Breaking confidentiality?

Trauma Columnist · Apr 20, 2016

Moved to HIPAA forum.

I realize you are from Canada, but in the US, HIPAA rules what we can and can't divulge regarding clinical situations.

Per our terms of service, we ask that all posters be mindful of posting too much info.

Pepper The Cat, BSN, RN · Apr 20, 2016

Moved to HIPAA forum.
I realize you are from Canada, but in the US, HIPAA rules what we can and can't divulge regarding clinical situations.
Per our terms of service, we ask that all posters be mindful of posting too much info.

Canada has similar laws.

In Ontario, is the Personal Health Information Privacy and Access Act (PHIPPA).

Most people just refer to it as the Privacy Act, or "breaking confideniality".

From what I understand from here, it is similar to HIPAA.

Just to add, this act is taken very seriously. We usually have to sign forms indicating we are aware of this act and consequences of breaking it. There have been a couple of cases in the Toronto area recently where people (not just nurses) have lost their jobs due to thhis

milesims · Apr 20, 2016

Yes, I'm just wondering how much you can disclose..

For example. I've seen someone on here explain how they've dealt with a nurse and how they've dealt with a difficult patient. They didn't state the patient's name or medical diagnosis, but they did reveal what they did with the patient, and their opinion on the patient. I'm wondering if revealing the actions that you did with an anonymous patient is too much disclosure, since it can still be recognized.

KRVRN, BSN, RN · Apr 20, 2016

It's important to remain anonymous yourself on AN. Another thing to remember is not to describe a situation on AN, and then also deacribe the same situation on facebook. Then your AN can be linked to your facebook page.

ComeTogether, LPN · Apr 27, 2016

Yes, I'm just wondering how much you can disclose..
For example. I've seen someone on here explain how they've dealt with a nurse and how they've dealt with a difficult patient. They didn't state the patient's name or medical diagnosis, but they did reveal what they did with the patient, and their opinion on the patient. I'm wondering if revealing the actions that you did with an anonymous patient is too much disclosure, since it can still be recognized.

If the patient can be identified, whether by context clues or otherwise, its a violation. For that to happen on AN the poster would have to divulge their location as well as a lot of very unique circumstances or straight up give an identifier. As long as the patient isn't identified, anything can be disclosed.

Most of us change the story enough to keep that from ever happening, but it never hurts to be extra careful.

Susie2310 · Apr 27, 2016

In addition to HIPAA, if your post makes it possible for you to be recognized, or for the situation/people you have referred to in your post to be recognized, then it is possible that someone may consider that you have violated their privacy (in addition, other people may be able to identify them) or defamed them, or someone (i.e. a patient/family member) may consider that you have violated ethical responsibilities as a nurse by your description of the situation/individuals you mention if they recognize themselves in your post.

There are other situations where what one posts anonymously may, if recognized, result in negative consequences for an individual, i.e. during legal proceedings; one's employer; and other situations exist. If a patient/family member recognized themselves in a post they could choose to report the post/poster to the facility where they received care, and could obtain the identity of the nurse and report the nurse to their state Board of Nursing.

jdub6 · May 1, 2016

Not sure what the technicalities of Canadian law are. In the US, it is only a violation if the pt can be identified by the audience. So, since I have never divulged even what state I am in much less where I work, if I give a clinical situation it is very unlikely that a person could determine for certain that it was completely unique and definitely happened only to them or someone they know. (Obviously if the pt is a celebrity or the situation has received media coverage it's a bit different. )

That said, I usually try to change at least one detail- gender, nationality, whatever- that doesn't effect the point of the post. I never reveal what I have changed. I also avoid saying when a particular situation occurred. I am confident that even though I have described situations I've dealt with that none of my pts or families would be able to say for certain that I was discussing them (they may think something very similar happened to them but that doesn't matter.) In the vast number of health care facilities in the US it is very unlikely that I have had the ONLY pt who ever came in with x situation. If the situation is really that unique or you are just concerned then change minor details and include a disclaimer that you have done so.

Ruby Vee, BSN · May 2, 2016

It's important to remain anonymous yourself on AN. Another thing to remember is not to describe a situation on AN, and then also deacribe the same situation on facebook. Then your AN can be linked to your facebook page.

It's also important not to use your selfie for an avatar and your name (or any part of your name, including nicknames) as a user name.

I've got 40 years of nursing experiences to draw from. When I share a story it's either decades old, happened in another state or the details are changed enough as to render it difficult to recognize. And then I tend to have two or three experiences to share and combine details from one story with a similar one and change all the names . . . You get the picture. I've never had anyone recognize themselves from one of my stories, even the girl who was sitting right next to me when I was typing one and who later read the story out loud to a co-worker, laughing hysterically. (She thought it may have been another coworker under discussion, and the story written by someone else again.).