HIPAA Violation, Fired

Nurses HIPAA

Published

Hi,

I am curious to know what others think of this.

Scenario

I took care of a patient on Unit 1 and the patient had a terminal illness. The patient and family were trying to decide whether to implement Hospice care. I transferred the patient later in the day to Unit 2 on another floor of the hospital where I work. (105 bed hospital)

The next day I came to work and was walking thought the cafeteria with some fellow co-workers and saw this patients family. It reminded me to go upstairs and see what the patient had decided about Hospice. Later on in the day I had a few minutes and went upstairs to Unit 2. I could not find the chart easily. I asked who the nurse was and spoke with her and asked her if she knew whether the patient chose to go on hospice. She said she didn't know. I asked if I could go visit and the nurse sad she didn't care. I went into the patients room, she was asleep and no visitors where there. I went back into the nurses station and the bedside nurse was still there charting, I told her the patient was sleeping and I did not wake her up. I asked if I could look at her chart and again she said she didn't care. I asked where it was, because I couldn't find it. She said she didn't know. ( I knew this bedside nurse a little better than the charge nurse, because we had worked together when I floated up there and had lunch and chatted a little bit. I considered her a friend and liked her). I stood in the middle of the nurses station, looking around and the charge nurse saw me and asked if she could help me. Know, I know the charge nurse from working at the hospital, through transferring patients to her unit. I had worked there for 1 year and floated on several occasions to her unit. We weren't friends as if eating lunch together. We were definitely not enemies and had never had any issues. It was a cordial, working relationship. We knew each others names in the hallway and said Hi with a smile in passing and thats the extend of our relationship. So when she asked if she could help me, I said yes, I'm looking for ------------ chart. She immediately saw it on a lower rack where the unit secretary was sitting and pointed it out to me. I went to the chart, opened it up to the progress notes....(HIPAA VIOLATION) and was in the chart for maybe 30 seconds, finding the progress notes and reading that they had decided on hospice. I closed the chart, said thank you and put the chart back where I found it.

The next day I was informed of my HIPAA violation and placed on leave and terminated 1 week later.

Just curious what other nurses responses are. I did the crime, I have learned from it and it was a very costly lesson. Honestly think, how many times has that happened to you in your workday......really think about it before you reply, which I hope you do, because I am just flabbergasted that the nurse would lead me to the chart, and no one EVER said,"Are you sure you want to do that? It all happened so fast......... There was no public sharing of information, there was no gossip, no conversations ever about it. Just my eyes in a chart of a patient I wasn't assigned to that day.

Thanks for any responses.....

That must have been difficult for you to learn a lesson in such a harsh way. Yes you should have known better. The charge nurse should have taken you aside and told you that you were violating the HIPAA rules. That's what I would have done! She could have acted as a mentor instead of judge and jury.

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Thank you, Been there, done that! My point exactly! I mean, I understand, I have no one to blame but myself. But seriously? I would never do what the charge nurse did to me This event happened a long time ago and I have since moved on to bigger and better opportunities. I just happened to read a few HIPAA questions and thought I would post my experience.

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Thank you, Been there, done that! My point exactly! I mean, I understand, I have no one to blame but myself. But seriously? I would never do what the charge nurse did to me This event happened a long time ago and I have since moved on to bigger and better opportunities. I just happened to read a few HIPAA questions and thought I would post my experience.

Do you know that the charge nurse is the one who reported you?

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kosmopolitan -

I am a bit surprised that you didn't know there are people sitting around just waiting to have a field day with stuff like this. Your peers can't override that/give you permission.

It is so sad that such a punitive disciplinary action occurred just because you had a benign interest in a pt followup.

Yep. Same employment result as if OP had taken a picture and posted it on FB with nasty commentary. :up:

I've retired, but back in the 'old days', I remember when we antique nurses would take interest (if poss) in how our pts fared when transferred/moved around. I remember callilng other in-house wings, even the hospital for a quick 'how she doing?'. NO WAY TODAY!!!

You don't have to be antique or retired ;) to remember that.

Like just about everyone else, I feel strongly that general HIPAA protections are important. Although I have mixed feelings about whether intentions should come into play (since they are sometimes misguided), I do think this is somehow sad for nursing. I mean, we are expected to give a ____ about people; to care. And for the most part (as a profession) we naturally do. The idea that our caring or interest in the well-being of someone on behalf of whom we have worked (sometimes with great effort) should be merely episodic or else we are some kind of criminal moves us more toward 'cog in the wheel' than caring professional who can make good judgments about such things.

Another similar effect (negative, IMO) all of this has had is in teaching orientees/new grads and in general professional learning. I am against the permutation of HIPAA that disallows reviewing the chart of previously cared for patient for the purpose of learning. Orientee and preceptor work hard to begin correcting critical metabolic derangements and intervening in response to the manifestations of such. It sure used to be great when you could "debrief" all of that later and look in the chart to see how things did or didn't begin to go in the right direction or, well, just what they heck came of all of it. What was required to finally turn things around? Oh well. Instead we are supposed to have the librarian pull some case studies. (???)

*Have been told that visiting someone is acceptable at my place if okay with the patient, and that the patient may update (previous) nurse during the visit if they wish. I have done this occasionally. I knock, state my name and explanation ("I don't know if you remember - I'm JKL and I took care of you when you came in yesterday. I thought I'd stop by and see how you're doing if that's okay with you?"). This is usually a very positive interaction. It certainly could be a good thing for patient satisfaction if anyone cared to think of it that way! As I said I don't to this very often, but when I do people have never failed to seem impressed and happy that someone cared to touch base in this manner.

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Specializes in Gerontology.
Thank you, Been there, done that! My point exactly! I mean, I understand, I have no one to blame but myself. But seriously? I would never do what the charge nurse did to me This event happened a long time ago and I have since moved on to bigger and better opportunities. I just happened to read a few HIPAA questions and thought I would post my experience.

Does not the charge nurse have a duty to report HIPAA infractions. I am Canadian but I know that if imbecome aware that another nurse has "breached confidentiality " as we call it here, I have a duty to report it.

Maybe the charge nurse thought you had a piece of documentation to add to the chart that had been left behind on your unit.

You were no longer part of the circle of care for this pt, so you had no right to read the notes, no matter what your intentions.

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Specializes in Travel, Home Health, Med-Surg.

Well, like Hippa or not it is there to protect the patient. Did you know it was a violation when you looked at the chart? You were wrong but I think that firing you was overkill unless you already had trouble in the past. How do you know who lodged the complaint, it could have been the secretary also, or the nurse you thought was your friend. Either way you had to learn some lessons the hard way. As a patient I would not really appreciate nurses or other staff following me around the hospital no matter their intentions, some people might appreciate that, others not so much. I am sorry for the trouble you now have but take it as lesson learned and continue on, good luck.

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Our facility has progressive discipline on privacy violations, based on how egregious the violation is. Termination is typically done for things like malicious violations or repeat offenders. In your situation, our facility would probably give you a suspension.

This, totally.

My personal advice - don't access information unless you have a valid reason to do so. If I am not caring for a patient, and not helping to support those caring for that patient, not performing an audit function either - I do not access a chart. I have several audit functions as part of my job, and I leave a note in those charts so if ever asked, I can remind the powers that be, WHY I was there. If there is no note, I was either helping to provide care, providing behind the scenes support (periop), or troubleshoot something specific (EMR or operational process related).

Coding a coworker was interesting when we had that experience. One of our surgeons is the one who accessed the coworker/patient's information (we needed documented allergies). The folks who audit our EMR access were not thrilled...asking why were you accessing a non-admitted patient's information - specifically on a patient that is not yours/your service's patient. Based on the snapshot they saw until the code data was entered (scanned) they assumed it was a violation. The paper/downtime code flowsheet and the list of staff who were involved is what got the surgeon out of trouble.

In short - if you don't have a patient care or business/operations reason to access information, then don't access it.

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Specializes in Infusion Nursing, Home Health Infusion.

While it was a violation it's not all that egregious.The intent shoud be looked at and you had no intent to get her insurance information and use it or use any information to blackmail the patient as examples.It should have been looked upon as a teaching opportunity and you should have been given a verbal warning and not fired.It was also a single instance that does not need to be reported right away.If I77+was asked for the chart I would have told you it was a violation.I have had nurses ask me if they can take a video of me starting an IV on their phones and I tell them ,"Never "do that !

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Specializes in Nephrology, Cardiology, ER, ICU.

MOved to HIPAA forum

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Specializes in Critical Care; Cardiac; Professional Development.

Patient information is protected on a need-to-know basis by HIPAA law. You violated that law, as you were no longer in a need-to-know position, but rather were satisfying your curiosity. Sometimes we have things that go unanswered in caring for our patients and you made a costly mistake.

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Specializes in Critical Care; Cardiac; Professional Development.
While it was a violation it's not all that egregious.The intent shoud be looked at and you had no intent to get her insurance information and use it or use any information to blackmail the patient as examples.It should have been looked upon as a teaching opportunity and you should have been given a verbal warning and not fired.It was also a single instance that does not need to be reported right away.If I77+was asked for the chart I would have told you it was a violation.I have had nurses ask me if they can take a video of me starting an IV on their phones and I tell them ,"Never "do that !

The law does not make accommodations for intent. PHI is protected on a need-to-know basis. Two people were fired in my facility just a couple of months ago for accessing patient charts for curiosity reasons. This is a serious issue these days, with the risk of huge fines for both facilities and individuals. Intent doesn't play in. I also find that to be unfortunate, as it can leave us with a lot of unresolved emotional turmoil regarding certain patients, but at the same time, the law isn't really ambiguous.

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In my experience, hospitals have been training people specifically in HIPPA to never peruse charts on patients who are not assigned to us. As you said this happened back in the day of paper charts, perhaps before everyone was constantly getting this shoved down our throats.

I have considered what you said and what people have written back to you. In my opinion, there is responsibility on the part of the charge nurse to whom you spoke to guard the patient's chart in the same way that one should not allow one's computer screen to be read by passing visitors or staff.

I also don't know how in the world you had the time in your day to not only get a lunch, but to go wandering around the hospital in search of people in other departments. So I am very skeptical that you are a real nurse. I think you are likely making stuff up. A real nurse would have five patients all calling for stuff at the same time and a supervisor walking around behind her telling her what a failure she is.

However, if your story is true, that as a nurse you had time to not only have lunch, but to go visit a patient you had on a prior shift, then you should have just said hello and hoped the patient was doing OK and left it at that. The staff in the other unit should not have allowed you access to a chart any more than they should have allowed a family member or a stranger access.

So yes, two wrongs don't make a right.

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