Ethical/Personal Dilemma - What would you do?

JMBnurse · Sep 3, 2012

My advice is to do what you feel you need to do, but think about it carefully. Once you officially report this type of incident to the nurse manager at the hospital or the head of the nursing program, they will be forced to act on it. They may insist that you identify the other people that were also given the private information from your gossipy classmate. This will then pull them into it, and they may not appreciate that. The action taken may possibly include loss of her job and/or expulsion from the nursing program. I'm not saying this is a bad thing necessarily, but you said you would feel guilty if she were fired. So, that considered, I would think very carefully about all of the repercussions and whether or not reporting the offense is worth all of the consequences it may bring. Maybe you should talk to the other classmates who were also given the information and ask them what they think. If you are all willing to accept that the punishment for her may be severe, will they go with you to report this together?

LynnLRN · Sep 3, 2012

I actually don't think this is a the schools problem at all. You should be going to the director of the Hospital at which she works, that is where the breach occurred.

SHGR, MSN, RN, CNS · Sep 3, 2012

OP, this is not the kind of person to consider a friend. You need to present your evidence to the higher ups and be done with her. You will encounter more ethical dilemmas as a nurse, believe me, and you don't need "a friend" to give you this kind of trouble.

edmia, BSN, RN · Sep 3, 2012

I know and admit I am totally ignorant on this but I think its stupid for you to turn her in, what exactly are you trying to gain from this? Maybe she gave too much info but are you trying to tell me nurses never talk about patients amoungst themselves? Maybe she was just so worried about it and just had to tell someone because she too felt awkward. If ANY of you say you don't or never shared info you all are liars. Some nurses go right back to their husbands/wives and talk all they want, maybe its not exactly the same but it is still a violation, people are human. Maybe the girl just told you because she sees you as a peer in the field, its not like she broadcasted it on the local news papers or anything like that like that other stupid nurse who got fired, maybe she should not have used personally identifiable infomation but still its a really awkward position.
Maybe someone can enlighten me, if a nurse has a case like this, is there some sort of confidential debriefing she could he gone over with a boss at work? What should have been the right steps for her to take in this situation? Its obvious something was bothering her and she needed to talk about it. Knowing myself I would feel totally awkward and pressured sitting in a class listening to a professor then knowing I go to work and I am responsible for their relative. I would feel like maybe to talk to the professor and tell them I an one of the nurses taking care of your relative if I had not already encounted them on the floor, in fact I would not know what to do.If everyone was like turning in each other, 90% of nurses would be out of work right now. Anyways thanks for the heads up to never trust my peers in nursing school. Gsss this is a backbiting field!

man-nurse2b: This person is not only a nursing student but also works in a hospital. She has had plenty of training regarding protecting privacy and HIPAA violations. If she had only spoken to her friend about it, maybe you have a point. But she texted the information, which is the same as broadcasting it in today's technology.

This is not OK at all. We are not condoning backstabbing at all, we are all concerned that this person's actions are in such clear violation of ethical and legal rules that we actually fear for her future as a nurse.

Also, to address you accusation that we are all liars, let me say this. There is a big difference between getting home and talking to your spouse about the hard day you had because "my patient was really hard to deal with" or whatever and saying, "Hi honey, you know who was my patient today? Mrs. XYZ! Can you believe it? She overdosed on cocaine!". That is a HIPAA violation. Sharing general information about your patient load without any identifying information is not. So, no, we are not lying when we say that we actually abide by HIPAA rules and regulations.

I don't think this girl was uncomfortable or whatever scenario you've dreamed up. I think she has no regards for the rules of the profession she is wanting to enter (and the fact that she cheated on an exam speaks to her character well).

To address you second paragraph. I have actually been assigned to care for patients at times that I realize I know from outside the hospital. When faced with this situation, I have acknowledged to the patient that I understand it may be uncomfortable to be cared for by me and could switch assignments if they wanted me to. No one has asked me to not care for them and I reassured them that nothing I learned about them during their hospital stay would ever leave the hospital and their privacy was the most important thing to me. Not a big deal. HIPAA always respected.

timmedico · Sep 3, 2012

Cheating on an exam, like violating HIPAA, is the very definition of unprofessional. If X cannot abide by rules and regulations, she shouldn't be a nurse. You should tell an advisor. If you were to tell the professor that her husband's business is out in the open due to X, she will be understandably biased. A good friend does what is right no matter what the other says...because in the end X will have learned the lesson (hopefully). Nursing isn't baseball...there is no "three strikes your out". Cheating AND violating HIPAA is going over the line. Sorry you are in such a position, but it is up to you. Your decision to act will, in the end, make you a better nurse and patient advocate.

mazy · Sep 3, 2012

Some posters have asked the question of what could be gained from turning this nurse in and I'm not sure how the issue of gain should even factor into this decision.

I feel for the OP to be confronted with this problem so early in the game. But she wouldn't be here asking the question and we wouldn't be discussing this if it were easy to fix.

When all is said and done this is an ethical dilemma. The rules of ethics exist precisely for those incredibly difficult situations where the tangible "gains" and "losses" of the outcome should not be as important a factor in making the decision as the moral imperative to do the right thing.

The right thing is to report the individual to the appropriate authorities and then step away so that those people can figure out what needs to happen for them to do the right thing on their end.

The student has done something wrong, which has created an entire toxic ripple effect through the school and the students and nursing community around her. Not to mention the patient and his family. The behavior needs to be addressed.

VictoriaGayle · Sep 3, 2012

I strongly disagree. This nursing student no doubt already has a very good understanding of HIPAA. She really should not receive a free pass for this egregious violation.But even if one believes there's nothing to gain by reporting, I will agree wiith another poster that OP has everything to lose by being aware of the violation and failing to act. Institutions are scared to death of running afoul of HIPAA. They will likely not only punish the offender but also anyone who knew yet failed to report the violation.

I agree. I've seen people that were standing near a coworker who said something about a patient in a common area given the same punshment as the one who actually violated HIPAA because they didn't stop her from giving report there.

Don't risk getting punished by your employer and possibly the school for someone elses actions.

I would go to your employer first, as she did this at work, not school, and as her co worker you have a duty to report violations to your supervisor.

Ruby Vee, BSN · Sep 3, 2012

Hello everyone- I need some insight on what to do on this event that occurred 3-4 weeks ago.Currently a RN student in my last semester; there is a friend ( X) in my program whom also works at one of the local hospitals which I do as well. During one of her shifts, X sent me a message stating that one of the patients in her floor was the husband of one of our past professors and whom we were supposed to have as a professor this last semester again. She told me in this message that the patient had been admitted a day before with X Diagnosis and also suffering from X and Y. I felt weird because even though she is a friend, I felt that its not right for her to be sharing that kind of information with me so I told her that she should be careful and respect patient confidentiality.1 week later school started and we find out that this professor will not be teaching our class for a personal issue.. While walking to class on campus, Y, another friend from the program tells me that this professor is probably not going to teach the class because her husband is sick, maybe pretty sick.. As not knowing, I asked Y how did she know, which she replied.. Oh, X told me... That made me feel even more uncomfortable because to be honest I really care for this professor, we have built a great relationship. A few hrs later I find out that X had not only told me, but also to Y and to Z.. Not sure if she mentioned it to more people or not..She violated HIPAA, Hospital Policy and Patient's rights... Should I mention this to my professor? That X told several of our class about her husband's condition? Should I contact the nurse manager of her floor and mention what X mentioned to me and several others? If I dont do it because she is a friend, I will be failing one of my duties as a healthcare provider and preventing this from happening in the future.. I would be very ****** off and upset if someone was leaking information from a family member..If I do say it and she gets fired from her work I will feel guilty, and what if she gets kicked off the program? She has done certain things in the program that I was not happy about in the past, like cheating while on an exam with another student and the professor had a serious talk with them..I just don't know what to do?? What would you do?Tell the professor? Tell her Nurse Manager? Thanks in advance.

Do you know for a fact that your friend got her information about your professor and her husband in a privileged context?

For example, several years ago, another client of my hair stylist received a heart transplant and became a patient in my ICU. I was off work the day it happened, but heard all about it when I went in for a haircut. Jocelyn, the stylist regaled me with details of where Penelope, the patient had been when she got "the call", how she rushed to the hospital, how long the surgery took, etc. I listened, but didn't say anything -- I didn't KNOW anything about it. As I was leaving the salon, I happened to see my manager parking her car down the block. I waved, got into my car and left.

The next day, at work, the manager called me into her office to tell me in no uncertain terms that she knew I'd been sharing privileged information and that my job was at risk. I insisted that I hadn't shared any information, that I hadn't had any information to share, and asked her why she thought that I had. "Jocelyn told me all about Penelope, including her blood sugar and hematocrit. How else would she have gotten that information?" Upon investigation, it turned out that Penelope and Jocelyn were close friends, and that Penelope's family had given Jocelyn the information. If the family passes on the information, it isn't privileged.

Perhaps your friend got her information from the professor herself, or from some other friend who got it from the professor. Before you go so far as to "tell on her", please make sure you know where the information came from.

VictoriaGayle · Sep 3, 2012

Do you know for a fact that your friend got her information about your professor and her husband in a privileged context?
For example, several years ago, another client of my hair stylist received a heart transplant and became a patient in my ICU. I was off work the day it happened, but heard all about it when I went in for a haircut. Jocelyn, the stylist regaled me with details of where Penelope, the patient had been when she got "the call", how she rushed to the hospital, how long the surgery took, etc. I listened, but didn't say anything -- I didn't KNOW anything about it. As I was leaving the salon, I happened to see my manager parking her car down the block. I waved, got into my car and left.
The next day, at work, the manager called me into her office to tell me in no uncertain terms that she knew I'd been sharing privileged information and that my job was at risk. I insisted that I hadn't shared any information, that I hadn't had any information to share, and asked her why she thought that I had. "Jocelyn told me all about Penelope, including her blood sugar and hematocrit. How else would she have gotten that information?" Upon investigation, it turned out that Penelope and Jocelyn were close friends, and that Penelope's family had given Jocelyn the information. If the family passes on the information, it isn't privileged.
Perhaps your friend got her information from the professor herself, or from some other friend who got it from the professor. Before you go so far as to "tell on her", please make sure you know where the information came from.

I'm interested to see what OP has to say, but the phrasing used makes it sound priveledged.

"on her shift...one of her patients"

BrandonLPN, LPN · Sep 3, 2012

I'm interested to see what OP has to say, but the phrasing used makes it sound priveledged."on her shift...one of her patients"

So she assumes. But unless her classmate explicitly said that she got the info via patient care, who's to say? For all we know this classmate/coworker talked with the professor and the professor said it's fine to share the info. I'm disturbed by how many posters are advocating "turn her in" without knowing all the facts. You're dealing with somebody's job and their education. Don't be so quick to judge.

VictoriaGayle · Sep 3, 2012

So she assumes. But unless her classmate explicitly said that she got the info via patient care, who's to say? For all we know this classmate/coworker talked with the professor and the professor said it's fine to share the info. I'm disturbed by how many posters are advocating "turn her in" without knowing all the facts. You're dealing with somebody's job and their education. Don't be so quick to judge.

I am not judging her. I do not know enough about her to do so. Which is why I put that I am interested in what OP has to say.

However the exact wording of OPs post is "During one of her shifts, X sent me a message stating that one of the patients in her floor..."

OP is the only one who really knows how detailed the message was and if she admitted that the information was priviledged.

I am not saying I know if it was priveleded or not, just that from the information we have been given, nothing seems to indicate that she heard it from the family, and that certain parts seem to say that she specifically said it was her patient. Please also remember that the only students who know why the teacher is taking time off heard about it from this other student, which is not definitive proof but does make it seem unlikely that she was given information by the family.

Esme12, ASN, BSN, RN · Sep 3, 2012

OP....I think you need to advise your friend to shut her mouth and tell her you no longer want to hear a word for if you do you will be going to her boss as well as the program head. Let her know this is a HIPAA violation and she is chucking her career away.

Loose lips sink ships....I think your professor has enough to deal with right now and your unethical friend? Will hang herself when given enough rope.

However.....if you say nothing there is a danger of being duplicitous as just as guilty as she.....it is clear in HIPAA regulations that a failure to report can lead to punishment as well.

I would have a meeting with my manager and tell her what I know......let your manager advise you. Keep it at the workplace as that is when the violation occurred.