Between the Lines of Care

“She doesn’t respect me.”

A client said those words to me recently after a staff member at another organization explained that they weren’t allowed to help him up if he fell.

At first, I understood why he felt that way. If someone refuses to help you in a vulnerable moment, it’s easy to interpret that as a lack of compassion. But as we talked, it became clear that what he was seeing as disrespect was actually a boundary designed to protect everyone involved.

Most people aren’t trained to safely lift an adult from the ground, nor are they able to determine whether moving someone could make an injury worse. Policies like these aren’t about refusing to help. They’re about preventing harm.

Then he told me something else.

Another staff member at the same organization had told him they would always help him up if he fell.

That one act of kindness had unintentionally changed his expectations. The next person who followed the policy wasn’t seen as someone keeping everyone safe. They were seen as someone who didn’t care.

That conversation stayed with me.

I’ve been thinking a lot about boundaries these past couple of weeks. It’s something I’ve written about before, but like many things, my understanding of it has changed over the years. The longer I do this work, the more I realize that healthy boundaries aren’t something you either have or you don’t. They develop through experience, reflection, and sometimes through making mistakes.

One thing I’ve always been grateful for is that nursing school encouraged us to identify our core values. At the time, I didn’t fully appreciate why that mattered. Years later, I can honestly say those values have become the foundation of almost every difficult decision I’ve had to make. In a field where emotions run high and there rarely seems to be one perfect answer, coming back to those values has helped keep me grounded.

One thing I’ve also come to understand is that many of the people I work with aren’t making decisions from the same place as most of us. Many are living in survival mode. Some are living with significant mental illness. Many are using substances that affect judgment, impulse control, and decision making. Others have spent years learning that if they don’t push boundaries, ask multiple people, or find creative ways to get their needs met, those needs simply won’t be met. Whether those strategies are healthy or not, they’ve often worked for them in the past.

That means they’re paying attention.

They notice who bends the rules, who makes exceptions, and who gives different answers. It’s rarely about trying to make someone’s day more difficult. More often, it’s about trying to meet an immediate need. If one staff member says yes and another says no, they’re naturally going to keep asking until they find the answer they’re hoping for.

Over time, that inconsistency creates confusion for clients and frustration for staff. The exception made out of kindness today can easily become the expectation that fuels conflict tomorrow.

We often describe this as manipulation, and sometimes that’s exactly what it is. But over the years, I’ve come to see many of these interactions differently. Most behaviour is an attempt to get a need met. The behaviour itself may not be appropriate, but the need underneath it is often very real. Recognizing that has made me more compassionate without making me less consistent. I can acknowledge the need, empathize with the person in front of me, and still hold the boundary.

Ironically, inconsistent boundaries usually come from a place of caring. People convince themselves that this one situation is different, that they know the risks, or that the rules don’t really apply this time. Sometimes nothing bad happens. Other times the consequences aren’t physical at all. They show up as resentment between coworkers, compassion fatigue, burnout, or clients receiving different answers depending on who happens to be working that day.

Looking back, I also realize how much leadership influences whether staff are able to maintain healthy boundaries. It’s one thing to tell people to follow policy. It’s another to create an environment where they feel supported when they do. If staff are worried they’ll be criticized by clients, coworkers, or even their manager for holding a boundary, it becomes much easier to bend it.

I think one of the biggest responsibilities leaders have is creating an environment where people feel safe asking questions, admitting uncertainty, and talking openly about difficult situations. We spend a lot of time teaching policies, but far less time explaining why they exist. When people understand the purpose behind a boundary, they’re much more likely to uphold it, even when it’s uncomfortable.

The longer I’ve worked in healthcare, the more I’ve realized that healthy workplace cultures don’t happen by accident. You can usually feel them within minutes of walking through the door. Staff feel safe asking questions. They feel supported when they make difficult decisions. They know reflection is valued more than perfection. When those things are missing, the culture changes, and eventually so does the care people receive.

When I was managing the shelter, if someone stepped into the grey, I wanted to understand their thinking. I wasn’t looking for perfection. I was looking for thoughtful decision making. Sometimes I agreed with their choice, and sometimes I didn’t, but every conversation became an opportunity to reflect, learn, and grow rather than assign blame.

Reflection develops critical thinking. It helps people make better decisions the next time they’re faced with a similar situation. If every mistake is met with criticism, people don’t stop making mistakes. They simply stop talking about them.

One of the hardest lessons I’ve learned over the years is that boundaries aren’t about protecting organizations. They’re about protecting people. They protect staff from physical injury. They protect clients from inconsistent care. They protect teams from unnecessary conflict, and they protect therapeutic relationships by making them predictable instead of dependent on one person’s willingness to bend the rules.

That doesn’t mean everything is black and white because it certainly isn’t. There will always be situations that fall into the grey. The goal isn’t to eliminate the grey. The goal is to have thoughtful people who can navigate it, supported by leaders who encourage reflection rather than simply demanding compliance.

Over the years I’ve also learned that clients don’t build trust because I always say yes. They build trust because they know what to expect from me. They know where my boundaries are, and they know those boundaries won’t change depending on my mood or how difficult the conversation is. For many of the people I work with, life has been anything but predictable. They’ve experienced inconsistency in relationships, housing, healthcare, and often throughout childhood. Being consistent isn’t cold. In many ways, it’s one of the most therapeutic things I can offer.

My values have never asked me to rescue people. They ask me to be compassionate, honest, fair, accountable, and respectful. Sometimes those values make decisions feel easy, and sometimes they pull in different directions. Learning to recognize the difference between helping someone and making myself feel better has probably been one of the most important lessons of my career.

For a long time I thought boundaries were mostly about saying no. Now I think they’re about saying yes to the things that matter most: consistency, safety, trust, and compassion that can be sustained over an entire career.

Boundaries aren’t barriers that stop us from caring.

They’re what make it possible to keep caring for years to come.