I am contracted out (self-employed) by this staffing agency as a private duty nurse. In the home we have a patient chart that looks like a typical chart in the nursing home. It has a plan of care, doctor's orders, MAR's, etc.
Well...this patient happens to have a relative who has recently moved to the area and is a big shot DON at a nursing home (at least, she "perceives" herself to be a big shot.) I met her one time and had to give her the attitude right back that she gave me and I hope I never have the misfortune of meeting her again. Anyway, the patient had a sinking spell/TIA and the day nurse on duty told me what happened with this relative and is worried and upset over it and I would just like to know if what I'm thinking is right.
The hot shot relative somehow caught wind that the ambulance had been called for the patient (according to the day nurse the relative was on her way to work--at app. 10am--and saw the ambulance in the driveway) and rushed over there. It's being toned down and putting it nicely to say this relative is a know-it-all and a snob. So, the relative runs in the house and takes over, ordering the day nurse to give her the MAR so she can see what this patient is taking. This patient takes meds all through the day (for ex. 9am, 11am, 2pm, 5pm, etc.) and when the day nurse pulled the 9am meds she went ahead and pulled the 11am meds, set them aside in a cup and signed them out on the MAR.
So, the hot shot grabs the MAR and when she sees that the 11am meds have been signed for she starts screaming at the day nurse, makes a big scene for the medics and all the world to see (you know, so everyone can see what a super nurse she is), saying things like don't you realize you could lose your license over this?
I have also heard this supernurse has read through nurse's notes when she comes to visit the patient.
Personality issues aside, is it in accordance with privacy laws and such for people (even family, and BTW, she isn't a child or grandchild) to look through patient charts when they have not been contracted out by this company to be involved in her care? It just doesn't seem right to me.
Gotta disagree with you on this point. At least in my state, your medical chart is yours. You, and whomever you deem, may read your chart at anytime. No doctors "permission".
HIPPA is a federal law, not state. The only person who can read their chart is the patient, unless the patient gives permission. In the hospital where I worked, the patient or family had to put in a written request to Medical Records and then there had to be a nurse or doctor present when looking at the chart. POA only takes over when the patient isn't competent to make decisions on their own.
You need to reread HIPPA regulations as you could lose your license.
If you're in this patients own home then you need curb the attitude towards her family. You don't have to let anyone run you over but you can simply tune her out.
No, you can't simply tune someone out who is in your face so don't tell me what to do about something when you don't know what the situation is like. It doesn't matter how accomodating you are to some people they will still spit in your face and I'm not going to apologize for taking up for myself or expressing facts. I treat people the way I want to be treated until they show me they want to be treated otherwise.
The day nurse has no business mixing 9am and 11am meds. The latest the 9am meds should be given in 9:30 and the earliest the 11am meds should be given is 10:30 so I don't see her motive unless it's laziness. Goodness, only one patient to care for. I have done private duty with trached patients with loads of meds and I never had trouble giving meds on time. But it is hearsay...no complaint against you.
It's irrelevant whether or not she should be mixing medications. This relative has not been appointed as supervisor of this nurse (no, this nurse is not me. I know this nurse and she is a very good person and hard worker who has put up with A LOT from this family, and I believe her when she said she did not mix any medications. I'm not going to criticize her for how she chooses to do something.) This relative had no right to assume role of superior to this nurse and reprimand her, especially in front of others, and having met this devil personally I get so angry thinking about it I wish I could write to someone who would reprimand HER for this behavior. If anyone needs and attitude adjustment it is this niece. And I know when I feel this way I am dealing with a bad apple, because I can get along with almost anybody but this person sends shivers down my spine.
The family has no business looking through the chart. There's no reason why they can't simply ask the nurse on duty how the patient is doing. Is the patient orientated? Just curious...she should have a say in this
But that's the issue, and it isn't even the family looking through the chart. It's the niece who just moved here from another part of the country. Yes, she is a DON but she is not a DON with the company we work for. This woman has 12 children and numerous grandchildren and great-grandchildren who are MARVELOUS! Then, here comes this niece who has become a self-appointed charge nurse of the house...she doesn't come by all that often but when she does she makes sure everyone knows about it and leaves grief in her wake. She is a rotten human and I'm not about to apologize for feeling as harshly toward her as she wants to be toward others.
By the way, there was never an issue with family going through charts until this niece came into the picture a few months ago.
Furthermore, the patient is oriented enough to answer questions appropriatelty and carry on a coherent conversation, however, she makes poor judgements (turning on a stove and putting her hand on it to see how hot it is) and displays obsessive compulsive behavior (folding and refolding towels and sheets time and again). She also has extremely poor short-term memory (we constantly have to remind her yes, she has taken her medication).
Since we are talking about reprimanding, isn't there someone this niece could be reported to? I'm not a vindictive person but I do believe she does need to be reprimanded. There may be no case, but it seems she has broken laws herself by using her position (I'm a nurse) to muscle her way around the home and take it upon herself to comb through the patient's chart and constantly belittle and question the nurses about what they are doing.
I, and I emphasize "I" would first speak with the family and see what they think is appropriate or not appropriate in regards to reporting this neice. What she does violates HIPPA and it doesn't matter if she is a nurse or not. Wrong is wrong.
Specializes in icu, er, transplant, case management, ps.
Gotta disagree with you on this point. At least in my state, your medical chart is yours. You, and whomever you deem, may read your chart at anytime. No doctors "permission".
HIPPA is a federal law, not state. The only person who can read their chart is the patient, unless the patient gives permission. In the hospital where I worked, the patient or family had to put in a written request to Medical Records and then there had to be a nurse or doctor present when looking at the chart. POA only takes over when the patient isn't competent to make decisions on their own.
You need to reread HIPPA regulations as you could lose your license.
]And your hospital better be careful when they dictate who has to be present when someone reads a medical record. SMH tried to do the same thing to me. They cited that it was 'hospital policy' and they would not allow anyone to read a record without a staff member being present. Fine, please show me the written hospital policy. Funny how policies have a habit of disappearing up in smoke when asked for, isn't it. And I and others here have requested our charts and have put these request into writing. Like I said. hospitals will throw up all sorts of phony roadblocks in an attempt to deny a patient or her representative access to their records. Most states have written laws that protect a patient's access to their medical records. And these laws may not put an unreasonable roadblocks in the path of the patient and her access to her records.
Specializes in Community Health, Med-Surg, Home Health.
While we basically know that charts or any medical information is not to be viewed; I am having a hard time with the fact that this information is in PLAIN view MANY times in the HOME. We cannot control where these things are located in the privacy of the house. I really don't know of a guarenteed method to place these things out of view. The patient may not be able to hide them, especially if they are bedridden, and yet, the nurse has to have access to them when she visits there. What solutions do you all have? Maybe this can help me the next time I take a home case.
Most states have written laws that protect a patient's access to their medical records. And these laws may not put an unreasonable roadblocks in the path of the patient and her access to her records.
Woody:balloons:
I went to the HIPPA website and the request to read your chart needs to be put in writing and most hospitals have a Med Record request form. The record doesn't have to be immediately provided. These are Federal laws.
From a HIPPA self study guide:
With a few exceptions, patients have the right to access, inspect and copy their health information. Requests must be granted within 30 days if the information is located on-site, and within 60 days if the information is located off-site. The provider may charge the patient for the actual cost of making copies of the health information.
There are some exceptions to the patient's right to access PHI. Before the health information is released to the patient, any element that falls under one of the exceptions should be identified and removed or covered up in a way that they cannot see it. The exceptions include:
* psychotherapy notes
* information that a health care professional determines could be harmful to the patient
* information compiled for use in a civil or criminal trial or administrative proceeding
* certain health information maintained by a covered entity that falls under the Clinical Laboratory Improvements Amendments of 1988.
The hospital I worked at did have a written policy for a doc or nurse to be present when the chart is in the patient's hands.
ginger58, ASN, RN
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