Three Clicks of a Mouse
.....is all it takes to find out personal information on a nurse in some states. Since the tragic events in Newtown, Connecticut, both gun control and mental illness have been hot topics, both here and elsewhere. Unfortunately, the focus appears to be zeroing in on the restriction of rights for certain populations, and in the nursing world, our right to privacy is already in serious danger.
As those who study the social habits of humans have observed, Internet forums are a reflection of society as a whole, no matter how exclusive the community. And as the spate of recent threads here on Allnurses indicates, the events at Sandy Hook Elementary School have spurred many a debate about the Second Amendment......and as an unfortunate by-product, the rights of citizens with mental illness.
Strangely, nowhere is the latter issue more divisive than in the healthcare professions. We have a reputation for being compassionate, non-judgmental, caring; yet within our ranks we are often merciless to those who suffer from diseases of the brain.
It starts early with nursing students, who are under immense pressure to begin with and who sometimes crumble under the weight of lengthy written assignments, skills labs, frequent tests, and clinical experiences. While the process of becoming a health professional is (and should be) challenging, sometimes students are winnowed out who could be excellent nurses, if only they were offered assistance with their mental health issues instead of condemnation.
If one is fortunate enough to make it through school and apply for licensure, however, her/his state Board of Nursing is ever ready to put a screeching halt to career plans. In many states, both the initial application and the renewal paperwork require the applicant to answer questions such as "Do you have a physical or mental condition which impairs, or may impair, your ability to practice nursing safely?" To answer this ambiguously-worded inquiry honestly means, at minimum, a delay in receiving clearance to practice and at worst, mandatory participation in a monitoring program that can subject one to restrictions on her/his license, frequent (and costly) urine drug screens, even daily reporting to a case manager or counselor.
And God help you if you should run into trouble during your career. An inpatient hospital admission will both cost you dearly and put your license at risk, especially if a 5150 (involuntary commitment) was necessary. But the worst scenario is the one that a fellow nurse shared with me recently: some states actually publish personal information about a nurse who has been sanctioned by the BON that anyone with two minutes and a computer can find easily.
That's right, folks. This nurse, who answered the mental-health question honestly, had restrictions placed on her license and was mandated to participate in a health professionals' monitoring program. The document supporting the nursing board's decision contains confidential information about her diagnosis and her psychiatrist's evaluation of her fitness to practice, yet her board order can be found with three mouse clicks.
Can we say HIPAA violation, anyone?
To say that this is outrageous only scrapes the tip of the iceberg; if this were an issue of a bad back or an incurable (but non-contagious) skin condition, we would not be having this conversation. Why, then, is it acceptable to share the intimate details of a nurse's psychiatric disorder on a public website that anyone who merely knows her name can access? Why is it necessary to make it harder for a nurse whose illness is well controlled, who sees her doctor regularly and complies with her treatment program, to find a job? And if the intention is to "assist" the "impaired" nurse, why is the focus on schizophrenia, bipolar, borderline personality etc. when the most prevalent mental disorder among nurses is depression?
Please share your experience of being a nurse with mental illness, especially if you've ever tangled with the BON or been discriminated against because of your disorder. There is strength in numbers, and if a significant segment of the nursing population stands up together to say ENOUGH, the powers that be will no longer be able to ignore us, or worse, strip us of our privacy in the name of "protecting the public".
Thanks in advance for your responses.Last edit by Joe V on Feb 2, '13
About VivaLasViejas, ASN, RN Guide
VivaLasViejas has '19' year(s) of experience and specializes in 'LTC, assisted living, geriatrics, psych'. From 'The Great Northwest'; 57 Years Old; Joined Sep '02; Posts: 26,100; Likes: 40,858.Feb 2, '13 by wish_me_luckThank you, Viva, for such a well written article. I appreciate it very much.Feb 2, '13 by TheCommuter, BSN, RN Senior ModeratorWell-done and informative, Viva. Thanks again!
By the way, the state where I reside (Texas) has a section on the BON website called 'Disciplinary Action Pages' where you can click on recent board actions and read all sorts of personal info on the sanctioned nurse: home address, license number, offenses, board orders, and the details that led up to the sanction.
In my opinion, the information being shared is much too much.Feb 3, '13 by VivaLasViejas, ASN, RN GuideI've heard that Texas is really strict about nurses with psych issues, and what you've said confirms it. I have a nurse friend who owns two memory care homes there, and recently she invited me to come to work with her at a substantially higher salary than I earn now. I told her I would've liked to, but couldn't imagine living so far away from my kids and grandkids. What I didn't tell her was that getting licensed there would be difficult, and to be honest I'd rather walk on a bed of hot coals than deal with TPAPN. I've read the horror stories.Feb 3, '13 by macawakeHow can it be acceptable to deny a patient their rights based on their profession? Dear patient, we will protect your right to privacy unless you were reckless and dumb enough to choose a career in healthcare
Publicly posting information about a person's psychiatric health = positively medieval, cruel and counterproductive if the goal is to help the patient to a better health.
All the public needs to know (in my opinion) is whether a nurse has or doesn't have a valid/active license. If the license is suspended/revoked/surrendered the general public needs to know that the nurse doesn't have a license, but that is all they need to know.
I believe that a person who knows that his/her career will be in danger and that his/her private information will be on public display will likely bottle up their problems and refrain from seeking professional help and perhaps resort to the time-honoured tradition of self-medication. Depression and burnout are common in the medical/nursing profession. Should individuals who work in this field be afforded less protection than other professions? Absurd
I've had several co-workers who have suffered from depression, anxiety, burnout and a few bipolar. Most of them have been able to carry out their duties. If they can't they go on sick leave and are offered treatment/therapy and are in most cases able to return to work once their health has improved/stabilized.Feb 3, '13 by wish_me_luckI agree. I know it's not a HIPAA violation and there's the Freedom of Information Act. But, that being said, I do not know how people are any safer knowing my personal mental health information (the person that Viva is referring to in the article is me.) I would imagine what the Board would be getting at is for people to stay away from me. That's counter productive. How do you break a stigma, better patient care (for people with mental illness), etc. if the message that Board of Nursing is sending is "this person has this mental illness, stay away from them"?Feb 3, '13 by wish_me_luckI know in VA, it's the Code of Virginia--section 54 (occupations), that describes the reasons/terms for denial of a nursing license (I received plenty of copies of the statute that describes the violation) and it's the Freedom of Information Act (FOIA--federal law) that allows the information to be public.
My concern is mainly dealing with the fact that the Code of Virginia was last amended as a whole (I think they ratify it by sections now) in 1950 or around that time. FOIA was enacted during Lyndon B Johnson's presidential term. Since then, we have had HIPAA enacted (in the 90s).
I really think that it is okay for the Board to ask the question (although I think the question should be very clear as opposed to the ambiguous nature that it has now). However, if someone answers "yes" to the question, approval should not only be done on a case by case basis; but I think the information should be kept private unless there is an imminent threat to the public. An example would be like if a nurse makes a statement that they are homicidal or threatens another person.
I do believe the laws (I say laws because the Board is following the laws; I have no idea if any one sitting on that Board agrees with the laws, they just follow them. So, I really should change what I said before to "The laws and government is sending the message to stay away from me.") show ignorance towards mental illness. They need to be updated to be current with the latest knowledge of mental health issues. I wonder if the Board of Nursing would support a change in the law to make it private.
Until then, I will continue to push for better care, awareness, education, and research on mental health issues.Feb 3, '13 by anotheroneugh. sickening. my state publishes a nurses zip code and full legal name. to find that out all you need is a first or last name. i oppurate under the assumption that what ever i have told anyone ( supposed to be confidential or not) will be found out by everyone. sad but safe assumption. no wonder people lie on those questions. i probably would if applicable and would never utilize eap. if anything, i would self pay with a fake name . scaryFeb 3, '13 by mariebailey, MSN, RNI stated this before, and I'll state it again. I feel strongly that the BON in her state used poor judgment when deciding to make that information public. I have 2 experiences to share. This is not easy for me; even though I am using a pseudonym, I am not as comfortable talking about my disorder as others. I think this is important though. I have bipolar disorder, and I was presented with questions on my board applications regarding mental impairment or mental illness twice. Here's how it played out:
Feb 3, '13 by adioI've seen several threads recently on this topic (haven't kept up with them, they may have been started by one of you all). With the "Do you have a physical or mental condition which impairs, or may impair, your ability to practice nursing safely?" question...
- In one state, the question asked if I had a mental or physical impairment which affected my ability to safely provide care for my patients. I took the application to my treating physician and requested a letter. She stated that I do NOT have a mental impairment that hinders my ability to safely provide care, so the answer is NO. Reason: I have been stable for years, properly treated with meds, and under a physician's care. I can provide safe care as easily as the next guy. I'm not sure it was the right decision, but I trusted my physician's judgment on this one. As you stated, the question is quite ambiguous.
- The next state was much less ambiguous. It directly asked if I was treated for a mental illness in the past 5 years. I answered "yes", & I called the BON anonymously to find out what to do to ensure I could be licensed in that state. They assured me this was confidential and not punitive. They requested a letter from my treating physician and me stating that I was able to provide safe and competent care to my patients, and I had a plan in place for continuing care when I moved to my new state. I followed their directions, & I was licensed. End of story. I am thankful to the BON for handling it the way they did.
What if a person was diagnosed as having, say, bipolar disorder but it is well controlled? It is so controlled that their daily life, including work, is not impacted by the condition. In this case, the person could very well answer "no" to that question. Or is that not the case?
I know a couple nurses who have been diagnosed with various mental health disorders and have answered no to similar questions. They take medication, either regularly or occasionally see a therapist and/or psychiatrist, and have not had recent episodes (in years or so) of whatever they were diagnosed with.
Should those nurses have answered "yes" instead? I completely disagree with allowing the public access to such private information, whether the condition is controlled or otherwise. I'm just curious for those nurses and anyone else in similar situations.Feb 3, '13 by mariebailey, MSN, RNQuote from adioIf you look the previous post, you will see 1 interpretation of that. It is an ambiguous question. I will not pretend to know the answer to that with certainty. It is probably best to call the board for clarification.What if a person was diagnosed as having, say, bipolar disorder but it is well controlled? It is so controlled that their daily life, including work, is not impacted by the condition. In this case, the person could very well answer "no" to that question. Or is that not the case?
Should those nurses have answered "yes" instead?Feb 3, '13 by adioI was typing my post as they responded. This is all very interesting to me. Hopefully more people will weigh in on this.
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