advancedprofessional boundariesdual relationshipsrural practiceethicsinformed consentaccess to care
A PMHNP practicing in a small rural town encounters a boundary challenge: the parent of her child's closest friend requests to become her patient for treatment of major depressive disorder. The nearest alternative psychiatric provider is 120 miles away. The parent reports worsening depressive symptoms including passive suicidal ideation. The PMHNP weighs the ethical implications of treating someone with whom she has a pre-existing social relationship against the patient's access-to-care needs.