oundaries protect what’s important. Setting boundaries on how we expend our energy, attention and time allows us to sustain these resources for the different arenas that matter in our lives, work, family, and wellbeing.   

For health care professionals, setting boundaries prior to COVID was just as challenging. We find meaning in service and caring of others. Health care culture tends to promote values like self-sacrifice and perfectionism, and though there are valid reasons for these values, we also need values such as self-care, support and compassion to promote safe, quality care. Setting healthy boundaries, communicating with ourselves and others “what’s ok and not ok” is an important key to sustaining professional and personal well-being. 

Especially during these times as we are recovering and rebuilding, we know we need to set boundaries to restore individual and team reservoirs. The question is how do we do that when the needs are still high and many of our teams are understaffed or burned out. 

“Boundaries are the distance where I can love you and me simultaneously.”

(Quote by Teacher & Author, Prentis Hemphill.)  

5 tips on how to set boundaries 

1. Identity the big why. Think about why we want to set boundaries. Health care professionals specifically and humans in general can do hard things when they understand the big why of meaning & purpose.
    

   It can be hard to say no even if we want to; in this case, focus what you're saying yes to: authenticity, health, family, joy, adventure... It’s not that you don’t care about your team or your work; it is about remembering what else you care about. What else is important in your life? Carving out space for these other values enables you to continue caring for your patients and your team.  

2. Be clear on what you need and communicate it. Identifying what you need and asking for it feels vulnerable and takes courage. It can also be an act of kindness to let people know how you would like to be treated, instead of expecting them to do the guesswork and get it wrong. If it’s a big ask, divide it into smaller asks, instead of just writing it off as not possible. Though it is not necessary, sharing some reasons for your request helps others to understand and better support you. If you have the resources, you can also help find coverage or refer out for what you cannot do.
    
3. Identify the resistance to not having boundaries. What emotions do you experience when you try to set or enforce your own boundaries? Fear, guilt, anxiety? Often their calling cards sound like “What if I let my team down? What if they think I don’t care or I’m selfish? What if they think I’m incompetent? What if I make them mad? What if I hurt my chances at promotion?”  
   
   Acknowledge the feelings and thoughts; slow down and perhaps answer a few of these “What ifs” to assess their risks and realistic impact. Even just slowing down for a minute to name an emotion helps, even if it doesn’t feel like it in the moment. 
   
   Besides these hard emotions, there may be beliefs and habits that you, your family and your team may hold that limit boundary setting. Name them and acknowledge that while they have served you in the past, do they serve you now as they are? What needs recalibrating? Sometimes, these habits are rooted in trauma, and consulting with a mental health professional may be helpful in healing and releasing.    
    
4. Ask what happens if boundaries aren’t set. Resentment? Conflict? Burnout? Effects on team relationships, patient care, and turnover?  
    
5. Focus on what you can control and let go of what you can’t, especially people’s reactions and judgments. Take care of your own feelings, as the process may be uncomfortable, and allow people to take care of their feelings. It’s not your responsibility to make others feel ok with your requests.   

Try it out with your team 

Team culture and leaders are important players in supporting the practice of boundary setting. Are boundaries discussed explicitly and modeled? Sharing examples and discussing the topic in team meetings can be helpful. For example, leaders can state why boundary setting is important and share an example of how they’ve done it. Check in with prompts or questions such as “When was a time you set a boundary? What was challenging and supportive of you doing it? What did you learn?” 

As a leader, sometimes you can’t grant an employee’s request. Even when you can’t grant the request, thank the person for their willingness to let you know what they need and their vulnerability. Tell them why you can’t grant their request and let them know you want them to keep advocating. 

Tips and scripts for boundary setting 

• Practice, practice, practice. (Start small. Practice doesn’t make perfect, but practice makes for more ease) 

• Consult with colleagues and mentors; seek the support you need.

• I need/want/would like: I would like to take on that assignment and do it justice; what can I take off my plate?

• No, thank you.   

• I don’t have the capacity right now.  

• Thank you for inviting me. It means a lot, but I can’t say yes at this time. 

• Give me a few days to think about it taking on that project. (Try slowing down the habitual urge to say yes) 

• I said yes, but I have reconsidered. I’m sorry to disappoint you. (Give yourself permission to change your mind.)   

• Would you be completely opposed to me changing my schedule?  

• Is it ridiculous to request a week/day off in the midst of all of this?  

• If I can’t take a week off, how about a 4-day weekend this month and could we plan for a week off in 3 months? (Recognize and avoid stress reaction’s tendency for tunnel vision or all or nothing thinking; negotiate).