HIPAA Violation, Fired

[kosmopolitan]

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.....

[klone, MSN, RN]

My thoughts - hospitals take privacy very seriously (as they should, because there are huge financial penalties for violations). You shouldn't be in anyone's chart out of curiosity. It's nobody else's responsibility to remind you what is and isn't a privacy violation. You should have known that.

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.

[AxelNewRN86]

The problem with nursing is we become invested in our patients and it thus easy to cross the line of HIPPA violations. This patient was no longer your patient and because of that you had no right to know whether or not they chose they chose hospice. Because you went to another unit and hunted down the chart, yes it was a violation. I am very sorry about your job. By no means does it sound like you had any ill intentions. But with nursing, curiosity can kill the cat. From my experience, hospitals have yearly trainings on HIPPA and they do not take it lightly. I think you are going to have to take this with a grain of salt, swallow your pride and learn from it and look elsewhere.

Awhile back, I was a relatively new receptionist/CNA on an critical care unit. One nurse came up to me wanting to me to find out the status of her previous status. I was then reminded by another nurse that that was a HIPPA violation. It was a good lesson for me.

[FolksBtrippin, BSN, RN]

Thank you for sharing your story as it may help someome else.

. My thoughts are that the charge nurse probably regretted her decision to direct you to the chart and then reported you as a result of those feelings. You.probably made the bedside nurse uncomfortable as well.

It is normal to wonder what happens to our patients after our relationship ends. But we have to just let it go. Because it isn't our right to know.

Although I feel for you at having been fired for this, I can identify several points at which you may have been able to stop yourself had you used better judgment. Entering a unit where you don't work was your first mistake. After that you made more mistakes, including involving 2 other people in the violation. So I can see how HR might consider this particular offense egregious enough for termination.

Best wishes to you in finding another job. It seems like you have what it takes to learn from your mistake and move on.

[Been there,done that, ASN, RN]

My thoughts - hospitals take privacy very seriously (as they should, because there are huge financial penalties for violations). You shouldn't be in anyone's chart out of curiosity. It's nobody else's responsibility to remind you what is and isn't a privacy violation. You should have known that.

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.

I think the OP is trying to make a point about mean, power-tripping co-workers. The charge nurse watched her do it, then reported her. S/he could just have easily pointed out it was a violation.

[caliotter3]

I think the OP is trying to make a point about mean, power-tripping co-workers. The charge nurse watched her do it, then reported her. S/he could just have easily pointed out it was a violation.

I have worked with people who would, could, and did, this very thing. Lead you into a trap? Yes. Now, you are more aware of the adage, "Trust no one".

[TX.RN.Shannon]

Yep!

I still have to remind myself of that, even after all my years in nursing.

[klone, MSN, RN]

I think the OP is trying to make a point about mean, power-tripping co-workers. The charge nurse watched her do it, then reported her. S/he could just have easily pointed out it was a violation.

Perhaps, but the OP did something that violated the law and got fired. That's the only thing I'm addressing here.

If the charge nurse who pointed her to the chart had come here sharing her side of the story, my feedback would have been different, and would have been tailored to HER actions.

[Sour Lemon]

I completely understand curiosity about past patients. I might have asked about the patient, in passing, as well. Your conduct seems a little overboard, though. You went to a different unit, entered the patients room, asked multiple employees about the patient, looked through the patient's chart, etc.

When the first nurse told you she "didn't know", that might have been some sort of hint that the conversation was inappropriate. It's difficult to tell without seeing the body language that went along with it. But even without a hint, you had to be well aware that your conduct was wrong. It would have been nice of the other staff to manage your behavior, but it's really not their responsibility to tell you what you already know.

The staff may have reported your behavior to someone without expecting that you'd be fired for it. The nurse you spoke to for "permission" to enter the patient's room and look at the patient's chart might have also felt very uncomfortable ...like she didn't do enough to stop you and could be held personally responsible if an issue arose at some point

Rethink your boundaries and come back strong. Best wishes.

[JustBeachyNurse, LPN]

Accept your personal responsibility. You not only went to a unit that you don't work on, sought out the patient (not like the family saw and approached you in the lobby or cafe and mentioned the disposition). You made multiple attempts to seek out confidential patient information you were not entitled to know for someone that you were no longer caring for. The staff nurse may have gave you two passive opportunities including saying she has no opinion if you visited the patient and "not knowing" where the chart of a patient under her care was located. Your actions, as stated, were willful and deliberate. The charge nurse may not have been able to predict your actions and thought perhaps you were making a correction or placing something in the chart not satisfying personal curiosity. Once the charge nurse realized your actions she was ethically, morally and legally obligated to report you as the nurse leader present.

Some nurses are in awe at such willful and deliberate actions and don't think to actively warn colleagues. Based on your story I don't see this as "back stabbing" or conspiratorial.

You made a willful choice to breach protocol, do I think termination for a single offense was necessary (unless you had other undisclosed write ups)

[amoLucia]

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

A lot of guessing is going on here. Maybe some third party nearby witnessed the situation and questioned it? Also if the medical record were electronic, there may have been some built in auditing system?

Perhaps you may have inadvertently handed them a 'coffin nail' if there was anything in your HR record? If you were in any type of 'progressive discipliine, this could have been just the right leverage to take such a draconian step as termination.

Then of course, most places can fire 'at will' JUST BECAUSE.

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!!!

With all the HIPAA training done for staff today, it should have caused you to take a step back. You did cross that fine line.

Hope things work out for you as you move on.

[nmimcbu, BSN, RN]

It doesn't matter if there wasn't any public sharing of information, gossip, or conversations about the patient's status. HIPAA regulations aren't solely on those three factors. At the end of the day, you were no longer caring for the patient and even went so far as to actively seek out information that you only wanted for peace of mind.

Working in multiple specialties and even different medical professions, I have never once sought out a patient's chart unless I absolutely needed it for patient care. I also refuse to open any chart for any patient unless I am directly involved in their care. First and foremost, you have to protect yourself and your patient. It is frustrating that even though we really truly want to follow up, we just can't in these circumstances.

The other two employees should also have been more invested in telling you that it wasn't a good idea as well. This scenario is essentially a "Swiss Cheese Model of Errors" that should have been prevented by proper HIPAA training and understanding.

In the future, I hope that this was a learning experience and that you are able to help others in understanding the importance of HIPAA and patient confidentiality. I wish the best for you. Remember to always protect yourself and your patients.