Nurses can cross boundaries in one situation and violate them in another. Professional sexual misconduct is an extreme boundary violation. Violators use power, influence, and their professional knowledge to obtain sexual gratification, romantic partners, or sexually deviant outlets. This is true even if the patient consents to or initiates the sexual contact. It's a clear breach of trust.
Most boundary violations are more ambiguous and more difficult to evaluate than sexual misconduct.
Visualize a continuum of behavior with underinvolvement on one extreme, overinvolvement on the other, and a center zone of helpfulness. No definite lines separate the zone of helpfulness from the ends of the continuum. Nurses may need to shift zones in some situations. For example, nurses working with prison inmates may need to establish the zone of helpfulness toward the left side of the continuum, while nurses working with pediatric patients may put their zone of helpfulness toward the right. Most nursing interactions occur in the zone of helpfulness.