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.....

Specializes in Critical Care; Cardiac; Professional Development.

The fact that someone "could have" reminded someone about the law doesn't now make the person who didn't remind responsible. The individual in trouble is 100% responsible for their own behavior and for knowing the law involved.

If I were on a floor and a nurse strange to me were nosing around in a chart, frankly, my automatic assumption would be that the nurse had a reason to be doing what they were doing that was completely legal. I don't tend to assume they are malicious, ignorant or unable to manage this. In other words, I respect them as a professional until I have cause not to. I would not have known to remind someone about HIPAA. That is a foundational part of healthcare these days. As a professional development specialist, I also happen to know that there is a ridiculous amount of education put out for nurses both during onboarding and then on an annual basis regarding HIPAA law. There is pretty much no excuse for not knowing.

The image of a nurse going to another floor and standing in the middle of the unit looking around like, now where did I put my glasses? ...

The assigned nurse didn't know if her patient was going on hospice, didn't know the whereabouts of the chart but the charge nurse spotted it immediately and pointed it out to the nurse who was not assigned to her team, let alone the patient, standing in the middle of her unit.

If any of that is true, that was quite a spectacle. I imagine there was eye contact being made amongst the bystanders behind you.

Back in the day when this might have been brushed off as common practice, HIPAA laws were non existent and you wouldn't have been fired.

Which leads me to believe this story was made up for sake of discussion but the story did bring out predictable comments about the notorious back stabbing nurses.

Realitistically you would have simply asked your lunch friend about a patient that you had been pretty involved in. She would have said I don't know yet because she certainly would have if that decision had been made and balls were in motion.

One last thing, anyone who would be brazen enough to walk into the middle of another unit in the way described, probably lacks some self awareness and has exhibited other behaviors similar in nature.

Specializes in Infusion Nursing, Home Health Infusion.
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.

Yes I have read it but I am not talking about the law but rather how the violation of said law should be dealt with by an organization. It is my belief that the intent of the individual should be taken into account. Were they trying to steal someone's insurance policy.Were they going to use the information to hurt someone.In this case it was just caring nurse concerned about her previous patient and did not even view this as a violation.They could have given her a warning and used it as a teaching moment.So not debating the law but how very minor violations should be dealt with by healthcare organizations.

Specializes in OR, Nursing Professional Development.
Yes I have read it but I am not talking about the law but rather how the violation of said law should be dealt with by an organization. It is my belief that the intent of the individual should be taken into account. Were they trying to steal someone's insurance policy.Were they going to use the information to hurt someone.In this case it was just caring nurse concerned about her previous patient and did not even view this as a violation.They could have given her a warning and used it as a teaching moment.So not debating the law but how very minor violations should be dealt with by healthcare organizations.

Intent does not matter. A violation is a violation. That violation not only puts the nurse in question at risk of penalties but also the facility. Why should the facility consider the nurse's intentions when it could cost them thousands (or more) of dollars in fines? And most facilities are going to write their privacy policies to follow HIPAA. A policy violation is indeed a reason to follow the disciplinary procedure. It doesn't matter how "minor" you view the violation. It's still a violation. Something to remember before you end up in trouble because your intentions weren't malicious.

My thought is yes, what you did was a HIPAA violation. You were no longer this patient's nurse, your "business" in their chart was terminated. At this point you were totally being nosy for the sake of being nosy.

That no one threw themselves between you and the chart in order to stop you means nothing.

Specializes in MICU, Burn ICU.

Yep, you fell for the "trap" ... it's crazy how doing something that seems so little can lead to big consequences.

Just make sure not to investigate patients that aren't under your direct care for the shift. You'll most likely never do this again.

Best of luck.

Specializes in Emergency, Telemetry, Transplant.
Yep, you fell for the "trap"

What trap? Are you saying that the CN on the floor set a trap for the OP? Do you mean the law is meant to trap otherwise well meaning nurses?

Specializes in MICU, Burn ICU.
What trap? Are you saying that the CN on the floor set a trap for the OP? Do you mean the law is meant to trap otherwise well meaning nurses?

I meant it to be figurative, hence the quotation :lol2:. OP had numerous chances of accessing the patient's info beforehand (kind of like a sign to stop) and finally there was the chance "trap" that led to breaking the law.

I'm sure the CN didn't do this intentionally to target the OP into getting her/him fired - it was a breach of confidentiality that the OP should have recognized, but unfortunately didn't. I am in no way saying the charge wanted her out; consequences should be made to anyone who violates HIPAA. Sorry for the confusion! :)

Specializes in Medsurg/ICU, Mental Health, Home Health.

A difficult lesson to be learned, for sure.

It's natural, as humans, to be curious about our patients even after they leave our care.

I see no problem with you going to visit the patient. It is not at all a HIPAA violation to know her room number if she isn't confidential. Especially since you did ask the nurse beforehand.

What you should have done (I know it's really easy to be a Monday morning quarterback!) is come back later to see if she was awake at that time. Then the patient herself could have informed you and therefore no HIPAA violation there, either.

Now, what seems "sneaky" is you searching for that chart. If the nurse caring for the patient was indeed ignorant of the hospice status, why did you think the chart would contain the answer? Do you think possibly the nurse did know but did not feel comfortable telling you? And then went to the charge nurse to inquire about you?

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.....

My advice is to take another HIPAA class because in all honestly you seem to be confused as to what a HIPAA violation entails.

If it is not your patient and you are not doing something for the patient in direct patient care that day, you have no right to have access to their chart. HIPAA training cannot possibly be any more clear on this.

You sought out the patient's chart not because you were taking care of the patient, you opened their chart out of your own curiosity. You...can't...do...that.

To answer your question, "does it happen several times during the course of the day"? Nope...not with me. I have no reason to look.

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