I have a sticky situation that I've never seen before and I'm looking for some insight. I'll try to stick to the facts.
1. I'm a case manager for a government agency and I coordinate, oversee and perform care for vulnerable -usally geriatric- patients in the community.
2. I've had this patient for several months now with pretty grievous abuse and repeated violations of patient responsibilities I outlined with the family when the patient was admitted. They agreed to our policies in writing and have been gently reminded multiple times since admission.
3. Pt. Is cared for by a grandchild with some serious anger issues. Constantly threatening and initiating legal action (not against us), refusing to allow patient to receive pain meds resulting in violent and aggressive behavior directed at us - I'm talking drawing blood-, granddaughter constantly screaming and cursing at us.
3. Our program manager refuses to discharge anyone, Including this one, with one FNP actually quitting our program because they couldn't stand the abuse anymore.
4. Pt. Revoked hospice at family request this weekend, again, as a result of gangrene escalating to sepsis to LE complicated by PVD and 100% dependence for bed mobility.
5. As is customary, I went to the hospital to coordinate care with the hospital staff and spoke with the patient's assigned nurse at the nurse's station.
6. While nurse and I were together, speaking in lowered voices in what I was confident was incidental disclosure.......
7. ....I was unaware that one of the CNA's working on the unit had come into the nurse's station and was hovering to eavesdrop on our discussion.
8. Charge nurse was saying some pretty crappy stuff and I was agreeing with and validating her frustrations. Not bad mouthing anyone, just listening to her vent and telling her that she wasn't the only one who'd dealt with all of the above referenced behavior from the patient's family.
9. Aforementioned CNA happened to be a close friend of patient's really angry family member.
10. I received a call this evening from said family member screaming at me, repeating the conversation the nurse and I had almost verbatim. She admitted that the CNA was her "best friend" and the CNA told her everything.
I got the family member calmed down and rational somehow by the grace of God by the time the conversation was over but I'm pretty angry myself. I'm pissed that my boss allows us to be treated this way. I know it's "part of the job" especially at end of life. It is what it is but I as a former hospice administrator and an RN, I have a zero tolerance policy for yelling, threatening and otherwise abuse of staff. It's one thing to vent and work though grief. Quite another to threaten staff, scream, curse, and otherwise bully them and attempt to intimidate with fear.
This CNA violated HIPAA. I'm concerned that this could somehow be turned against me and I take HIPAA pretty seriously because that's just what we do.
Not sure how to proceed as far as telling my boss, who is very open in letting us know he doesn't care and doesn't appreciate us making waves. Lay low, be quiet and "grow the program" (increase pt. Census).
How do I handle this? What should I have done differently ?
Thanks in advance for insight.
***edit: I work in an Interdisciplinary care model very similar to hospice except that we care for patients across at every stage of disease and life, so we frequently discuss and care plan for patient and family behaviors and responses to interventions. Just to clarify that I wasn't gossiping or bad mouthing anyone. No name calling or any of that.
Those are good thoughts from you @MunoRN and @LouDogg, but I still kind of think it could be pieced together in either direction. HHS's definition of treatment includes "provision, coordination, or management of health care and related services." There is nothing to suggest they mean to limit this definition strictly to services related to physical conditions only (besides, one could make the case that the patient's living situation, including his difficult family members, is directly related to his health and healthcare anyway). As I said, I doubt the charge nurse's comments were the extent of the conversation and just because the eavesdropper may not have conveyed the full contents of the convo to the family member doesn't mean a protected context didn't exist.
I don't know ??♀️, you two may very well be correct--but I kind of believe that if a formal complaint were made to OCR they would not look kindly on an employee of a covered entity divulging social-health-related information that was obtained from the context of a likely-protected conversation. I know you are noting that it was gossipy in nature, but I don't know if they would get into the weeds like that or just be very displeased that the contents were passed on, related to a patient, by an employee of a covered entity.
I guess it's interesting to think about either way.
I agree, based on information we don't have this could go either way, and we're skipping the bigger issue of whether the family even had the right to be involved in the patient's decision making given the patient's apparent capacity to make their wishes known, and the family's overriding of the patient's wishes which should have resulted in a clear prohibition in their involvement in any decision making, potentially extending into when the patient becomes no longer able to make their own decisions.
Well we both know if the shoe was on the other foot, wouldnt tell your friend whose family member you were talkin about? Bottom line you probably should have waited to speak in private if it got off topic and included negative opinions about the patient. If I were you I would take this as lesson learned.
MunoRN, RN
8,058 Posts
I agree, based on information we don't have this could go either way, and we're skipping the bigger issue of whether the family even had the right to be involved in the patient's decision making given the patient's apparent capacity to make their wishes known, and the family's overriding of the patient's wishes which should have resulted in a clear prohibition in their involvement in any decision making, potentially extending into when the patient becomes no longer able to make their own decisions.