An ethical question.

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I work alongside this nurse in a 2 RN ER and to my eyes, she is one of the worst gossips I have ever met. I tolerate her because I have to if I want to continue working here. (And all in all, I really like where I am working so it is usually no big deal.) But a few days ago, I think she really crossed a line and it has stuck in my craw since then. I really want to call her out on it to the point that I want to report her to the state for violation of confidentiality.

A woman came to our ER via EMS who was the sole person in a one car MVA. She had bumps and bruises and a minor head lac. The attending MD ordered his routine labs, among them, an ETOH level. Her ETOH level came back at roughly twice the legal limit.

A police officer was in the ER doing the accident paperwork. As he was leaving, my 'partner' asked him about what he was going to do about her blood alcohol level. His reply was, "What do you mean?" She told him that her B.A.L. was 0.15. His reply was, "Well I guess I am going to have to arrest her for D.U.I. " Upon hearing that, I was absolutely flabbergasted.

I have always felt that as a nurse, my prime role is to be a patient advocate. In NO WAY do I see my role as an agent of the state. Unless I have objective evidence that a patient intends harm, or is a potential threat to themselves or others, any circumstance that brings them to my care is irrelevant and nobody's business save for those directly involved in their care. In that light, I just can't believe what that nurse did to her. I am so upset about this. That nurse could very well have ruined that woman's life from a legal perspective. At the very least, it will cost her about $5,000. How is that being a patient advocate?

Thoughts? Opinions?

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My personal opinion is that the officer did in fact have a right to know as he was investigating the accident. Her BAL is relevant. Granted, she was the only injury, but her actions were in violation of the law and could have caused direct harm to others. The nurse did not ruin that woman's life from a legal perspective, the woman's own actions did. One could even argue that the nurse may very well save the woman's life because she may not drink and drive after paying the price for it, but you can be sure she would if she didn't have to pay any consequences for her actions.

Now, let me say that I don't know the "correct" answer here, so I'll be interested to read others thoughts, but I think the nurse acted in not only the patients best interest, but also the publics.

Amanda

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Specializes in Med-Surg.

My husband, a police officer, indicated that in our state it is now law that ER staff must notify an officer when alcohol limits are elevated in a driver involved in an accident. I would say it would depend on the state you're in. Would be a good question for those who set policy in your facility.

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i would think there's a duty to report.

being an advocate ensures your pt. receives timely and efficient medical care.

it shouldn't protect those who break the law.

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You need to find out the laws in your state. There are obviously times when we have to breach confidentiality.

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Unless I have objective evidence that a patient intends harm, or is a potential threat to themselves or others, any circumstance that brings them to my care is irrelevant and nobody's business save for those directly involved in their care. In that light, I just can't believe what that nurse did to her. I am so upset about this. That nurse could very well have ruined that woman's life from a legal perspective. At the very least, it will cost her about $5,000. How is that being a patient advocate?

Thoughts? Opinions?

I would say that driving at twice the legal BAC is a potential threat to others, no?

So it's going to cost her money. Big boo-hoo. Maybe there's someone out there who won't be killed or crippled from her drunken driving.

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Specializes in Acute Care Psych, DNP Student.

I believe the elements required to breech patient confidentiality are this: if the patient is an imminent danger to himself or others. This would preclude a past danger. I have to admit I'm quite surprised that many think it's appropriate to report this to law inforcement. We are not extensions of the police in the ER. That said, there are laws in place that we all know about - the requirement to report gun shot victims comes to mind. But an instance of an adult with a high BAL? I guess what I am getting at is if the law in my state required me to report this high BAL patient - I would without hesitation - it's the law. But if the law didn't require me to report it, I absolutely would not. It is not my job to rat out my patient to the police and I'm not doing it unless the law mandates it.

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I am sorry you have to work someone that you do not get get along with, that happens alot and is a situation most of us will or have found ourselves in at least once in our lives. However, do not let that cloud your decision about what she did. Who is to say that this is the the patients first accident while she was drinking, and who is to say that the next time she won't hurt someone else or herself even kill them. Drinking and driving is too dangerous to not report and is major social concern for all of us. As far as your co-worker goes, just hang in there people like her usually hang themselves without you having to do anything, just give her enough rope

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Specializes in Critical Care, ER.

Pehaps it might help to think about it this way...

Why not be an advocate for the innocent people who may get permanently injurred, killed or lose loved ones should this woman not learn her lesson and get away with this because she has not been penalized.

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Specializes in Acute Care Psych, DNP Student.
Pehaps it might help to think about it this way...

Why not be an advocate for the innocent people who may get permanently injurred, killed or lose loved ones should this woman not learn her lesson and get away with this because she has not been penalized.

The emotional side of me agrees whole-heartedly with the above statement. But the logical side of me says that I am the patient's nurse. I am the patient's advocate. It is stepping out of my role to advocate for the public at large. If the police investigating the accident wish to - they can subpeana the medical records and find out the BAL. That is their job.

This is just such a slippery slope. But just because this person was drunk driving this one time does not mean they will again. (Yes I have a hard time saying this, but it is true.) I just think it's too speculative to say that reporting is required to ensure future public safety, even though the danger really bothers me. I guess this issue does not meet the 'imminent danger' threshold in my thinking.

I am uncomfortable with any aspect of losing trust with patients. I googled the issue and found that some states say that health care providers may report, but are not required to. These states specifically said that it must not be considered an ethical breech if the provider does not report. That is what I found so far.

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Specializes in Acute Care Psych, DNP Student.

Ugh. As I search my thinking about this, I find that I would support and vote for a law that mandates reporting on this issue. What I am uncomfortable with is medical professionals deciding to on a case by case basis (sometimes whim) and the public viewing the medical establishment as in charge of them being reported to the police or not. I hope that makes sense.

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Specializes in Med-Surg.
That nurse could very well have ruined that woman’s life from a legal perspective. At the very least, it will cost her about $5,000. How is that being a patient advocate?

Thoughts? Opinions?

Kudos to that nurse. This drunk driver could have ruined countless other lives and/or killed and maimed herself, so she's fortunate if you look at it from the perspective that $5000 isn't a lot to pay if it saves her from killing someone else.. This just might the be bottom that helps her to quit drinking and driving. I have no problem with what she did.

I understand and respect your perspective. I understand too that this nurse is probably a pain in the butt and didn't have community interest in her heart.

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