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by SC RN

I am in my last semester with literally days to go ... we are discussing ethics in healthcare and I researched and chose the topic of "Should healthcare workers be required to dislcose their HIV status to their employer"? Yes, I know this is a hot topic and one that is bound to raise some issues.

I have found tons of information on why nurses should NOT have to disclose their status (ANA and CNA websites), however, I would like to play the devil's advocate and argue the opposite side that is that nurses SHOULD have to disclose their status. This is proving to be a difficult side to take and the online research has my eyes in spasm.

I've searched all of the websites known to man and have a short list of reasons why nurses should have to disclose their status but I'm hoping that all of you seasoned nurses might have some opinions to add as to why they should have to tell their employer.

Again, we are debating both sides as it is a ETHICAL issue and there is no right or wrong answer. I'm hoping to open my classmates eyes as to both sides of the story. You don't have to agree with this side of the issue to offer up opinions.

Thanks for any help anyone can provide.

[SC RN]

Well, here's my ethical debate speech (must be 2-3 minutes in length). Remember, I am not actually FOR nurses having to tell their employer but that is the side that I am required to debate:

Should nurses who are HIV+ be required to disclose their status to their employer?

Yes, I believe that they should be required to tell their employer if they are HIV+.

A little refresher course first. HIV is spread by sexual contact with an infected person, by sharing needles and/or syringes with someone who is infected, or, less commonly through transfusions of infected blood or blood clotting factors.

In the health care setting, workers have been infected with HIV after being stuck with needles containing HIV-infected blood or, less frequently, after infected blood gets into a worker’s open cut or a mucous membrane (for example, the eyes or inside of the nose).

There has been only one instance of patients being infected by a health care worker in the United States; this involved HIV transmission from one infected dentist to six patients.

But is this one instance, one too many?

Healthcare workers are required to use standard precautions when in direct contact with patients. Does this happen all of the time, every time? What about emergencies? There is not always time to get a gown, mask and gloves on when the patient’s life is at stake.

How do you feel about HIV+ nurses? Would you trust a HIV+ nurse to take care of your grandmother with pneumonia? Would you trust that same nurse to take care of your father post-op total hip replacement? How about that same nurse taking care of you during and immediately after open heart surgery? How about your hemophiliac child? Disclosing your status allows your employer to place you in less invasive, more stable, medically appropriate areas.

Nurses have an obligation to their patient to “do no harm”. The nurse is first and foremost a patient advocate. We assist our patients in understanding and signing “informed consent” paperwork. Don’t our patients have the right to know all risks – no matter how small – associated with their care?

Nurses are consistently ranked as the most trusted profession. One of our ethical principals of professional practice is veracity = to tell the truth. And the 9th ethical principle is respect for others … the nurses primary ethical obligation is to the client.

Disclosure does not mean disrimination. Nurses with HIV are protected by the American with Disabilities Act. The California State Board of Nursing has no specific policy on this issue and thus each hospital disclosure requirements vary. Disclosure of HIV status may not be a legal requirement at this time however I do believe that it is an ethical requirement.

[Nurse Ratched]

I think you've made the best argument for a difficult-to-argue point of view. Nice work!

[nialloh]

And you thought you needed our help. Good job.

[tvccrn]

Very well presented.

[LPNer]

I also think you have prepared and excellent debate.
I also wish I could think of another reason, I've always believed 3 (or more) reasons pro or con make the best debate (any debate.)
Alas, I can't think of one, but then, until you mentioned it, hadn't tried to as I believe nurses know how to protect their pts, co-workers, etc.
Still, a second and third reason would really help the debate.

[Kyriaka]

I think that HIV is treated differantly than other infectious diseases that a nurse may have. I personally dont think it should be.

I have 2 ID's. I have Borrelia burgdorferi (cyst form--chronic deep tissue Lyme) and Babesiosis. I am not required to be listed for the first and the 2nd depends on the state (last time I checked).

HOWEVER, I have always been very open about my status.

But, I must admit that my diseases do not come with a stigma. Yes, they are infectious but because I was infected through a tick and not through sexual contact it makes a differance in my openess.

But...in the Hispanic community (particularly in migrant workers) there IS a stigma with Lyme. Because it is seen as more of an uncleanliness issue, whereas in the normal population it is seen as an active healthy outdoorish disease. If that makes any sense!

[Mommy2Katiebaby]

Out of curiosity, what do you think would happen to the tone of your debate if you changed your wording to substitute "Health care professional" for "Nurse?" THAT would include everyone from CNA's to doctors and all the folks in between... wonder how it'd read then?

[SC RN]

Thanks for all of the replies! I gave my speech this morning and recieved 28.6 out of 30! Woo Hoo!

And, yes, I'd thought of substituting "healthcare workers" for "nurses" but since I am in nursing school, not med school, I chose to focus on nurses only. But I do think that the subject should be debated with inclusion of doctors, respiratory therapists, phlebotomists and many more.

It was a great topic and definitely eye opening. My classmate (and close friend) argued the other point (nurses should NOT have to disclose) and she went first to speak. After I spoke, she told me that I had changed her mind again! What a fantastic ethical topic .... it definitely beat the tired ethical topics of euthanasia and abortion. It was nice to bring up something new!

[sleepless in norman]

It never ceases to amaze me, the never ending supply of Good Deed Do'ers on this site, I know a female nurse who was infected by a needle stick, drawing ABG's, the attending and all other ER personell became aware of this pt's status and who got stuck, before long the entire hospital knew, she quit, I haven't heard from her or about her, only to know, this was her right to privacy, she had to uproot her entire familly,the unethical behavior of Society as a whole is not one to be trusted with personal knowlege such as this, and as far as this government's agencies coming to your aid such as the american disabilities union, don't hold your breath, try filing unemploymnet or wokrers comp and see how long you stand in the soup line berfore your first check, if you get one. As far as your personal or political career as a civil rights advocate or a careing human being, good luck with that, purely on a ethical basis.