It's Driving Me Crazy

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The assignments at my job are never made in time to look up patients before the shift starts. Is it like this everywhere? I can't stand going in not feeling prepared.

On 11/19/2019 at 3:17 PM, FacultyRN said:

The previous poster who identifies this practice as a HIPAA violation is correct. You are not part of the care team 30 minutes before your shift begins; you're likely not even clocked in as a paid employee of your facility at that point. You do not have a need to know.

This is arguable or an unfortunate development at the least, and is mostly only an issue because people are only allowed to punch in a couple of minutes before taking their assignment, which is a completely separate issue (I don't personally know any other "professionals" who are forced to start their day in such a manner but I guess that's beside the point). The spirit and intent of HIPAA wasn't to criminalize people who prepared for their day in this manner immediately prior to taking legal responsibility for the patients. To say there is no legitimate, care-related interest in the information in question is a somewhat disingenuous twist.

The practice of getting basic info down before report may be outdated, it may not be the preference of the majority, and/or it may be less than ideal for other reasons, but those things are very different from saying this issue has anything to do with the spirit of HIPAA.

Having a very good handle on things prior to taking legal responsibility is something that has stopped now due to regulation and business preferences. Lots of people say they don't need to know anything because they can look it up. Whether they do or not is another matter entirely. It seems like a good deal of the time they don't. ??‍♀️

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Well, when I was a bedside nurse the assignments are usually up 30 mins before shift change and this was Med-Surg, ER, and ICU. When I was starting out, I would come early, get my assignment and try to get report from the nurse early. After giving me report, that nurse can hang around and finish some of the left over work but I can start looking up my patient's data. These were hospitals where we never punched in and out and hours are based on an honor system.

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52 minutes ago, JKL33 said:

This is arguable or an unfortunate development at the least, and is mostly only an issue because people are only allowed to punch in a couple of minutes before taking their assignment, which is a completely separate issue (I don't personally know any other "professionals" who are forced to start their day in such a manner but I guess that's beside the point). The spirit and intent of HIPAA wasn't to criminalize people who prepared for their day in this manner immediately prior to taking legal responsibility for the patients. To say there is no legitimate, care-related interest in the information in question is a somewhat disingenuous twist.

The practice of getting basic info down before report may be outdated, it may not be the preference of the majority, and/or it may be less than ideal for other reasons, but those things are very different from saying this issue has anything to do with the spirit of HIPAA.

Having a very good handle on things prior to taking legal responsibility is something that has stopped now due to regulation and business preferences. Lots of people say they don't need to know anything because they can look it up. Whether they do or not is another matter entirely. It seems like a good deal of the time they don't. ??‍♀️

I'm not arguing with you that this kind of scenario was not the intent of HIPAA. (Well, nor arguing with you at all, for that matter!) I agree with you that it's only an issue because of petty clocking policies.

However, as someone who teaches health law, with a heavy emphasis on HIPAA, it is ultimately a breach. Other than the weight of the associated fines, HIPAA doesn't include exemptions for breaches/violations that occur with good intentions.

A nurse who has not started her shift is not a member of the patient's care team and has no need to know at *that time.* I'm not saying that is reasonable - just the reality of the law. It's no different than how a nurse who has completed her shift can't look up the patient's chart out of curiosity/genuine concern to see how the patient is doing.

It's not really a gray area. Under the mimimim necessary standard, a lay person with no current role in the patient's care (including an RN who is not clocked in to his or her job) has no "need to know." Does it make sense to learn about patients ahead of time without the shift change rush? Yep. But is it a legally acceptable practice? No.

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5 minutes ago, FacultyRN said:

I'm not arguing with you that this kind of scenario was not the intent of HIPAA. (Well, nor arguing with you at all, for that matter!) I agree with you that it's only an issue because of petty clocking policies.

However, as someone who teaches health law, with a heavy emphasis on HIPAA, it is ultimately a breach. Other than the weight of the associated fines, HIPAA doesn't include exemptions for breaches/violations that occur with good intentions.

A nurse who has not started her shift is not a member of the patient's care team and has no need to know at *that time.* I'm not saying that is reasonable - just the reality of the law. It's no different than how a nurse who has completed her shift can't look up the patient's chart out of curiosity/genuine concern to see how the patient is doing.

It's not really a gray area. Under the mimimim necessary standard, a lay person with no current role in the patient's care (including an RN who is not clocked in to his or her job) has no "need to know." Does it make sense to learn about patients ahead of time without the shift change rush? Yep. But is it a legally acceptable practice? No.

I am sorry if it sounded like I was arguing your personal understanding of the issue; I can see how it did. In particular, I wrote, "To say there is no legitimate, care-related interest in the information in question is a somewhat disingenuous twist" - and I did not mean you personally, but rather meant that technicalities may make things so (according to the law) but it's still sort of disingenuous. The only reason that there is not a plausible, legal "need to know" in the particular example we are discussing is because of an unrelated technicality. A similar unfortunate example is the lack of ability to review recent cases with orientees for educational purposes, because of this same rationale.

I am saying that the law may make things so, but in some instances the results are irrational and unfortunate, and this is one such scenario. I can't imagine how this has benefitted (or protected) one single patient.

You don't need to qualify yourself; you're not informing me of anything. I didn't inform readers that your interpretation is wrong for a reason. I am simply saying that I believe this development is unfortunate; that is all.

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Additionally, it is necessary to advise that people follow the technicalities of the law. But it is not necessary to speak of some of these applications as if each individual application is beneficial; one is allowed to have hope that someday we might come up with even better privacy solutions that actually help patients without unnecessarily burdening them and those who care for them.

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Can't disagree with you there!!

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Specializes in Critical Care.
On 11/19/2019 at 12:17 PM, FacultyRN said:

The previous poster who identifies this practice as a HIPAA violation is correct. You are not part of the care team 30 minutes before your shift begins; you're likely not even clocked in as a paid employee of your facility at that point. You do not have a need to know. And yes, it's common for assignments to be created, or changed, right up through shift change because patient acuity, admissions and discharge information, etc. is always evolving. Make yourself a helpful report sheet; learn to ask pertinent questions. (This does not include "When are her next meds due?" - Time management for your shift is your responsibility, not the outgoing nurse's.) Once you get report, do a speed scan of each chart for 2 minutes - allergies, medical history, scheduled procedures, labs - to make sure you have all key info correct. Write down times for scheduled meds on your report sheet. Go from there! It will get easier with practice.

It's a popular myth, but it's not actually a HIPAA violation to look up your patients prior the start of your shift, so long as the information your accessing are for the purpose of preparing to provide care to the patient, it makes no difference if that access occurred at 6:45 or 7:15 since the purpose of accessing the information isn't different based on the time.

There are potential labor law issues, as well as insurance coverage issues (in the event you were to injure yourself while looking up patients), but it is not a HIPAA violation.

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Specializes in Geriatrics, Dialysis.

While I can fully understand the desire to prepare for a shift by looking up patient information beforehand what I can't wrap my head around is why so many nurses are willing and even eager to do this on their own time. My employer doesn't pay me enough while I am working, no way am I doing anything work related off the clock! Not to mention the risks of "working off the clock" which this is, some employers of the more unscrupulous kind encourage working off the clock to finish charting but decent employers are pretty strict about not allowing this.

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I am not convinced this is a HIPPA violation.

Anybody know of a case in which a nurse came in early to be prepared for a shift by reading H&Ps, but was sanctioned for a HIPPA violation>

If a doctor is on the way to the ER, and I call her to let her know Billie Bob is in respiratory distress, and I think she'll be intubating, are we in violation?

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Not a HIPAA violation because it's not codified, but the insurance or whatever can get you in a lot of trouble.

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On 11/28/2019 at 3:47 AM, hherrn said:

I am not convinced this is a HIPPA violation.

Anybody know of a case in which a nurse came in early to be prepared for a shift by reading H&Ps, but was sanctioned for a HIPPA violation>

If a doctor is on the way to the ER, and I call her to let her know Billie Bob is in respiratory distress, and I think she'll be intubating, are we in violation?

I think the real problem in terms of a HIPAA violation would come if for some reason the assignment was changed immediately prior to the shift start, resulting in the OP looking at charts for patients ultimately not assigned to them.

There was a post about a critical care unit RN who was looking up an ER patient as they had been advised that they were next up for an admission and wanted to be ready. Not unreasonable for an unstable ER patient who will probably be coming at very short notice.

Sadly the patient died in the ER. Chart was audited and Unit RN was flagged and fired for a HIPAA violation. Grossly unfair in my opinion and completely ignores her intent, which was to be ready to provide quality care not to invade someone's privacy.

I feel this is a situation that could very easily (although unfairly) cause a lot of problems for a well intended nurse. The reality is a lot of us couldn't afford to hire a lawyer to defend ourselves against unfair interpretations of the HIPAA laws, but the hospitals/ BON sure can.

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