Boundaries for Healthcare Workers

12 MINUTE READ

From Luke’s Journal 2022 | Rest | Vol.27 No.1

Boundaries around work and home life is an issue that many can struggle with. The push for efficiency and results has kept many people at work longer and minimised other parts of life. Instead of laying down rules for how to manage boundaries, I’d like to share some thoughts about working and living as a doctor in a small town. I hope some of these principles would be applicable to everyone, and might spur you to think about your own boundaries around work and home life.

I recently completed a ministry orientation course¹ with my church in order to serve on a Sunday. Something I found helpful was the discussion on boundaries:

God has given us the gift of boundaries in creation and in the Bible, creating order from chaos, defining relationships.

Boundaries are culturally and socially determined and include spiritual, financial, physical, emotional, language, sexual and other boundaries.

We will need to cross boundaries regularly, for example speaking to a person, sending a text message, shaking someone’s hand, or challenging another person’s point of view. These can all be part of normal and acceptable boundary-crossing within a ministry context.

Something that I had not considered before was that boundaries are something that is given to us as an example in the Bible. God laid down rules and laws for his people in order to create order and to encourage the flourishing of his people. Another thing I hadn’t considered was that we have so many hard and soft boundaries that we cross everyday. Sending a message to someone crosses the space between two people, and we have social etiquettes around how we act. Boundaries are good things, and where we set them can determine how people treat us, but they don’t need to dictate how we live. Instead, if we think about which lines are fixed and which are moveable then we can encourage the flourishing of ourselves and our communities.

“…boundaries are something that is given to us as an example in the Bible.”

My first experience living in the country was during medical school at the rural clinical school. I got to experience how the boundaries around life and work were different from being in the city. The students lived in a housing complex together and we saw each other everyday at the hospital and then again at home. We got to learn each other’s idiosyncrasies and hobbies like one housemate’s fondness for home brew and one student’s experimentation with hydroponic plants. Going to the local shop or restaurant meant you would probably see somebody you knew. It meant we all got to know each other pretty well. This presented opportunities for people to see what it means to be a Christian by getting to know me. It also presented me with the challenge of living like a Christian. 

Something that seemed to naturally flow from so much time together was the need to have time apart and time alone. We didn’t need to state our boundaries around this time as we just seemed to adjust to each other and there was ample space for us to be alone when we needed to be. When we initially moved in, we clearly stated who’s rooms and parking spaces were going to be assigned during the various rotations and since everybody kept within these agreed boundaries there was little conflict.

I found living in regional towns enjoyable and rewarding both personally and professionally during medical school. Being one of only a few medical students in a smaller town gave me more opportunities to see and do things I wouldn’t have been able to in the city. There was always a sense that God was directing my path to work out of the big city, and I went through the rural generalist pathway in order to become a rural GP. I didn’t have a clear sense of where I wanted to end up after I became a GP, but I felt as if my time in the rural clinical school was pointing me in that direction. I enjoyed taking a sense of ownership and responsibility, and had generally been well supported by those supervising me.

“Many social relationships had fixed ways of relating to each other. This brought a whole new dimension to living outside of the city. Moving to a remote community meant I had to find my place in a different set of boundaries.”

My first term as a General Practice Registrar was in an Aboriginal community in the Northern Territory. Several of us were placed in small Aboriginal communities to work as doctors in Aboriginal health centres. The work life balance was great because the doctors would cover working hours and the nurses were on call after hours and on weekends, so fatigue was not an issue. During our orientation, we were given a cultural background to the social structures around Aboriginal culture, as well as the types of people who tend to work in remote Australia. Many social relationships had fixed ways of relating to each other. This brought a whole new dimension to living outside of the city. Moving to a remote community meant I had to find my place in a different set of boundaries.

I found working with Aboriginal people to be challenging and rewarding in equal measure. I found acceptance in the church because I was a Christian, and this gave me entry into the lives of people where others did not have access. Boundaries can hold people together as well as apart. When the most important boundary that holds people together is Jesus, every other difference becomes less important. Something interesting that seemed to happen when I entered into this seemingly rigid social structure was that they made a somewhat special category for me in their social structure. I was able to receive a skin name in their culture, but with allowances for who I was in the community and what my role was. These seemingly hard boundaries were softened for a purpose. This taught me that sometimes our social norms can change when we need them to, and that our own personal boundaries can change when we need them to.

Being one of only a few doctors in the community meant that I had to see some friends as patients. I didn’t see this as a particular issue because if there were particularly sensitive issues, these patients had the choice to see another doctor within the clinic. If I did see any of my friends as patients, I would try to make sure that it was in a clinical setting with the same treatment and rules as any of my other patients. Something I was wary of was being subjective, and I would run my decisions past a colleague if I had the sense that I was not being objective. 

I now work in a rural hospital in Western Australia. The boundaries around work hours are set by an 80 hour fortnight and an on-call roster, with several other doctors helping to keep the hospital running. Social boundaries are not so set in stone, and I see patients in the local supermarket and stop to have conversations sometimes. For me, it’s nice to be able to have a social as well as a medical continuity of care. 

Certain boundaries should be considered by all health professionals, and some of these will need to be tempered by the circumstances that you are in. Apart from the bounds of the law and the Bible, personal boundaries should always be subject to wisdom. Below are just a few areas that boundaries can be considered, and each of us should seek out God in the ways in which we need to be seeking out His will for how we set those boundaries.

Work boundaries

Time

For many of us, time seems to be the greatest resource that we can give to people. We are all given the same number of hours in the day and are bestowed with the responsibility of how to use it.

Psalm 90:12 says “So teach us to number our days that we may get a heart of wisdom.”

Along with every other gift that we have, we should seek out God in how we spend our time. Each of us will go through different seasons that have different demands on our time. In all of these periods it takes wisdom from God to know how much time we should devote to each endeavour.

Patients

Metropolitan health professionals often have a choice about how near they want to live to their patients, how involved they become in the community they practice in, and who their patients are. Even in small towns we can choose to live in a world separate from the patients we treat, only seeing them in a clinical setting and forming our own social enclaves with work colleagues. The medical culture in Australia seems to set the professional distance from a patient at an arm’s length. The reasoning behind this is to protect objectivity and patient care (Good medical practice).^2,3

If we look at the example of Jesus as a healer – He saw everyone who came to Him, but He sometimes needed to be alone (Matt 14:13; Luke 5:16; Mark 1:35). He intentionally sought out his own people to teach and to heal but did not refuse foreigners from following him (Mark 7:24-30; Matt 8:5-13; John 12:20-26). It is natural for us to need time away from people to rest and restore ourselves. At the same time, we are sometimes called to do more than we feel capable of.

If we are to follow Jesus’ example, we should not look like our non-Christian colleagues in how we interact. While it may be acceptable to stay at an arm’s distance from our patients, if our conscience is not right about this we should listen and not be afraid to engage with what is uncomfortable.

Social Media

Social media is worthy of special mention and thought. Although social media can be unnecessarily time consuming and require boundaries around how much time we spend using it, we need to be careful about what we post on social media (see ‘Nobody Expects the Spanish Inquisition!’ – John Steenhof).^4,5 In our current socio-political environment, AHPRA and the Medical Board have wide powers to suspend registration based on what we post on social media, and some have come to harm because of it.

Relationship boundaries

Friendship is something we all need. God created us to be in relationship with one another. In Genesis 2, the first thing that God declares to be ‘not good’ is Adam being alone. We all need friendship and a sense of fellowship. In General Practice particularly, I found it often felt lonely because of the professional distance between yourself and your patients. Having friends that you can talk to about your day is important, especially when difficult circumstances around your home and work arise. Being part of a church means that you will always have a family wherever you go. If we are sensitive to the Holy Spirit and follow His leading we will receive a family here on earth and in eternity (Mark 10:29-31).

Financial

It can be helpful to think about boundaries around your finances. For most health professionals in Australia, the question will not be how much can I afford to give away but how much should I give? This question will have a different answer for everyone, but it is difficult to say you are giving away too much if you aren’t giving at all. Having a church that you give to regularly is a good start. Setting aside a portion that you put aside for the needs of others around you and for those overseas can also be helpful.

“…looking at our budgets can be a way to honour God with what he has given. If your conscience is prompting you to give more, it might be time to have another look at your budget.”

Something that is easy to do is to go through the year and not think about how much you spend. I find that when I look closely and honestly at my finances that it is often emotionally draining as a process. However, looking at our budgets can be a way to honour God with what he has given. If your conscience is prompting you to give more, it might be time to have another look at your budget.

Technology

For some of us, the distinction between work and home time has been blurred due to the digital age and the ease by which we are now contactable. Telephone, email, and text messaging have made contacting people easier. COVID-19 has meant that more of us have been working from home, and the physical boundary between work and home has been lost for many. Technology has also filled our lives with potentially endless reminders, emails and constant interruption. Simple things like turning off notifications and setting times to check emails can make our lives a little bit less interrupted, but setting boundaries around when you can and can’t be contacted may require some difficult thought and discussion.

Sabbath

Burn-out is something that many of us face. The realities of living in a fallen world with sin and corruption can be destructive to our souls. Jesus said that the Sabbath was made for man, not man for the Sabbath (Mark 2:27). The Sabbath was given to us as a day to rest and to stop work. While this may not be the cure for burn-out, it is certainly something we should think about.

A helpful boundary around work is having a day off once a week, and having time off from work for rest and recreation. Having a day off also gives us the chance to look forward to the ultimate rest we will have in heaven (Heb 4:9-10). 

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