HIV in LTC

explorer · May 17, 2005

Hi, I have been lurking here for some time now and have decided to jump in. I am an LPN and work in a sub-acute/ltc facility. I really enjoy my work and very rarely do i ever disagree with my DON on an issue. Except for this...New admit over the weekend who is hiv pos.(I have no problems there). The nurses were told by DON under no circumstances are we to tell our cna's that this pt. is hiv pos. I have a real problem with that. i feel they have a right to know, especially because they are direct care providers. Our DON feels that our cna's may refuse to care for this pt. i think that is a bunch of crap. She hired these cna's on their ability and integrity, and she is not giving them the benifit of the doubt. To keep a secret like this is crazy. It will eventually leak out and then the sh** will hit the fan!! :angryfire I hate not being honest with my cna's, I have such respect for their work and dedication to their jobs.
What is everyones opinion on this issue. I am really angry at my DON, and am at a loss. Any help would be greatly apreciated.

I think that the CNA's have a right to know what they are working with. You

wouldn't try to hide it if the person had TB.

:balloons:

CHATSDALE · May 17, 2005

we have several hiv+ residents...the cnas all know who is what..but several [read many] of the other residents are promiscuous are being exposed...these residents many to not have the capacity to make an informed consent and the family members i am sure are not being informed of the risk

really makes me uneasy

Chad_KY_SRNA · May 17, 2005

I am not sure of the legalities but I am pretty sure you can't tell the CNAs. However if they happen to be looking in the charts and find that particular note or lab slip you can't really stop them from knowing. A few CNA's will be weird about providing care to HIV+ residents most will be their wonderful selves. I would want to know because sometimes there are blood and body fluid spills and with HIV they need to be taken a little more seriously. In a perfect world all of us CNAs wear gloves for every resident contact but this isn't perfect. I'll admit I don't always wear gloves (very very rarely).

Bird2 · May 17, 2005

I am not sure of the legalities but I am pretty sure you can't tell the CNAs. However if they happen to be looking in the charts and find that particular note or lab slip you can't really stop them from knowing. A few CNA's will be weird about providing care to HIV+ residents most will be their wonderful selves. I would want to know because sometimes there are blood and body fluid spills and with HIV they need to be taken a little more seriously. In a perfect world all of us CNAs wear gloves for every resident contact but this isn't perfect. I'll admit I don't always wear gloves (very very rarely).

I believe that it would be a HIPPA violation. The staff just need to know what type of precautions are needed but not the diagnosis. Since OSHA requires Bloodborne Pathogen in-services and HIPPA is also a requirement every one should hopefully be on the same page.

stidget99 · May 17, 2005

The HIPPA laws are based on a "need-to-know" basis. In the health care field, I strongly believe that knowing a person's +HIV/hepatitis status is definitely one of those "need-to-know" issues. I would definitely take issue w/ the DON for not properly informing the CNA staff of this very necessary piece of information. If the shoe were on the other foot (i.e. nurses are not told of a pt w/ a +HIV status), I would be terribly terribly angry. I think withholding the information could possibly have legal implications for the facility.

Bird2 · May 17, 2005

Do you have a HIPPA Compliance Officer in your building/Company that you can ask? I also would want to know but I have always been told, whether right or wrong, that Doctors do not have to document that the pt is HIV. This is why standard precautions must be followed.

NJLPN · May 17, 2005

Thank you all for your replies!! I have decided to voice my concerns to my DON and deal with the conscequences. I don't feel telling the cna's is a HIPPA violation because of their direct care. i also faliled to mention that the pts. hiv status is not to be in her chart. It isn't listed anywhere, except for transfer and MD reports from the hospital. Which will be taken out of the chart after MD officially admits pt. to the facility. So it will be possible that some nurses won't know.(per diem,agency)

nckdl · May 17, 2005

Because of hippa we aren't supposed to tell the cna's if a pt has mrsa or c-diff either. We only tell them to make sure to use universal precautions. Of course they usually guess what they have, when we have the gowns outside the pt's room. In nursing school, our teacher told us we would not know if our pt is Hiv positive but told us to look for certain medications to clue you in on the status. Too bad I can't for the life of me remember what those drugs were!! I guess i should look back in my piles of papers in the closet. :rolleyes:

UM Review RN, ASN, RN · May 17, 2005

Because of hippa we aren't supposed to tell the cna's if a pt has mrsa or c-diff either. We only tell them to make sure to use universal precautions. Of course they usually guess what they have, when we have the gowns outside the pt's room. In nursing school, our teacher told us we would not know if our pt is Hiv positive but told us to look for certain medications to clue you in on the status. Too bad I can't for the life of me remember what those drugs were!! I guess i should look back in my piles of papers in the closet.

You can't tell a direct caregiver? I would want them to know because not all potential exposures are reported by CNAs.

CoffeeRTC, BSN, RN · May 17, 2005

Okay....what will they be doing different if they knew? We teach all of our CNAs to treat everyone as if they had AIDs, MRSA, CDIFF, etc.

I'm not sure what I would do.

Inservice is deffinatly warrented for all caregivers, tho.

Chad_KY_SRNA · May 17, 2005

Don't even get me started on how much I love HIPPA. But I have worked with older CNAs who don't ever wear gloves because "these old people don't have anything". I don't know how many times I have heard that but if I had a nickel... In theory aren't you (not your DON) liable for concealing this from them if they get HIV due to patient contact and you didn't make them aware this patient had an infectious disease such as HIV. I know that I take extra precautions with residents that I know have a contagious disease.