Breach of Confidentiality?

Nurses General Nursing

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merlee

1,246 Posts

This has become harder and more complex than ever. Where to draw the lines?

If you work in the same community that you live, you will at some point 'bump' into a former pt/client. I have managed to just smile and nod and then keep moving unless THEY stop me. And then I acknowledge that I was the nurse they knew.

I have rec'd calls from families long after I cared for them to come to funerals, and then they usually tell everyone else who I am.

It's a very fine line; better to err on the HIPAA side!

tyvin, BSN, RN

1,620 Posts

Specializes in Hospice / Psych / RNAC.

Where is the breach? The information was volunteered in the presence of the people in the room. You comply with the tenets of nursing and your states nurse practice act. You people are casual acquaintances and if she volunteered the info with the other people in the room it was her decision. Did you coerce her, ask her questions about why she was there, what her Dx was etc... before she told you the information? If not how can it be a breach of confidentiality?

ckh23, BSN, RN

1,446 Posts

Specializes in ER/ICU/STICU.
Where is the breach? The information was volunteered in the presence of the people in the room. You comply with the tenets of nursing and your states nurse practice act. You people are casual acquaintances and if she volunteered the info with the other people in the room it was her decision. Did you coerce her, ask her questions about why she was there, what her Dx was etc... before she told you the information? If not how can it be a breach of confidentiality?

I agree. As someone else mentioned, we are not robots. Also how can there be any breach, unless you go out and start blabbing to everyone. I guess you shouldn't answer this person's call light either if they need something. I guess your instructor would have you walk by and say "Sorry Mrs. Jones I cannot not help you with anything because I know your daughter. Let me go get someone else to help you get on the bedpan."

Thank god I'm not in school anymore.

Specializes in Hospital Education Coordinator.

To the original poster - regardless of what WE say, you have to jump thru loops to get out of school. So do as the instructor says for now. Welcome to nursing!

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Breach of confidentiality?

Uh no...because you didn't tell anyone about the fact that the patient was in the hospital, you did not access their records when you were not assigned the patient. You saw them in plain view and talked to them...they may have thought you were rude if you did otherwise and any medical information that they told you they VOLUNTEERED to share with you...and I am sure you are planning to keep that to yourself.

No, no violation.

Instructor is beyond wrong and I cannot believe she told a group of students that.

Now...if you saw, let's say, a patients name you knew on a chart and then took it upon yourself to visit that room? Then yes...b/c that puts them in an uncomfortable situation..but if you saw them and you were friends, that is different.

Well I am not so sure ....let me play devils advocate. I agree that most of the time it is not big deal and if you make eye contact you can't be rude. Being rude may even make the patient feel worse or embarrassed that someone they know saw them "undressed" in the hospital. But entering the room when they are not in your care to chit chat without being asked can be construed as HIPAA...a privacy issue.

Playing devils advocate.... let's say this person, even though you know them, doesn't want ANYONE to EVER see them "undressed". You are not assigned to them so technically you shouldn't go chit chat in the room without being asked. Invasion of privacy exists when an expectation of privacy exists ie: the patients room and if you enter and are not asked can be a breech of privacy.

Although probably not HIPAA an invasion of privacy just the same. HIPAA would come into play if like you said above...you saw the name on the chart and went into the room without being asked....and of course if you went to bunco that night and told everyone how awful someone looked without make-up because she is in our hospital......would be HIPAA.

Even though it is splitting hairs....technically you can say hello! and unless invited to "Come on in!" you need to move on.....If you are not assigned to the patient and the patient is not requiring assistance...you should ask permission to enter the patient's room at the door or ask the patients nurse if you may visit.

I am not saying I agree....I'm just giving it that twist to give another POV......

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Chin up

694 Posts

Specializes in Med surg, LTC, Administration.
I agree. As someone else mentioned, we are not robots. Also how can there be any breach, unless you go out and start blabbing to everyone. I guess you shouldn't answer this person's call light either if they need something. I guess your instructor would have you walk by and say "Sorry Mrs. Jones I cannot not help you with anything because I know your daughter. Let me go get someone else to help you get on the bedpan."

Thank god I'm not in school anymore.

Lol!!

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

Your instructor is way off the mark and it is unfortunate that she is sharing her lack of understanding with students.

It is not a confidentiality breach to acknowledge an aquaintance while in the healthcare setting, to have a casual conversation, nor to listen while the person voluntarily shares health-related information with you.

IT IS a violation to later contact that aquaintance outside the healthcare setting and re-hash your chance encounter.

Big difference.

Chin up

694 Posts

Specializes in Med surg, LTC, Administration.
Well I am not so sure ....let me play devils advocate. I agree that most of the time it is not big deal and if you make eye contact you can't be rude. Being rude may even make the patient feel worse or embarrassed that someone they know saw them "undressed" in the hospital. But entering the room when they are not in your care to chit chat without being asked can be construed as HIPAA...a privacy issue.

Playing devils advocate.... let's say this person, even though you know them, doesn't want ANYONE to EVER see them "undressed". You are not assigned to them so technically you shouldn't go chit chat in the room without being asked. Invasion of privacy exists when an expectation of privacy exists ie: the patients room and if you enter and are not asked can be a breech of privacy.

Although probably not HIPAA an invasion of privacy just the same. HIPAA would come into play if like you said above...you saw the name on the chart and went into the room without being asked....and of course if you went to bunco that night and told everyone how awful someone looked without make-up because she is in our hospital......would be HIPAA.

Even though it is splitting hairs....technically you can say hello! and unless invited to "Come on in!" you need to move on.....If you are not assigned to the patient and the patient is not requiring assistance...you should ask permission to enter the patient's room at the door or ask the patients nurse if you may visit.

I am not saying I agree....I'm just giving it that twist to give another POV......

I gave you a kudo, because I agree with your scenario. My issue, is in the instructor stating, you cannot acknowledge them at all. Meaning, in the hallway. First off, if we see someone, we cant just pretend we did not, once eye contact is made....So we see them and they see us, we are good, but not best friends. She says hello, i say hi back, or vice versa, this in not a breach. Not by any stretch. Now if i saw her and she did not know i did, I could rush off, pretend not to notice her, or I can still smile and say hello. I still don't see an issue, any reasonable prudent person, er nurse, would automatically say hello to a friend. Now the room issue is different. The OP, never said how she ended up in that room. If not invited, I would never have gone in. First off, I don't have the time. If the call light was on, and I was walking by, of course I would have to enter. If she asked me to come by and visit, once done with my shift I would.....She is a good friend. Now, if it were my best friend, or a family member, I am there as soon as I see them in the hospital. There isn't a law strong enough to stop me. I really wouldn't care. I think nurses have the judgement to do the right thing, and it should be respected. I realize there are idiots out there, but they are the exception, not the rule. So, unless, the OP ( who is a student and may not know) saw this person, said hi and went about her business. Then when she had down time, or break, decided to then go in, then she would be wrong and I can see the instructor, letting her know. Peace!

Hope this made sense...lil bit?

Specializes in PICU, Sedation/Radiology, PACU.

This is a scenario we were given in school and the class assignment was to decide if there was a confidentiality breach. We were leaning to no, because no medical information was shared unwillingly.

Personally, I think the nurse could have encountered the patient in many different ways- answering a call light, caring for the roommate, going in to turn off the light, etc. As long as the nurse didn't share medical information or obtain it without consent, HIPAA doesn't have any clause for this situation.

canesdukegirl, BSN, RN

1 Article; 2,543 Posts

Specializes in Trauma Surgery, Nursing Management.

I was in this VERY scenario the first year I worked on the Med/Surg floor. I saw the parents of my old HS BFF walking in the hall. The recognized me immediately and gave me a hug. We chatted for only a few seconds, then I found an "out" to let them return to their room. These folks are very Southern, and manners to them trump pain, if you know what I mean. I knew this about them, so I made sure to limit my dialogue with them. During our brief encounter, at no time did they invite me into their room to visit. I took their cue and stayed my distance.

Later that week I received a card from them. They thanked me for "doing what I do in helping people", and then wrote that they appreciated the fact that I respected their privacy. The husband, who was the pt, is terribly modest and also a very proud man. His wife wrote that he was terrified that I would come into his room and see him "at his worst, with his butt hanging out and all".

I totally understood what she meant, and I think the card that she sent was a nice "thank you". I am only sorry that he was experiencing anxiety simply from wondering if I was just going to "pop in". Poor guy!

As I have said numerous times in my posts, you have to look at things from the patient's perspective. Would I want my friends, who happened to be staff nurses on the unit that I was on, come and visit me when I am so sick that I must be hospitalized? Um...no. Would I want a phone call from them? Heck yeah!

When I was hospitalized I did not want anyone to visit me. There were some nurses that did come to see me, but I asked them to tell the others that I was not quite ready for visitors yet. I was puking q20m, and when I wasn't puking, I was strung out on Phenergan and too sleepy to even follow a conversation. AND I looked like a Medieval wash woman who hadn't showered in days. NOT the kind of face I want to show!

Do I think that the visiting nurses breached my confidentiality? No, but I would have probably rested easier if I was not in the care of the hospital that I worked in for the very reasons I listed. I don't want my co-workers having a lasting image of me puking in a kidney basin.

iceprincess492

85 Posts

My class in nursing school was trying to figure out if this was a confidentiality breach:

You are working as a nurse on the floor of a hospital and see a person that you know from outside of the hospital. You make eye contact and say hello. Later you stop by the room to say hello to the patient and their hospitalized family member, who is also an old friend. You both talk a little bit about how you and your family are doing and how the patient and her family are. The patient shares some details about why they are hospitalized.

Was this a breach of confidentiality? No personal information was shared without the patient's consent, nor was anyone else- healthcare team or otherwise- told of the conversation. Our instructor says it was, stating that the nurse should not acknowledge anyone that she knows and the acknowledgement was a breach of confidentiality.

Opinions?

This may be the weirdest thing I've heard.......this week. (and it's been a really weird week so far):uhoh3:

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