in the sand for massaging scrotums. I might help prop them on a pillow, but massaging them? That’s a hard pass, sorry.  

While this story might lean on the humorous side of nursing, it also highlights a less obvious aspect of our profession: boundary setting isn’t always about big, dramatic stands. Often, it’s the quieter, more subtle decisions we make that protect our well-being and respect. It’s about knowing where to draw the line, even if that line seems to move with each new patient or situation. And sometimes, it’s about finding the strength to say no, even when every part of you is wondering if you’re just part of a very odd joke.  

Addressing Guilt and Emotional Resilience

Feeling guilty for setting boundaries is a common struggle, especially in professions dedicated to caring for others. It’s crucial to understand that setting boundaries is not a sign of inadequacy or selfishness but a step toward sustainable caregiving. Recognizing guilt as a natural response that can be managed and reframed is essential. Remember, taking care of yourself allows you to provide better care for others, and setting boundaries is a vital part of self-care.  

Subtle Challenges of Setting Boundaries

Here are subtle ways you might be unknowingly overextending yourself:  

• Routinely Staying Late: Extending work hours for non-urgent tasks leads to exhaustion. If you cannot manage all your tasks in 12 hours, which is the norm in nursing, maybe it’s worth communicating with your boss about potential solutions.  
• Skipping Breaks: Missing breaks for non-critical requests or paperwork is harmful. I know it feels like you will be further behind if you take your break, and unless you have a break nurse (yes, that’s a thing), you likely will, but take your break anyway. I once calculated that a company owed me about $15,000 in breaks I did not take. It would be best to rest; your patients need you to rest.  
• Handling Non-Essential Tasks: Frequently doing tasks meant for other staff adds unnecessary burden. I know, if you are like me, the idea of asking for help is cringe-worthy, but you can do it, I promise. Allow others to support you just as you support them.  
• Being the Constant ‘Go-To’ Person: Regularly covering shifts or extra queries can be draining.  
• Overextending Emotional Support: Excessive emotional support without limits leads to burnout.  
• Responding Immediately to All Calls: Answering non-urgent calls during breaks prevents rest.  
• Always Accepting Extra Tasks: Saying yes to additional tasks can accumulate stress. Remember, it’s OK to say NO, and you must watch out for caretaking vs. caregiving.  
• Regular Personal Favors for Colleagues: Continuously helping without reciprocation can be unbalanced.  

Reflection and Advice

Reflecting and caring for myself by setting clear, professional boundaries was as crucial as caring for my patients. It would have saved me a lot of energy. Asking for help can be challenging, saying no can be difficult, and setting a boundary can be tricky, but it’s all about the first step. Every time you do this, it will slowly get more accessible for you.  

Here are some tips for setting boundaries:  

• Recognize Your Limits: You’re human, with limits. Acknowledging this is the first step.  
• Communicate Clearly: Be direct. It’s OK to say, “I can’t take an extra shift,” or “I need a break.”  
• Manage thoughts of guilt: Self-care allows you to care better for others. Hmmm, note the guilt for me always comes, so maybe I should say don’t let the guilty thoughts take you down a shame spiral. When guilty thoughts come, know they are thoughts, not facts.  
• Navigate Changes in Relationships: Enforcing boundaries may change relationships. This is part of the process. As you begin to enforce and prioritize yourself, you will lose some people, but you will gain so much energy and insight into who your friends really are because they like you or are using you. It’s a great way to clear some space.  
• Seek Support: Talk to a supervisor or an experienced nurse if you’re struggling.  =
• Stay Consistent: Enforcing your boundaries is vital for respect and understanding. Setting the boundary was easy for me; the tricky part was enforcing it. You can do it!  

The Bottom Line

Setting boundaries and finding balance at work is a continuous, lifelong journey. Reflect on your boundaries and how you might start setting them for your well-being and professional integrity. Consider jotting down your thoughts or discussing them with a colleague or mentor. Remember, your well-being is the foundation of your ability to care for others. 

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