Breach of Confidentiality?

Nurses General Nursing

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My class in nursing school was trying to figure out if this was a confidentiality breach:

You are working as a nurse on the floor of a hospital and see a person that you know from outside of the hospital. You make eye contact and say hello. Later you stop by the room to say hello to the patient and their hospitalized family member, who is also an old friend. You both talk a little bit about how you and your family are doing and how the patient and her family are. The patient shares some details about why they are hospitalized.

Was this a breach of confidentiality? No personal information was shared without the patient's consent, nor was anyone else- healthcare team or otherwise- told of the conversation. Our instructor says it was, stating that the nurse should not acknowledge anyone that she knows and the acknowledgement was a breach of confidentiality.

Opinions?

Specializes in Med surg, LTC, Administration.
This has become harder and more complex than ever. Where to draw the lines?

If you work in the same community that you live, you will at some point 'bump' into a former pt/client. I have managed to just smile and nod and then keep moving unless THEY stop me. And then I acknowledge that I was the nurse they knew.

I have rec'd calls from families long after I cared for them to come to funerals, and then they usually tell everyone else who I am.

It's a very fine line; better to err on the HIPAA side!

Political Correctness is the reason for the garbage, or most of it. They want to legislate our brains. We cant think, feel, judge, or laugh without looking at the fine lines. I am sorry, no eggshell walking for me. I will continue to hope I have good judgement, since I do tend to blurt out what I am thinking. I aint about to stop now. Peace!

Specializes in PICU, NICU, L&D, Public Health, Hospice.
My class in nursing school was trying to figure out if this was a confidentiality breach:

You are working as a nurse on the floor of a hospital and see a person that you know from outside of the hospital. You make eye contact and say hello. Later you stop by the room to say hello to the patient and their hospitalized family member, who is also an old friend. You both talk a little bit about how you and your family are doing and how the patient and her family are. The patient shares some details about why they are hospitalized.

Was this a breach of confidentiality? No personal information was shared without the patient's consent, nor was anyone else- healthcare team or otherwise- told of the conversation. Our instructor says it was, stating that the nurse should not acknowledge anyone that she knows and the acknowledgement was a breach of confidentiality.

Opinions?

Here is my litmus test;

Did I use my position as an RN, employee, health care professional to gain any knowledge (any at all) about this patient's private and protected personal information?

In this scenario I meet this acquaintance by chance, this is not something that I have control over. No Breach.

I meet them in the hospital where I work. Again, pure chance and no breach.

The person offers up personal information about herself and the hospitalized mutual friend. At this point I can ask her to stop and tell her that "I don't need to know that information and could get into trouble by knowing it" and that her telling me is a breach of HIPAA. However, we all know that friends and family often value our counsel, knowledge, and opinions when it relates to health and heath care in their lives. They tell us "things" and ask us "things". If my friend tells me specifics that I have not inquired about, I have NOT breached HIPAA. My breach would occur should I discuss that information with another, assuming that I use identifying details.

So, I stop by the mutual friend's hospital room and visit for a spell. Did I stop by while on duty? How did I find out which room number? Did my friend invite me up or mention the room number earlier, or perhaps I asked? Did I call information and get the room number or did I look in the census? Is it a breach of HIPAA for a nurse to stop by and visit a friend in the same hospital he or she works? Of course not...but we must be careful not to give the wrong impressions when we do.

Our family, friends, and neighbors are generally HAPPY to have someone that they KNOW working in the hospital system they are using. It is COMFORTING for most to feel that they have a personal ADVOCATE who knows and has an "inside edge" with the nurses and staff caring for them.

I am afraid that your instructor was a bit off mark in this call. Having said that...as a student you need to exercise EXTREME CAUTION when dealing with this type of situation. You are inexperienced enough that you could get yourself into some serious TROUBLE.

Good Luck!

Specializes in Med surg, LTC, Administration.

Well, don't ever bother me when I am in the hospital. I like to be left alone. But my peeps know that. Peace!

and please, don't even look my way.... blah!!

Specializes in Med surg, LTC, Administration.
This is a scenario we were given in school and the class assignment was to decide if there was a confidentiality breach. We were leaning to no, because no medical information was shared unwillingly.

Personally, I think the nurse could have encountered the patient in many different ways- answering a call light, caring for the roommate, going in to turn off the light, etc. As long as the nurse didn't share medical information or obtain it without consent, HIPAA doesn't have any clause for this situation.

exactly! now go to bed!

Specializes in NICU, Post-partum.
Well I am not so sure ....let me play devils advocate. I agree that most of the time it is not big deal and if you make eye contact you can't be rude. Being rude may even make the patient feel worse or embarrassed that someone they know saw them "undressed" in the hospital. But entering the room when they are not in your care to chit chat without being asked can be construed as HIPAA...a privacy issue.

Playing devils advocate.... let's say this person, even though you know them, doesn't want ANYONE to EVER see them "undressed". You are not assigned to them so technically you shouldn't go chit chat in the room without being asked. Invasion of privacy exists when an expectation of privacy exists ie: the patients room and if you enter and are not asked can be a breech of privacy.

Although probably not HIPAA an invasion of privacy just the same. HIPAA would come into play if like you said above...you saw the name on the chart and went into the room without being asked....and of course if you went to bunco that night and told everyone how awful someone looked without make-up because she is in our hospital......would be HIPAA.

Even though it is splitting hairs....technically you can say hello! and unless invited to "Come on in!" you need to move on.....If you are not assigned to the patient and the patient is not requiring assistance...you should ask permission to enter the patient's room at the door or ask the patients nurse if you may visit.

I am not saying I agree....I'm just giving it that twist to give another POV......

Well, the OP said that she "saw" the patient and I assumed that meant she saw the patient personally....not just a name on the chart.

I also stated that if she saw the friend's name on the chart and then took it upon herself to "visit'...no question that would be a breach.

However, if the situation as the OP described occurred? No breach occurred.

HIPAA is not the big mystery everyone thinks it is...it is simple...you can exercise common courtesy. If you see someone you know, you are allowed to say hello to them in the facility if you know them outside the facility. However, it WOULD NOT be acceptable to run into a patient at Walmart and strike up a conversation if the only place they know you is the facility unless they come up to you first.

You don't discuss with anyone who you saw where if they are a patient nor anything discussed or access a chart unless you are assigned that patient or have another medical reason for accessing it.

It is that simple.

Specializes in ER.
my class in nursing school was trying to figure out if this was a confidentiality breach:

you are working as a nurse on the floor of a hospital and see a person that you know from outside of the hospital. you make eye contact and say hello. later you stop by the room to say hello to the patient and their hospitalized family member, who is also an old friend. you both talk a little bit about how you and your family are doing and how the patient and her family are. the patient shares some details about why they are hospitalized.

was this a breach of confidentiality? no personal information was shared without the patient's consent, nor was anyone else- healthcare team or otherwise- told of the conversation. our instructor says it was, stating that the nurse should not acknowledge anyone that she knows and the acknowledgement was a breach of confidentiality.

opinions?

if you clarify whether or not the patient was:

a) the person that the nurse made eye contact with

or

b) the "eye contact" person's family member

i could offer my viewpoint, until then, what you have are two different scenarios

When I was a student, at the beginning of my 4th semester, I was assigned to a ward where one of my friends lived. Her mother had a stroke and was admitted to the same hospital I was at. I was not certain if she was in the ward I was on. I noticed my friend's mom's last name was on the assignment board and had to make sure that it was not the same person I knew. I had to let my instructor know if I knew that patient so I can avoid getting assigned to her. I made sure I was on the other side of the hallway in case she was there......and she was. Her other family members had seen me and started a convo, I must say, as a student, I tried my best not to engage myself too much with the family as it may seem to breach confidentiality. though they did indulged me a few details of the situation, it seemed rude to say "no, I do not need to know the details".

I had to stop by and say hello because it seemed rude not to. They did request that I become the patient's nurse and I had explain why I could not.

I think in the end, it is okay to talk to the family IF they approached you first, a smile and nod of acknowledgment is good enough.

My class in nursing school was trying to figure out if this was a confidentiality breach:

You are working as a nurse on the floor of a hospital and see a person that you know from outside of the hospital. You make eye contact and say hello. Later you stop by the room to say hello to the patient and their hospitalized family member, who is also an old friend. You both talk a little bit about how you and your family are doing and how the patient and her family are. The patient shares some details about why they are hospitalized.

Was this a breach of confidentiality? No personal information was shared without the patient's consent, nor was anyone else- healthcare team or otherwise- told of the conversation. Our instructor says it was, stating that the nurse should not acknowledge anyone that she knows and the acknowledgement was a breach of confidentiality.

Opinions?

She probably also writes HIPPA

Specializes in Vascular Neurology and Neurocritical Care.

I have had the same situation happen. I was pulled to work in a mental health unit and saw and MADE EYE CONTACT with someone that I know from the outside.Of course, I haven't shared any details, but it was very awkward. We only exchanged brief, passing greetings because we made eye contact. It can be very difficult, especially if they didn't want any of their social contacts to know. Just be careful.

If you live in a small rural community, there is no way that you can avoid not knowing quite a few people on the floor. I always ask if they feel comfortable with me taking care of them, and they usually say they are glad that I am there and they don't mind. You can still be a professional. You just don't discuss their hospital visit when you see them next outside the hospital. However, if I did see them in the hallway and wasn't assigned to them I would say hi, but would not search them out, if they wanted me there they could say my room is such and such and if you have time you can drop by and see me, I would not drop by unannounced or if I wasn't invited. HIPAA is more on the lines of don't check out charts of people that you aren't assigned to or talk about what is going on with a patient when standing on an elevator..that type of thing....Not oh you can't talk to someone that you know in the hallway because that is a breach of confidentiality....:)(just don't look up their name in the system, you will get in trouble!)

Have you ever had to go to the ER in the hospital you worked at? And they put you in the hall? A lot of people walking by know you...they say hi. That is not breach of confidentiality. This is the best example I can use because it happened to me. I did not like being in the hall, but the ER was closed to the general public and I needed attention while at work. Just saying...

Nursing has always been confidential. This is nothing new. HIPPA was designed for insurance data warehouses and was turned into a nursing issue. Just some history about HIPPA.

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