But suppose it's someone else's romance that puts you in a difficult spot—or at a professional disadvantage. What if your co-worker is involved with your mutual boss and getting preferential treatment?

"It's important to know about your facility's anti-discrimination policies," says Sullivan. "You may have a case if you can prove discrimination in an objective way."

A recent California Supreme Court ruling makes it increasingly likely that facilities without employee dating and discrimination policies will devise them. In a case involving a prison warden charged with giving preferential treatment to employees he'd had affairs with, the justices ruled that pervasive sexual favoritism can be considered a form of sexual harassment.

Patient liaisons cross the line

Despite the perils of involvement with colleagues, it's relationships with patients that are most likely to put nurses in professional jeopardy. NCSBN considers "failure to maintain professional boundaries with clients" to be misconduct because the patient can be harmed or placed at risk.

"Romance with a patient falls within the whole area of boundary setting," says Haddad. "You're in a role of authority, you have confidential information, and the patient is vulnerable." Engaging in sex with a patient, of course, is beyond the pale and can result in disciplinary action. But flirting and romantic advances even without sexual involvement can lead to sanctions, as well.

Nationwide, a small number of disciplinary cases arise from nurse-patient relationships each year. In a Wisconsin case, for example, a female nurse was found professionally negligent for developing a sexual relationship with a psychiatric patient who'd been a victim of adolescent sexual abuse.

Neither can you assume that a relationship with a patient is acceptable after discharge, as one California case demonstrates. The state nursing board ruled that a male RN went too far in his relationship with a patient who had been hospitalized for sex-related problems. During the patient's stay, the nurse gave her gifts and his phone number and called her when he was off duty. After the patient was discharged, she and the nurse were involved for two weeks, after which she needed to be readmitted to the hospital. An appeals court backed the state board in finding that the nurse had engaged in professional misconduct.

Then there's the case of Catherine, a rehab nurse who treated a teenage patient like a little brother. She visited when she was off duty, counseled him about his personal life, and shared details of her own life when he asked. The teenager mistook her attentions for love and became despondent when he learned his mistake.

Fortunately, Catherine is a fictional character in an educational video distributed by NCSBN ("Crossing the line: When professional boundaries are violated"). Nurses who get overly involved with their patients are exploiting their position of power in the therapeutic relationship to meet their own needs rather than those of the patient, the video counsels. Other violations include behaving as a friend rather than as a professional, using patient information inappropriately, and disclosing too much personal information.

There are some common sense caveats, to be sure. A nurse who lives and works in a small community may not be able to avoid being chummy with a long-time neighbor or friend-turned-patient. And the rules about dating a former patient depend on the length of time that has passed since the hospital stay and the kind of treatment involved. Nurses need to be particularly wary of over-involvement with patients in long-term situations such as rehab, home care, oncology, and kidney dialysis, or in psychiatric settings, where patients are emotionally vulnerable. (See for guidelines from the NCSBN on the warning signs of a boundary violation.)

Are there no happy endings, then, for nurses whose relationships begin in a workplace setting? Remember Casey, who left her job rather than deal with a potential liaison with her boss? Six months later (with her marriage now broken beyond repair), she was invited to an office party by a friend who still worked at the research clinic. Everyone was pleased to see her, but no one more so than her former boss, who was no longer involved with the manager. Casey never did return to her job at the clinic, but she and the clinic's director did marry. They are now expecting their second child. Sometimes, sparks on the job do lead to a happy ending.

The danger signs of getting too close

To avoid crossing professional boundaries, the National Council of State Boards of Nursing urges nurses who exhibit any of the following behaviors to reexamine their relationship with the patient without delay:

Excessive self-disclosure: The nurse discloses personal problems, sexual attraction, or intimate details to the patient.

Secretive behavior: The nurse keeps secrets with the patient or becomes defensive when their interaction is questioned.

"Super nurse" behavior: The nurse believes only she—or he—can meet the patient's needs.

Special treatment: The nurse spends inappropriate amounts of time with a patient, visits when off duty, gives or accepts gifts, or trades assignments to care for the patient.

Flirtation: The nurse employs sexual innuendo, tells off-color jokes, or uses offensive language.

"You and me against the world": The nurse views the patient protectively and takes his or her position regardless of the situation.

Failure to protect the patient: The nurse fails to recognize a sexual attraction and fails to transfer care of the patient to ensure proper nurse-patient boundaries.