What are CNA's allowed to know? (HIPAA question)

  1. Okay, I am curious if I am right or are other co-workers right.

    Are CNA's allowed to look in charts?

    I question this for two situations - one was a CNA who went to look in her grandmothers chart for information (curiosity reasons) and when I told her not to she got very upset. I told her it was a HIPAA violation. She (weeks later) told me that where she used to work the CNA's used to get in charts all the time and a nurse who works with us backed her up. They stated maybe it is a facility thing but I said HIPAA is federal and CNA's are not allowed in charts. We also got into an argument about what I should tell the CNA (like if a person had AIDS, etc) and I said technically that is a HIPAA violation. And she stated that she should have a right to know because they (CNAs) are the "primary caregivers", and I said HIPAA would say if you use universal precautions that should cover everyone no matter what a resident has. and if there was anything that didn't I would tell her what equipment to use.

    Another situation was a similar one, a CNA was looking in residents chart on behalf of another worker (it was her friends aunt). And she also got mad and stated I had never said anything before and I told her that was because I had never saw her do it.

    My point is that I think that CNA's should not be in charts. There is nothing in there that they need to know and if they do it should come from the nurses (me). Other people, even nurses, disagree. I feel like if they are caught doing it on "my watch" then I would be the one in trouble, and I feel it is my job to vigorously protect patients info as I would my own. I know they are not allowed to look in charts of relatives or curiosity reasons for sure, but what is the law when it comes to HIPAA and CNA's?
    Last edit by Donnagg123 on Aug 5, '08
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    Joined: Jun '08; Posts: 26; Likes: 18

    35 Comments

  3. by   TiredMD
    I don't know the answer to this (although I'm sure the "minimum necessary info to do your job" part applies here). I've seen facilities swing to either extreme.

    I will tell you though, when I was a CNA a bunch of years ago, I was assigned to be a psych sitter for a patient who was actively suicidal, and had already said that he planned to grab any sharp object he could find and slit his throat. Worried that I would end up knee deep in the dude's blood, I asked about his infectious status.

    The nurse reamed me out, yelling at me (in public, in front of the nursing station, in front of the entire staff and some patients) that it was none of my business, I needed to learn my place, etc etc.

    It was far and away one of the most demeaning experiences of my life.

    I guess what I'm trying to say is that if you have to tell a CNA that they can't access certain info about patients, that's fine (and yeah, I think in general you're right on here). But please be very careful about how you do it. To this day, that experience still pops up in my head, and I have to remind myself that the nurses I work with aren't like that one from oh so long ago.
  4. by   Donnagg123
    Oh no! I would never say it hateful or mean or berade a CNA. If I had to discuss this it would be in private quietly. But the CNA's I work with just pick up charts and start looking in them without asking me or anything. I do tell the CNA's certain things, because you are right it would be important to know, but they get royally PO'd at me when I don't tell them EVERYTHING about the residents like why did we send so and so to the hospital etc. I just feel they do not have the knowledge base to back up everything they look at AND they tend to gossip.
  5. by   Butterfliesnroses
    Where I work we can look in charts (I'm a CNA)....Alot of times I can find out pertinent information such as transfers, if the resident is continent, ect. I also have worked there a long time so I often times understand the medical jargon, ect. The nurses and my DNS have no problem with us reading the charts. I mean YES I use universal precautions BUT what if a resident has something that I MUST wear a mask for? Then what? I've actually had that happened. Nobody told me and I was looking at the chart and freaked! Why had nobody told me? As the saying goes CYA. If no-one else cares if I get disease that is transmitted via air then I sure as heck do! HOWEVER the situations you are speaking of I don't agree with! My grandmother was in my nursing home as a resident. I did read her chart to see what I was walking into (because really I had no idea of what I was walking into, I knew her personally but there are different ideas the chart will have, interventions for behaviors, ect) and so I looked at the chart for that reason. I didn't share with family or use personally, when I took care of her I was a professional and even called her by her first name.
  6. by   Plagueis
    As a CNA, I understand that we are able to look at care plans, which mention important things about residents that are pertinent to their care, such as their diets, mobility status, combative behavior, and whether they are a one or two-person assist (or mechanical lift). We need this information in order to care for them, and we can be in big trouble if we don't follow the care plan. However, the care plans where I work are separate from the medical charts and I have never looked in them (the charts). I thought that it was considered wrong to look at charts out of "curiosity," and to look at a patient's chart on behalf of a curious friend smells wrong to me.
  7. by   SharonH, RN
    I don't understand why they would not be allowed to look in the charts. They provide intimate care to the patient and they need to know about medical and social history also. The cases you cited are a violation of HIPAA but if we are talking about in general, I don't see anything wrong with a CNA looking at the chart.
  8. by   HeyLush3
    I work as a CNA at a doctors office and have full access to all the charts in the clinic for our patients as well as their hospital charts (we send pts and our doc's to the neighboring hospital for procedures). For someone to tell me I couldn't look at their chart would be absolutely ridiculous and degrading. Perhaps it is different in a purely hospital setting, but I need to be able to look in their chart to provided adequate care and be two steps ahead of the doctor. Also, what would I do if the pt called with a question about their care? Would I have to tell the pt, "I'm sorry, I don't know what is going on because I can't look in your chart. You have to wait til the RN gets some time to call you back." That just seems crazy.

    On the other hand, looking in a family members (or anyones) chart just for curiosity IS a HIPPA violation, no matter what certification or lisence you hold.

    Edited to add: I find your statement: "I just feel they do not have the knowledge base to back up everything they look at AND they tend to gossip." VERY offensive. Many CNA's have an extensive knowledge base, and many are nursing students who want to learn more. Not JUST CNAs tend to gossip- almost everyone does and I find a blanket statement like that very stereotypical and off base.
  9. by   NewRN2008
    first of all, i dont see this as a CNA problem. looks like hippa all over the place. reading family and friends charts? THATS the prob.
    report.
    -H-
  10. by   AlabamaBelle
    The two examples you gave ARE HIPPA violations in the most egregious fashion. It matters not one little bit that the staff members were CNAs, RNs or MDs. These 2 were in the chart for no other reason but to "snoop". They were not involved in way, shape, form or fashion in the care of those patients.

    If you are not DIRECTLY involved in the care of the patient whose chart you are reading, the offender should expect discplinary action.

    If you are directly involved in a patient's care, you can access the chart, as far as I understand the regs relating to HIPPA. Also, I can't access my own electronic patient record without first signing the appropriate releases without violating HIPPA

    Off my soapbox now.
  11. by   AlabamaBelle
    Didn't see the OP's second post. We ALL gossip at some time or another, I'll admit to it.

    As for the knowledge base thing, I've learned a lot from the CNAs who have practiced (and practiced well & properly) for longer that I have as an RN. If they notice something about one of my patients, you'd better believe I'm listening. Experience is a great teacher.
  12. by   Pipsqueak
    Quote from WarEagle4Life
    The two examples you gave ARE HIPPA violations in the most egregious fashion. It matters not one little bit that the staff members were CNAs, RNs or MDs. These 2 were in the chart for no other reason but to "snoop". They were not involved in way, shape, form or fashion in the care of those patients.

    If you are not DIRECTLY involved in the care of the patient whose chart you are reading, the offender should expect discplinary action.

    If you are directly involved in a patient's care, you can access the chart, as far as I understand the regs relating to HIPPA. Also, I can't access my own electronic patient record without first signing the appropriate releases without violating HIPPA

    Off my soapbox now.

    I completely agree with everything stated here by WarEagle.

    At the LTC I worked CNA's were not allowed to access charts. Careplans, yes, charts, no. They received report from the nurses, we told them what they needed to know. I understand that this may differ from facility to facility and I can see where a CNA might need access to a chart to effectively do their job.

    But nobody should be looking through a chart if it isn't necessary to provide pt care.....even if its your patient. Example: Let's say the CNA is allowed access to the chart by facility policy to be able to effectively do their job. So a CNA who is also a nursing student decides she wants to look through the charts of the patients she is assigned to for the intent of learning. BAM: HIPAA violation! Now if said CNA looks in the chart to access the care plan, that's ok. (This exact scenario happened at my work and the CNA and nurse who encouraged her to look and learn were both fired).
  13. by   NurseKatie08
    When I worked in LTC as an aide, I did not have, nor did I seek access to the patients charts. We were told & knew just what we needed to know to care for that resident.

    When I worked in the hospital, as a Student Nurse II (tech/cna, whatever you want to call it) I was allowed & encouraged to look at the charts of the patients I took care of on my downtime. I rarely had the time to do so, but would occasionally look at my patients charts to learn more about their treatment & history--solely for learning purposes.
  14. by   TiggerBelly
    But who encouraged you to look and was it legal? I never saw the need to look in a patient's chart. Anything questions I had regarding the patient's care could be answered by that patient's nurse. Anytime I had someone new, I would ask are they under any type of precautions? Any special diet, any orders regarding their mobility.

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