{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:48:22Z","timestamp":1782362902284,"version":"3.54.5"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Patient- and family-initiated abuse of nurses is widely recognized as workplace violence, but it also raises a distinct professional-regulatory question: when may a nurse end or restrict an established therapeutic relationship without creating an allegation of abandonment or discriminatory denial of care? This perspective focuses on Alberta and examines whether the province\u2019s nursing regulator provides a comprehensive, nurse-specific, all-registrant standard comparable in clarity to Alberta\u2019s physician standard. The concern is not the absence of every form of protection but the absence of a clearly defined regulatory pathway for all Alberta RNs and NPs. Methods: Publicly available legal, occupational health and safety, regulatory, legal-risk and scholarly materials were purposively selected where they addressed relationship termination, discontinuing or declining care, workplace violence, immediate safety risk, abandonment, documentation, continuity of care or patient safeguards. Results: The College of Physicians and Surgeons of Alberta standard provides a clearly defined regulatory pathway, including immediate discharge where a patient poses a safety risk, is abusive or fails to respect professional boundaries. Alberta nursing materials contain important elements but do not yet constitute a dedicated Alberta RN\/NP standard applicable across office-based, community, virtual, home care and independent nursing practice. Interprovincial nursing standards demonstrate feasibility, operational detail, emerging professional consensus and potential templates for policy transfer; however, they do not bind the CRNA or create an Alberta regulatory benchmark for complaint review. Conclusions: Alberta should adopt a nurse-specific standard for ending or restricting abusive patient- and family-initiated relationships. Such a standard should include ordinary and urgent safety pathways, prohibited grounds, documentation requirements, continuity safeguards, employer integration and practical templates. Nurse protection and patient protection are mutually reinforcing regulatory objectives.<\/jats:p>","DOI":"10.3390\/nursrep16070212","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T03:20:21Z","timestamp":1782357621000},"page":"212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ending Abusive Patient- and Family-Initiated Relationships in Alberta Nursing Practice: The Case for a Nurse-Specific Regulatory Standard"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4621-5404","authenticated-orcid":false,"given":"Dawid","family":"Karczewski","sequence":"first","affiliation":[{"name":"Cranston Ridge Medical Clinic, Calgary, AB T3M 3A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1991-9184","authenticated-orcid":false,"given":"Tomasz","family":"Karczewski","sequence":"additional","affiliation":[{"name":"Cranston Ridge Medical Clinic, Calgary, AB T3M 3A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Olsen","sequence":"additional","affiliation":[{"name":"Cranston Ridge Medical Clinic, Calgary, AB T3M 3A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","unstructured":"College of Physicians and Surgeons of Alberta (2026, June 10). Terminating the Physician-Patient Relationship in Office-Based Settings. Available online: https:\/\/cpsa.ca\/physicians\/standards-of-practice\/terminating-the-physician-patient-relationship-in-office-based-settings\/."},{"key":"ref_2","unstructured":"College of Physicians and Surgeons of Alberta (2026, June 10). Advice to the Profession: Ending the Physician-Patient Relationship. Published 16 May 2024; Updated 18 December 2024. Available online: https:\/\/cpsa.ca\/wp-content\/uploads\/2024\/05\/AP_Ending-the-P-P-Relationship.pdf."},{"key":"ref_3","unstructured":"College of Registered Nurses of Alberta (2026, June 10). Practice Standards for Registrants. Effective 31 March 2023. Available online: https:\/\/www.nurses.ab.ca\/protecting-the-public\/standards-code-of-ethics\/standards-for-rns-and-nps\/practice-standards-for-registrants\/."},{"key":"ref_4","unstructured":"College of Registered Nurses of Alberta (2026, June 10). Nurse Practitioner Frequently Asked Questions. Available online: https:\/\/www.nurses.ab.ca\/protecting-the-public\/practice-guidance\/nurse-practitioner-frequently-asked-questions\/."},{"key":"ref_5","unstructured":"College of Registered Nurses of Alberta (2026, June 10). Self-Employed Practice: Practice Advice for Registered Nurses. Published December 2025. Available online: https:\/\/www.nurses.ab.ca\/protecting-the-public\/standards-code-of-ethics\/guidelines-and-practice-advice\/self-employed-practice-practice-advice-for-registered-nurses\/."},{"key":"ref_6","unstructured":"College of Registered Nurses of Alberta (2026, June 10). Documentation Standards. Effective 31 March 2023. Available online: https:\/\/crna.com\/protecting-the-public\/standards-code-of-ethics\/standards-for-rns-and-nps\/documentation-standards\/."},{"key":"ref_7","unstructured":"College of Registered Nurses of Alberta (2026, June 10). Addressing Unsafe Practice Situations. Published March 2023. Available online: https:\/\/www.nurses.ab.ca\/protecting-the-public\/standards-code-of-ethics\/guidelines-and-practice-advice\/addressing-unsafe-practice-situations\/."},{"key":"ref_8","unstructured":"Government of Canada, Department of Justice (2026, June 10). Criminal Code, R.S.C. 1985, c. C-46, s. 423.2, Intimidation\u2014Health Services. Available online: https:\/\/laws-lois.justice.gc.ca\/eng\/acts\/c-46\/section-423.2.html."},{"key":"ref_9","unstructured":"Government of Alberta (2026, June 10). Occupational Health and Safety Code, Part 27: Violence and Harassment. Available online: https:\/\/search-ohs-laws.alberta.ca\/legislation\/occupational-health-and-safety-code\/part-27-violence-and-harassment\/."},{"key":"ref_10","unstructured":"Government of Alberta (2026, June 10). Workplace Violence and Harassment. Available online: https:\/\/www.alberta.ca\/workplace-harassment-violence."},{"key":"ref_11","unstructured":"(2026, June 10). Alberta Human Rights Act, RSA 2000, c. A-25.5. Available online: https:\/\/www.canlii.org\/t\/81xx."},{"key":"ref_12","unstructured":"College of Nurses of Ontario (2026, June 10). Discontinuing or Declining to Provide Care. Practice Standard. First published June 2024; Updated March 2026. Available online: https:\/\/www.cno.org\/Assets\/CNO\/Documents\/Standard-and-Learning\/Practice-Standards\/ps-discontinuing-or-declining-to-provide-care-en.pdf."},{"key":"ref_13","unstructured":"College of Nurses of Ontario (2026, June 10). Discontinuing or Declining to Provide Care: Guidance for Nurse Practitioners. Available online: https:\/\/www.cno.org\/standards-learning\/standards-guidelines\/discontinuing-or-declining-to-provide-care-guidance."},{"key":"ref_14","unstructured":"British Columbia College of Nurses and Midwives (2026, June 10). Nurses: Duty to Provide Care. Ethics Standard. Effective 1 April 2026. Available online: https:\/\/www.bccnm.ca\/RN\/PracticeStandards\/Pages\/DutyToProvideCare.aspx."},{"key":"ref_15","unstructured":"British Columbia College of Nurses and Midwives (2026, June 10). Duty to Provide Care: Nurse Practitioners. Available online: https:\/\/www.bccnm.ca\/NP\/learning\/dutytoprovidecare\/Pages\/Default.aspx."},{"key":"ref_16","unstructured":"College of Registered Nurses of Saskatchewan (2026, June 10). Ending the Nurse Practitioner-Client Relationship. Effective 17 February 2026. Available online: https:\/\/www.crns.ca\/wp-content\/uploads\/2023\/03\/Ending-the-NP-Client-Relationship.pdf."},{"key":"ref_17","unstructured":"NHS England (2026, June 10). Violence Prevention and Reduction Standard. Updated 3 December 2024. Available online: https:\/\/www.england.nhs.uk\/long-read\/violence-prevention-and-reduction-standard\/."},{"key":"ref_18","unstructured":"Nursing and Midwifery Board of Australia (2026, June 10). Professional Standards, Available online: https:\/\/www.nursingmidwiferyboard.gov.au\/codes-guidelines-statements\/professional-standards.aspx."},{"key":"ref_19","unstructured":"Nursing Council of New Zealand (2026, June 10). Code of Conduct. Available online: https:\/\/nursingcouncil.org.nz\/Public\/NCNZ\/nursing-section\/Code_of_Conduct.aspx."},{"key":"ref_20","unstructured":"American Nurses Association (2026, June 10). Workplace Violence. Position Statement. Available online: https:\/\/www.nursingworld.org\/globalassets\/practiceandpolicy\/nursing-excellence\/workplace-violence--ana-position-statement.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1136\/oemed-2019-105849","article-title":"Prevalence of workplace violence against healthcare workers: A systematic review and meta-analysis","volume":"76","author":"Liu","year":"2019","journal-title":"Occup. Environ. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.puhe.2023.05.021","article-title":"Workplace violence against healthcare workers: An umbrella review of systematic reviews and meta-analyses","volume":"221","author":"Rossi","year":"2023","journal-title":"Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Schulz-Quach, C., Lyver, B., Reynolds, C., Hanagan, T., Haines, J., Shannon, J., Pozzobon, L.D., Sarraf, Y., Sabbah, S., and Ensafi, S. (2025). Understanding and measuring workplace violence in healthcare: A Canadian systematic framework to address a global healthcare phenomenon. BMC Emerg. Med., 25.","DOI":"10.1186\/s12873-024-01144-1"},{"key":"ref_24","unstructured":"Canadian Federation of Nurses Unions (2026, June 10). Violence and Harassment at Work Has Become a Universal Experience for Nurses, New National Survey Finds. Available online: https:\/\/nursesunions.ca\/violence-and-harassment-at-work-has-become-a-universal-experience-for-nurses-new-national-survey-finds\/."},{"key":"ref_25","unstructured":"Canadian Federation of Nurses Unions (2026, June 10). White Paper: Violence Against Nurses in Canada: An Urgent Call to Action. Available online: https:\/\/nursesunions.ca\/research\/white-paper-violence-against-nurses-in-canada-an-urgent-call-to-action\/."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Spencer, C., Sitarz, J., Fouse, J., and DeSanto, K. (2023). Nurses\u2019 rationale for underreporting of patient and visitor perpetrated workplace violence: A systematic review. BMC Nurs., 22.","DOI":"10.1186\/s12912-023-01226-8"},{"key":"ref_27","unstructured":"Canadian Nurses Protective Society (2026, June 10). Ask a Lawyer: Ending the NP-Client Relationship. Available online: https:\/\/cnps.ca\/article\/ending-the-np-client-relationship\/."},{"key":"ref_28","unstructured":"Canadian Nurses Protective Society (2026, June 10). Ask a Lawyer: Engaging with Non-Compliant Patients and Discontinuing Nursing Services. Available online: https:\/\/cnps.ca\/article\/ask-a-lawyer-engaging-with-non-compliant-patients-and-discontinuing-nursing-services\/."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/7\/212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T04:27:48Z","timestamp":1782361668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/7\/212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,25]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nursrep16070212"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16070212","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,25]]}}}