Am I On Camera? No Paparazzi Please!

In a time where technology seems to be the common theme throughout the world, and the majority of people have smartphones with video and camera capabilities at their fingertips, it is most certainly changing healthcare. Have you ever been asked by a family member to be recorded during standard care...or even thought you were being secretly taped by them? Nurses General Nursing Article

There have been lawsuits and stories galore about HIPAA violations related to healthcare practitioners taking pictures of interesting wounds, markings, tattoos, etc. on patients, and when patients found out, they became upset and sued for violations of their privacy. If you are a patient with an interesting medical case, there are two ways it can go: you want to hide under a rock and just get treatment, or you may be interested (especially at a teaching hospital) in having your case discussed at multiple levels and allow pictures of every step of your case so that others can learn from what you experienced.

I understand both sides, which is why most hospitals, if not all, have releases that patients can sign for medical use of photographs (as part of the medical record) so that patients are aware pictures may be taken, but they are being used for medical educational purposes. Patients have the ability to approve or decline the use of pictures, and it gives them that power of decision over their body, in a time when they can feel helpless, which is crucial for them.

Recently there has been a new trend that I have seen at my own hospital, but heard about from various nurses throughout the country, and it is the reverse: patients (or their families) taking videos and pictures of healthcare providers, during routine care and/or family meetings without telling them. During family meetings, especially if a patient is in a critical care unit and family members may be making decisions for a loved one who cannot make decisions for themselves; they may be stressed during the conversation, worried if they are making the right decision and wanting to remember every word of the conversation to relay to other family members to explain their decision making process, but does that give them the right to secretly record our conversation?

I don't think there is anything to hide, but I can also understand how healthcare providers might feel worried that if they are recorded, or videotaped, that this somehow might put them in a position for a possible litigation later on, especially if the outcome of the patient isn't what their family hoped for (and we all know that healthcare providers do the best they can, but we cannot save everyone.)

As for being videoed during routine care of a patient; I don't see what the benefit is for the family, or for the patient. I don't videotape my mechanic when I get an oil change, I trust that they are the expert: they remove the old oil, put new oil in, and my engine is happy and healthy. Granted, I don't have a great relationship with my mechanic, but videotaping their every move would be weird, and I wouldn't blame them if they declined to be videoed.

Maybe that is a bad example, but as a nurse, I form a relationship with my patient and their family members (or at least I do my best to have a trusting relationship) so I think it is even more of an offensive request to videotape me when I am performing care.

Are they wanting to do it to make sure that I am doing things properly? Will they compare and contrast how each nurse cares for them/their loved one? As we all know, there are variations in nursing care, due to personal style, but that doesn't mean that one way is wrong and another is right, the end result can be the same, even though two nurses might go about care in a different way; to an untrained eye, or someone who has no idea about current evidenced based practice or hospital policy, they might think small variations are important, that aren't.

I know some nurses double glove all the time, for no particular reason other than that if they are, for example, removing an IV, they like to take out the IV and pull in into the top glove to throw it out and remove the risk of dirtying a bed. Other people don't do that, but it doesn't mean the nurse is not removing the IV correctly. Those two scenarios look very different to a layperson.

Nurses normally explain what they are doing with a patient either before or during the process, to not only empower them with knowledge, but to make them more a part of their care; doesn't a family member videotaping this make it seem disingenuous, invasive, and distrusting? Where is the trust and the relationship formed with families/a patient when they tape my interactions?

We give patients the power to approve use of pictures of their medical cases as a part of their medical records, but we have had cases of "secret" videos by families, that we found out about afterwards, but were never asked if it was OK. Where is our power to say no when someone is secretly videotaping us? There is no form that has to be signed, as healthcare practitioners to allow families to record us, and if we allow it, do we then have to worry about possible litigation after the fact, even if they were intended just for informational purposes?

Technology is a great mobility for information and keeping people connected electronically, but there are times we need to leave technology at the door, and connect as humans.

Specializes in Critical Care.
It seems that it falls on the hospital staff to prevent breech of other patients information but beyond that, it gets fuzzy.

I was correct in that my particular state requires consent of all involved parties for audio recording. There is no restriction on video recording in "public spaces". I don't think that hospital rooms would fall into that category.

Here is a published case study that I found on the topic.

http://www.aqihq.org/files/airscases/CASE_2012_02_Spy_vs_Spy.pdf

Whether or not videotaping or audio recording is not defined by location, it's defined by whether or not there is an "expectation of privacy". A hospital room is a place where there can be both an expectation of privacy and no expectation of privacy, depending on who we are talking about. One useful way of measuring that is to ask whether or not it's place where it would be appropriate to get naked. In a hospital room, that's a normal place for a patient to be naked, so they have a reasonable expectation of privacy. A nurse however does not have a reasonable expectation of privacy; would it be normal to walk into a patient's room and just take your clothes off?

For audio recording you would need permission of those involved in many cases, but again that doesn't apply to nurses. When you are speaking to a patient you obviously aren't trying to keep that information private from the patient, you're talking to them. Recording a nurse's conversation with another patient on the other hand, yes that would be illegal.

I will stick to the legal advice the lawyers at my current 2 federal facilities I work at and the private facility I also occasionally work at.

Regarding photos or videos of patients (wounds, tumors, parts of procedure, etc) - our facility policy allows us to record/capture for documentation or educational purposes. Patients give us permission for that - it's in both our general consent for treatment AND our procedure consents. Not all patients (or their representatives) READ the consent for treatment or consent for procedure(s), but it IS in there. We don't take photos of unique tattoos, and to be 100% honest, in probably 90% of the situations where we are recording or capturing images - the patient is prepped and draped in such a way that only the operative site is visible so it would be very difficult to identify a patient from those images. If we're taking photos during a lap appy - there is NO identifying info on those photos.

I've been in several facility-produced videos (videos that might make it outside of the healthcare system/on the internet/etc). For each of these, the hospital PR folks speak to the folks who MAY be caught on camera - and they have to obtain consent from us to be in the video. If it's just something for departmental use and not going to be distributed - it's a little more lax.

I wouldn't have any issue with providing discharge instructions and having families audio or video record that. If that is how they learn best (or they feel they need to be able to "refer back" to a demonstration of something) then we should be helping them.

I've had patients/families ask for full names of caregivers and try to get photos of us on the day of a procedure or something. I don't think that's overall appropriate. There are often too many others around and not enough privacy. Not only that, I have an uncommon name. If you had a complaint about someone who works in my department with MY name - I'm the only option of who it could be. Plus, it's fairly easy to figure out who was involved with patients' care. You don't need my last name or my photo to figure out I'm me.

I've had patients/families ask for full names of caregivers and try to get photos of us on the day of a procedure or something. I don't think that's overall appropriate. There are often too many others around and not enough privacy. Not only that, I have an uncommon name. If you had a complaint about someone who works in my department with MY name - I'm the only option of who it could be. Plus, it's fairly easy to figure out who was involved with patients' care. You don't need my last name or my photo to figure out I'm me.

To my knowledge, patients have the legal right to know the name of the licensed nurse caring for them, just as all patients have the legal right to contact their State Board of Nursing to file a complaint about nursing care they have received from any nurse. Patients have the right to look up a nurse's licensure details at their State Board of Nursing. Professional nurses don't provide nursing care anonymously; our licensure brings with it professional responsibilities and accountability to the public for the care we provide. So, if a patient asks us our full name, my understanding is that we are legally required to provide it, just as we would expect to know the full name of the physician treating us.

If a licensed nurse taking care of me or my family refused to tell me his/her name, and I had a good reason for asking for this information, I would ask for the supervisor and I would request the medical records where this nurse's care was documented. I might even consider making a complaint to my State Board of Nursing that this nurse refused to provide me with their name when I requested.

My main problem with this is the likelihood of winding up on YouTube or Facebook. I do not wish to be either place, and have no accounts on either site. If you wish to take my picture, I have a problem with it, partially from my background (Amish, although not practicing, it sticks) and just from a privacy issue. I don't even like my picture taken for driver's license and name tags.

Specializes in Critical Care.
I will stick to the legal advice the lawyers at my current 2 federal facilities I work at and the private facility I also occasionally work at.

Which is what?

Thank you for your article. Along the line of being on camera I would like to add another consideration.

Hospital administration is watching.

More and more cameras are being placed all over in healthcare facilities. In my own hospital we now have a team of 'nurses' whose sole job is to sit in front of monitors and view patient care in each pt room. A colleague of mine from a different facility was giving pt care when a 'voice' asked him if he wouldn't rather do a different task for his patient instead... You can readily see where this can lead... In my facility there are, also, cameras installed at every PYXIS station. Along with this is the current use of Vocera type communication devices which have the ability to locate whoever is wearing them. One of the more worrisome aspects of the addition of this type of observation is the lack of transparency from the administrators as the installation of cameras is not announced to the staff members.

My concern is with any and all misinterpretations or abuse/misuse that can occur.

The take away from this, I feel, is that we need to understand we are always being watched and/or video recorded and listened to and that unless we are willing to be displayed on the 'big screen' we need to be circumspect in everything we say or do.

Specializes in as above.

Simple: say, NO! And hold your hand up or give them the finger, not the pointy one.

Camera's, even the cute ones have no place when giving patient care, unless its an operation.

Let them complain to the boss lady or admin, you have a job to do.

No cell phones are allowed in most hospitals, because of the radio transmitter than can interfer..good god, you should know this.

Specializes in as above.

Big Brother IS watching. They are afraid of lawsuits, get used to it. 1984 is NOW a reality.

Specializes in Critical Care.
Simple: say, NO! And hold your hand up or give them the finger, not the pointy one.

Camera's, even the cute ones have no place when giving patient care, unless its an operation.

Let them complain to the boss lady or admin, you have a job to do.

No cell phones are allowed in most hospitals, because of the radio transmitter than can interfer..good god, you should know this.

Maybe it's different in Canada, but in the US the majority of hospitals don't ban all transmitter containing devices out of fear they will interfere with equipment, and actually much of the current equipment itself contains wireless transmitters.

Long ago, there was some evidence that there could be some dangerous interference of equipment by devices with wireless transmitters but only in highly unusual circumstances. For instance, one study showed that a now long-out-of-production ventilator could be affected if you took a cell phone, added a signal amplifier and put the device within 3 cm of the circuit board (which required removing the casing of the ventilator), then it could have some significant effect. Even older equipment still in use in hospitals is far better shielded and there's no evidence that the use of transmitters has any negative effects.

Specializes in OR, Nursing Professional Development.
No cell phones are allowed in most hospitals, because of the radio transmitter than can interfer..good god, you should know this.

Considering the number of cell phones in use at my facility at any given moment, we should have a much, much higher death rate if cell phone radio transmitters interfered with anything. Physicians use them, patients use them, staff use them, visitors use them. Heck, we've got anesthesia providers sitting at the head of the OR bed playing games on their phones (the fact that they're doing that is a whole separate issue) and surgeons making phone calls on their cell phones before and after surgery while still standing in the OR. No equipment has ever malfunctioned, no patient has ever died because a cell phone was in use.

Show me a peer-reviewed study that shows a patient was harmed or died because of interference from a cell phone that is about today's current phones.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
To my knowledge, patients have the legal right to know the name of the licensed nurse caring for them, just as all patients have the legal right to contact their State Board of Nursing to file a complaint about nursing care they have received from any nurse. Patients have the right to look up a nurse's licensure details at their State Board of Nursing. Professional nurses don't provide nursing care anonymously; our licensure brings with it professional responsibilities and accountability to the public for the care we provide. So, if a patient asks us our full name, my understanding is that we are legally required to provide it, just as we would expect to know the full name of the physician treating us.

If a licensed nurse taking care of me or my family refused to tell me his/her name, and I had a good reason for asking for this information, I would ask for the supervisor and I would request the medical records where this nurse's care was documented. I might even consider making a complaint to my State Board of Nursing that this nurse refused to provide me with their name when I requested.

Patients have the right to know the full name of anyone taking care of them. They don't have the right to photograph them or video them -- at least not in my hospital. It's part of the paperwork you sign when you agree to get care here.