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?
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?
What would you like to happen to this woman? Say for instance she gets back behind the wheel with 0.15 BAL... you or someone you know could be the next thing she runs into. I say good for your partner for not wanting someone to get away with drinking and driving. That nurse didn't ruin the pts life she did it to herself when she drank and drove. Luckily for her she didn't kill someone. In the long run maybe this pt will learn her lesson and not drink and drive... so she will live longer. How's that for advocating!
PS. I know this goes against HIPAA but sometimes you just have to trust your conscience and protect people from themselves.
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.
This case has me torn between an emotional response and a logical response. I think I'm going to have to agree with Multi who said that if it were legally mandated by my state to report it, then I would absolutely do so without hesitation. However, if it weren't a legal requirement, then I would not dare think myself above the laws of patient confidentiality by breaching them.....no matter how badly this woman "could" have hurt herself or someone else.
My question is, how is this different than when you get patients in the ER who test positive for marijuana and amphetamines? These are both illegal substances and I have never heard of someone calling the police and having these patients arrested. I am in the field of healthcare, not law enforcement. I will follow the laws, but I will not break the laws to "serve the better good" of the population.
My question is, how is this different than when you get patients in the ER who test positive for marijuana and amphetamines? These are both illegal substances and I have never heard of someone calling the police and having these patients arrested. I am in the field of healthcare, not law enforcement. I will follow the laws, but I will not break the laws to "serve the better good" of the population.
FWIW, the laws r/t drug use are slightly different. To my knowledge, there is nothing illegal about having drugs in your system, per se: it is buying, selling, or possessing that is against the law, or operating a motor vehicle, aircraft, performing surgery under the influence, etc. Also, having illegal substance in your system is explicitly a violation of the law if you are under court orders: indictment, probation, parole, etc.
Now, an employer can fire you for it, a BON can revoke your license for it, etc. These are "civil" penalties, not criminal.
What would you like to happen to this woman? Say for instance she gets back behind the wheel with 0.15 BAL... you or someone you know could be the next thing she runs into. I say good for your partner for not wanting someone to get away with drinking and driving. That nurse didn't ruin the pts life she did it to herself when she drank and drove. Luckily for her she didn't kill someone. In the long run maybe this pt will learn her lesson and not drink and drive... so she will live longer. How's that for advocating!
PS. I know this goes against HIPAA but sometimes you just have to trust your conscience and protect people from themselves.
So...you're willing to lose your license, pay a hefty fine, and possibly end up in some federal prison?
b) PENALTIES.--A person described in subsection (a) shall--
"(1) be fined not more than $50,000, imprisoned not more than 1 year, or both;
"(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and
"(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.
Man, the "I'm a supernurse and I know what is best for you" attitude scares me as badly as communists and the Taliban-type mentality does.
THIS is the type of thinking that allows a person to be committed to a psych facility on the flimsiest of reasons/justifications.
This is supposed to be a Nation of Laws, not of Men (persons, whatever).
So, by JennyLR's logic we should institutionalize this woman because she is a danger to herself and/or others? I realize that's a stretch, but it IS the ultimate end of the slippery slope she seems to advocate.
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?
Certainly there are probably some circumstances that may sway most, if not all of us, to the side of informing the police. That being said, I wholeheartedly agree with your basic premise: We are NOT police informants nor are we law enforcement personnel. Just because her BAL was above the legal limit does NOT mean SHE was the cause of the accident.
To the other side of this: Go ahead and be a snitch. That type of behaviour tends to "bite back" eventually. Big Brother's already watching too much and getting into our pocket-books/wallets WAY too much.
I would vote for a law mandating reporting of intoxicated auto accident patients. I think. I'm still a little torn, but probably. What I am adamantly against is what I found to be the law in several states, voluntary reporting. In several states it is up to the health care provider to decide if they will report to the police. These states say that it is perfectly ethical for the provider to not report and they will never be punished for not reporting. Just they have the option. I find that terrifying. Health care providers should not be in the role of deciding who they will turn into the police. It ought to be mandated by law or not. Period. I don't want the public viewing them as at our mercy whether we will call the police, at our whim.
Here's a scenerio to chew on. Patient A is a young black male. He is brought to the ER post auto accident and intoxicated. Patient B is middle-aged, white and an accountant. Patient A says he was out with his friends and just had two (really two!) beers. Patient B says he had a business dinner with clients and is sure he only had two beers (sure!). Who gets reported when it is voluntary and up to the discretion of the ER?
And what message does this telegraph to the public about our role in society when we may report someone to teh police?
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
Some really important points Amanda, have to agree with what you've said, so true....it's all relative!
Specializes in ER (new), Respitory/Med Surg floor.
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.
I agree with that too. Not that you want to hide this pt's drinking problem or not want to get involved or breech confidentiality. If there were other people involved and if it was legally mandated to do so of course. Nurses are PATIENT advocates. I could see encouraging counsleing or rehab but blatently stating to a cop 'what are you going to do about...' that seems from the information by the OP getting caught up in drama. Serious, but was it really that necesary. I don't drink either and by no means indicating the pt should get a free ride. Just I wouldn't blurt that info out either unless legally I am suppose too.
Specializes in ER (new), Respitory/Med Surg floor.
What I am adamantly against is what I found to be the law in several states, voluntary reporting.....I find that terrifying. Health care providers should not be in the role of deciding who they will turn into the police.
I totally agree with that. I can't stand it when people put you in a spot to make decisions that you shouldn't have too. That's why this situation bothers me. WE are there for the pt. How will pt's trust us if we make those decisions. It should be mandated or police take legal action to obtain the records.
I thought that was the reason for the ETOH level being taken, to find out if that was the cause of the accident. It is illegal to drink and drive and she was lucky she only injured herself. As a nurse and person that drives and has family that drives, I want drunk drivers punished for risking other peoples' lives because of their selfishness.
KyPinkRN
283 Posts
What would you like to happen to this woman? Say for instance she gets back behind the wheel with 0.15 BAL... you or someone you know could be the next thing she runs into. I say good for your partner for not wanting someone to get away with drinking and driving. That nurse didn't ruin the pts life she did it to herself when she drank and drove. Luckily for her she didn't kill someone. In the long run maybe this pt will learn her lesson and not drink and drive... so she will live longer. How's that for advocating!
PS. I know this goes against HIPAA but sometimes you just have to trust your conscience and protect people from themselves.