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

Nurses HIPAA

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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?

Specializes in ALF, Medical, ER.

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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Specializes in Rural Nursing = Med/Surg, ER, OB, ICU.

I worked as a CNA for 15 years. 5 long term care and the last 10 in a hospital. I have always had acess to the charts of the patients I was caring for. Anything beyond reading the chart to aid in your patient care is indeed a Hippa violation.

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Specializes in Surgical Telemetry.

I just want to chime in that I believe it is NOT a HIPPA violation for a student to access client charts for learning purposes. The things mentioned in the OP are, because they are not providing direct care to that patient.

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I worked as a CNA in a major metropolitan hospital and was allowed to sign off on the charts for vital signs, I's & O's, ambulation, etc., that I did. It was standard practice.

I interviewed at another hospital in the area for a different position whose charting was all done on the computer. CNA's were allowed access to these records also and expected to input their own data.

I have never seen anything that would suggest it was a violation for CNA's to access pt charts.

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Specializes in Pediatric Psychiatry, Home Health VNA.

I'm an RN still working as a CNA until I find a job, and sorry, but I'm going to check every single one of my patients' charts. I cannot rely on my nurses to give me completely accurate information and we use so much agency and per diem that a patient's status is always different shift to shift. I have to do what's necessary to protect myself and my patients. I'm not looking in the chart for fun, I'm looking in it so I can know what I'm dealing with. If a nurse told me not to look in a chart I would inform him or her of my feelings and if I still received grief over it I would ask for a different assignment. I think it IS my business if a patient has a communicable disease because gloves rip and sometimes signs don't always go up on the door the way they should. My safety is first.

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Specializes in LTC.

As a CNA I couldn't do my job without accessing patient's charts. Part of my job is filing things in the chart, chartting, and breaking down charts when a patient is discharged.

Do I read through the charts? No. I go where I need to get the info I need and that's it. From what I've learned about HIPAA accessing information that doesn't pertain to my job is a HIPAA violation. An example of this would be as a CNA going through the patient's labs or checking the patient's MAR.

Now reading through a chart because it's a family member or a friends is a complete HIPAA violation and in most places of work it means imediate termination.

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Specializes in LPN, Peds, Public Health.

I don't know the whole guidelines on HIPAA but I can say that it IS a violation to get into ANYONE'S medical chart (grandmother or not) without the need to do so. Her pulling her grandmother's chart just out of curiosity and doing the same for the co-worker are grounds for termination. Have seen it happen on more than one occasion.

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Specializes in Community Health, Med-Surg, Home Health.

I believe that if ANYONE is looking up charts to gain personal information on their aunt, friends, neighbors, on behalf of another co-worker or anything else is unethical. In fact, the co-worker that asked the favor knew they were wrong, otherwise, they would have looked themselves.

However, I have no problem with CNAs looking into the charts for clinical reasons. They are a part of our team, are doing personal care to our patients that may expose them to harmful pathogens and those who are doing 1:1 may need to know if the patient may harm themselves or other staff members. And, that is a horrible act to publically degrade any of our team members.

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There is such a huge difference between going into a chart because your mother's sisters friend's cousin's best friend... wants to know whats going on with that person and the question of the thread...

Why should a CNA not be able to understand their patient as a whole?? What if this patient was just told they have a terminal illness and only weeks to live? What if the patient was refusing to eat or acting off? CNAs would see this behavior before most others, and understanding that they are going through a rough period with their treatment would make it easier to put two and two together wouldn't it? IMO, information regarding anything communicable that a patient has been diagnosed with should be freely accessable to ALL those that have to care for the patient. Sure, universal precautions and all of that, but you should still know what to be careful of.

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I'm a CNA in a Texas nursing home. The CNA's and NA's are actively encouraged to read the charts if they have a free moment. This is especially important when we first get a new resident because OFTEN important information isn't passed along like it's supposed to be. There is far to little communication between the different shifts, and honestly I couldn't tell you where the care plans are located. The last time I saw them they were in the DON's office because she hadn't worked on them in 2 years and the Medicare survey team found them and freaked out. What I'm saying is that CNA's have to be able to cover what others are not doing for them. I can't even count the number of times we've been working and I've told aids they need to use better precautions because of potentially dangerous infections they didn't know about.

Also, we have several residents who ask us to call their families for them and the only place those numbers are located is in their charts. We don't hide what we're doing from the nurses and our level of service to the residents is certainly the better for their willingness to share. If I worked someplace and was told I wasn't allowed to know about the persons transmittable diseases I would walk out very quickly. The safety issues far outweigh the potential that one or two aids will break confidentiality.

Also, I work nights and have a limited amount of contact with most residents which limits my need to see the care plans. Usually I only have to know basic things like am I going to die if I go in without a mask or gown and how many people do I need to transfer them (or if they do it their selves). Since we sometimes only have one aid at night it means I have to drag the nurse away from what she's doing every time I need a question answered.

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Specializes in Geriatrics, Transplant, Education.
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.

In the second job mentioned, where I was allowed and encouraged to look at the chart, it was because I was a student nurse and was there to learn as well as work. My position was slightly different that that of a CNA, because I was allowed to do simple dressings, d/c saline locks & various other skills that I had demonstrated competency on, as well as complete standard CNA duties like ADLs, vitals, etc. Direct caregivers were part of a three tiered system at this hospital--you were either a CNA, a Student Nurse I or a Student Nurse II. Depending on your position, you had a different skill set.

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Okay, first I think I need to clarify. I was not trying to make sweeping judgments on the CNA profession as a whole I was just talking about where I work. I am sorry if I offended some but it was not an attack on the CNA profession.

Was I saying that all CNA's gossip...NO. I have some very good CNA's but they as individuals tend to gossip...I was not making a wide spread judgement on all CNA's.

Also, I understand that CNA's care for residents and are very close to residents. But in our facility it is policy that the nurse call family etc. Also do I think CNA's are stupid and have NO knowlege base in nursing? ...a resounding NO. I just meant they are not licensed by the state to know these things.

Background info:

I work in LTC, the care plans are not hidden, any charting they have to do is in an electronic system seperate from the nurses station, they all have "tickets" pieces of paper that are kept in a drawer with free access to all CNA's that list diet, mobility, etc etc. for all residents "in the system". Whenever there is someone new they are given report every shift of everyone so they can ask the CNA caring for them before them any questions or the nurse. Edited to add CNA's atour facility do not do vital signs, the nurse do. They do not do any treatments of any sort on the residents.

What I was asking is that aside from need to know information to care for residents (which they have plenty of other areas to access this information) are CNA's from a HIPAA standpoint allowed to look in residents charts? I hear of people getting fired all the time for HIPAA violation and ignorance of the law is not a good excuse (from a court standpoint). I am NOT trying to block CNA's from giving good care to our residents, I just want to make sure form a legal standpoint that I would be covered because I worked too hard for my license to have it taken away because of someone else. That is all.

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