HIPAA/confidentiality during an Outbreak

[Nurse2b Fun]

I am a nursing student working on my bachelors and I work as a CNA on a subacute rehab unit. We have had a recent breakout of Scabies in a couple patients. We are acting prophylacticly and treating every patient on the unit with a shower and 1 topical treatment of cream followed by a second shower the next day.

I told one of the patients that I needed to take her for a shower and then apply a cream to her body. When she asked why, I told her there was a breakout of a rash in the facility. She asked what the rash is, and I proceeded to tell her Scabies. Immediately, 4 nurses jumped in and told me to not say anything more and that I cannot tell her what the outbreak is. Later, one of the nurses said I shouldn't talk to the patients about the showers. The way they reacted made me feel pretty incompetent and down about myself.

Did I really do something wrong? Or am I allowed to tell the patient the name of the disease? In my head, the patient is being told they have to do something for a medical reason and then put a prescription medication all over their body. To me this sounds las though it is unethical to refuse to tell the patient what the prescription is for. In no way did I tell the patient who had confirmed scabies. Was I in the wrong for telling the patient? Should I have refused to tell her it's for scabies?

[Username invalid, RN]

I misread the question and voted no. I meant yes, tell the patient. But I'm still in nursing school, too... woops!

[SouthpawRN]

You are not telling the patient about any diagnosis they have, you are not identifying the source of the outbreak. Saying that you have been instructed to give all residents a shower and apply a prophylactic treatment due to a scabies outbreak in the facility does not seem to even violate a scope of practice for a CNA, if the patient asks if they have Scabies, then you would need to say that is a question for their nurse or HCP. Not saying anything is a violation of Informed consent IMHO. Is applying this specific topical treatment within your CNA scope of practice?

[DeeAngel]

Telling a patients they are being treated for a scabies outbreak is not breaking confidential information as no patient idenifiers are being exposed.

[JKL33]

Saying that you have been instructed to give all residents a shower and apply a prophylactic treatment due to a scabies outbreak in the facility does not seem to even violate a scope of practice for a CNA

Not trying to argue, this is just my experience - - according to what I've been taught and seen in workplace policies, it would violate the CNA scope of practice. In my experience it would have to go something like this:

"Mrs. Jones, we need to give you a bath"

---"What? It's ten o'clock at night! Why??"

"I'll be happy to get your nurse to come and talk with you about it"

They are not able to give an original instruction to a patient about the purpose or rationale for a treatment....even as simple as it is in this particular case. I believe that is a distinction from them mentioning something in passing that is ongoing and the patient knows about, such as "Remember? We use this shampoo to help with your psoriasis"

That said, I 100% agree with previous thoughts that the real mistake (which I, too, believe was illegal) was not having the residents OR their POAs informed prior to the start of this.

[JustBeachyNurse, LPN]

I misread the question and voted no. I meant yes, tell the patient. But I'm still in nursing school, too... woops!

That's not within the scope of a CNA/nursing student though.

[GSDlvrRN, MSN]

Off topic but....when I worked at a SNF I was told by my supervisor that I could not delegate applying medicated creams to CNAs, because you have to be a nurse to administer medications. I live in California so I am not sure how it goes elsewhere. Should the nurses have delegated that task to the OP in the first place? I wouldn't give blood pressure meds to a CNA to administer to the patient, so what is the difference?

[JKL33]

That too!!

[SouthpawRN]

Off topic but....when I worked at a SNF I was told by my supervisor that I could not delegate applying medicated creams to CNAs, because you have to be a nurse to administer medications. I live in California so I am not sure how it goes elsewhere. Should the nurses have delegated that task to the OP in the first place? I wouldn't give blood pressure meds to a CNA to administer to the patient, so what is the difference?

Yeah, that is what I was wondering and why I asked. I don't believe the CNA is trained in the 5, 6, or 9 rights (depending which reference you want to use) of medication administration. Do they know to ask about allergies to medicines and check the patient's record for them (many in these facilities do not have the cognitive capacity to know their own allergies.

[KRVRN, BSN, RN]

Are CNA's allowed to apply that? It is medication after all. I assume some topicals are okay for a CNA to apply, AD ointment to the peri area for example.

[CoffeeRTC, BSN, RN]

From a federal legal standpoint;

Nothing about this situation was HIPAA privacy issue. As Someone already mentioned, without disclosing whom has/had scabies there isn't a privacy violation.

Second, federal law, as well as most state patient rights law, mandates that each patient has the right to know their diagnosis and options for treatment. In most cases, patients also have the right to object to treatment.

As a CNA, you most definitely should not have been forced into this position, but your actions, though probably not part of your job description, probably saved your employer from violating the law. I would speak to management about making sure patients are being properly consulted about their medical needs.

AND...technically the CNA's should not have been applying a medicated cream/ ointment!

In what world is it okay to appy a medicine without informed consent?

I'd love to know if the facility did all the other measures to prevent and treat the outbreak? Removing linens etc?

[FolksBtrippin, BSN, RN]

You know, that is kind of a repeating theme on this forum and I'm not sure why. Commonsense and ethics let you know that the way this situation is being handled isn't right. The eye-rolling and scoffing are your confirmation that these individuals aren't behaving professionally/ethically.

Learn now not to let others whom you know are wrong make you feel *anything* about yourself. They have literally nothing...zero...to do with you. The faster you believe this, the better off you'll be.

As a recent student, and because you said you have seen this a lot, I would like to respond to you about this.

When I was a student (graduated in Dec) and I saw nurses act unethically/unprofessionally it caused me to question my career choice. Like, if this is normal/expected, then do I really want to take on this job? That is what runs through a (conscientious) student's mind when confronted with that kind of situation.

Studentsdon't have the confidence and experience to know that the nurses they are observing are wrong. They don't have the experience to know what is normal and expected in the profession. So it is completely natural for them to second-guess themselves in this situation or to feel moral distress.

[JKL33]

As a recent student, and because you said you have seen this a lot, I would like to respond to you about this.

When I was a student (graduated in Dec) and I saw nurses act unethically/unprofessionally it caused me to question my career choice. Like, if this is normal/expected, then do I really want to take on this job? That is what runs through a (conscientious) student's mind when confronted with that kind of situation.

Studentsdon't have the confidence and experience to know that the nurses they are observing are wrong. They don't have the experience to know what is normal and expected in the profession. So it is completely natural for them to second-guess themselves in this situation or to feel moral distress.

Thanks! I can see how that would be true for some.