HIPAA Violation - Should I Sign Written Warning & Re-training

[Nurse Beth, MSN]

Dear Nurse Beth,

I am a charge nurse with access to ED tracker check for possible patients which will come to my floor. Looked on a pt that ended up being a coworker at my hospital. Did not look at record, but shows I clicked on it. Now have to sign a paper saying I was retrained for I guess HIPAA or negligence. Should I sign the paper even though it was not intentional. I have an excellent record; do not want this to go against my employee record.

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Dear HIPAA violation,

Go ahead and sign the paper. A "refusal to sign" in your file will not help your case. Signing typically means you received the warning, not that you agree with it. (If you work in a union facility, check with your union rep).

You have no control as to whether this goes against your employee record or not. The paper (warning) will most likely be put in your your HR file, signed or unsigned.

It could be that you were lucky to get off with a written warning and re-training, because many facilities automatically terminate employees without warning due to anything that could be remotely construed as a HIPAA violation. It seems they do this to send a message to all employees. The fine assessed for HIPAA violations is very high.

In your example, is it against policy for a charge nurse responsible for the unit's admissions to review the chart for acuity, possible isolation, and so on? In other words, would this have been acceptable if the patient was not a co-worker? (if so, double standard). Are you expected to wait for a verbal report and not open the chart in this instance?

What was your reason for clicking on the chart if not to read it or get information? If you do not have a defensible reason to explain your actions, this may be why you landed in trouble.

The best way to protect yourself, your patients, and your facility is to clearly understand the policy. This information should be provided in Charge Nurse training. You should not be responsible for something you were never taught. It is not a violation to view a patient's record when it is needed for their treatment.

For example, in my role as an educator, it is not a HIPAA violation to use actual patient cases as case studies for the purposes of training. All personal patient identifiers must be removed. One example is when I teach new nurses to collect some tele strips as part of learning arrhythmia. All patient information is removed from the strip, but it may be used for training.

As far as having this on your record, it is one isolated incident in an otherwise excellent performance record. Not saying it doesn't hurt, but in the long run will not have much impact.

Best wishes,

Nurse Beth

[EdieBrous, BSN, MSN]

Not sure I agree with, "Not saying it doesn't hurt, but in the long run will not have much impact."Many employers report privacy violations to the nursing board regardless of what employment action they take against the employee. A nurse's license can be disciplined for professional misconduct with allegations of privacy violations.

[englishtrish]

I'm shocked that the writer is allowed to review the tracker to check for possible patients. Until the patient has been accepted as an admission to your floor, there is no need to be reviewing the chart. Surely there is a process in place to ensure appropriate admissions to appropriate units. At my facility the original posters actions are known as ED stalking and are always addressed by nursing leadership and the privacy officer as a privacy violation

[kbrn2002, ADN, RN]

I am not familiar with this ED tracker check so please correct me if I am wrong: If this co-worker was in that system as a potential patient how is clicking on that name any different than any other name which may be there as a possible patient to your floor? If this is the case I don't see the violation here.

If this co-workers name was not somehow flagged in this ED tracker as a potential patient to your floor however and you still clicked on the name it would be a violation as you have no business accessing the file if there is no possibility of the patient ending up admitted to your floor. Accidentally or not you still accessed the file and whether you actually read anything in it or not doesn't negate the fact that you opened it.

If the co-workers name was part of the group that were potential admissions for you to review then you should try to have the write up rescinded but if the co-worker was not in that group then I would say gracefully accept the write-up and retraining and just be happy the consequences for accessing that file aren't worse.

[Julius Seizure]

If you feel that you did nothing outside of your justifiable job duties, you could write a personal statement and request that it be placed in your file with the signed paper about re-training. Just be careful what you write in the personal statement - it must be all true and all above board, and if its not possible to write it that way, maybe you will need to reconsider if you really were above-board in your actions.