CNA Violating HIPAA

[Nurse Beth, MSN]

Dear Nurse Beth,

I have a question regarding home health and CNA's. We have a CNA that calls/texts the primary nurses too many times a day for things that are not issues. Which in turn takes time from the pts that we are currently providing care for thinking that we need to answer because it could be important.

Examples: unwrapping wounds and sending pictures every visit even when we have told her that is considered wound care and to leave dressing in place until next nurse visit, pt feels really tired but doesn't want to go to the Dr and all VS WNL and many many more. How do I tactfully tell her what warrants a phone call to a nurse? Should I make a list of when to call and what all should I include in the list? Thanks!

Dear Too Many Texts,

Unwrapping a wound that she has been asked to leave dressed and taking a photo of it (on her personal phone?) goes beyond asking too many questions. Your manager needs to be involved. It borders on HIPAA and scope of practice issues. Does your agency have a policy on taking and sending pictures?

When giving instructions and delegating, ask for her understanding. For example, ask if there is anything about not undressing a wound that she doesn't understand, and finish up with 'Can we agree that you are not to remove wound dressings?"

Do you feel her initial training was sufficient? If she is a new employee, she may benefit from spending a shift with an experienced CNA. Making a list of when to call and when not to call might be very helpful for both of you. Explain she is not to report normals, and give her examples of abnormals that should be reported, such as a temperature, loss of appetite, confusion, and so on. Give her a copy of her job description.

Bring her into the office for the talk, and give her time to ask questions and clarify. You could role-play a couple of scenarios to illustrate and gauge her comprehension. Listen to her responses and try to determine if this is a knowledge deficit, a performance issue, or lack of experience and insecurity.

Any verbal coaching should be documented. Once job expectations are clear, there must be follow-up. Touch base in a week or so to see if she has any questions and praise her for her improved performance.

It's fair in this situation to expect immediate changes in behavior. Again, if you are not the manager, involve the manager. All the nurses working with this CNA should reinforce the same expectations.