Kicked out of class for a "HIPAA" violation?

[Trip_McNeelyRN2b]

Hello, I am a Senior nursing student and I was kicked out of clinicals and made to repeat the course for a few issues that happened during the day. I would be lying if I said I wasn't as prepared as I should of been that day, but I believe what happened to me was incredibly unjust. I am accused of violating HIPAA because I let another student into my patients room to look at her ventilator. As students, we are always trying to learn and he has never seen a ventilator before. I thought this was a good opportunity to learn, so I asked my nurse BEFORE we entered the patient room if it was okay for him to enter my patients room and look at her ventilator, in which the nurse said it was fine to do. A few days later, I get an email telling me not to go to clinicals and meet with my supervision. They were also appalled that I had to ask my nurse one of the medications were that we were hanging, and I also accidentally withdrew 30 iu's instead of 3 iu's of insulin AT the med station, in which the nurse saw and said that was way too much, in which I agreed with, apologized, and moved on.

The nurse reported me to her supervisors, which then contacted my school and were absolutely disgusted with my performance. When I met with my supervision, they completely sided with the hospital and were cared more about the school's image and less about my side of the story. If another student entering my patients room with permission from the nurse was a HIPAA violation, shouldn't the nurse be punished as well because she was the one who gave me permission to do so? That being said, I was removed from the course, 7 months away from graduation and had to sit out nearly 4 months before I could retake the class and pushes my graduation date back. Is this a legitimate case of a HIPAA violation?

HIPAA Violation Examples

[video=youtube_share;-Sgj9xuPr1A]

[Christina_RNBSN]

I'm sorry that this happened to you, but I don't think that it was unfair. In the hospital, the Insulin issue would be known as a "near miss." Many hospitals still consider this a medical error, even though it did not reach the patient. In our hospital, we would technically still have to complete an incident report as RNs. My guess is that this was the main reason why you had to sit out the class, and the other issues were whatever the precepting RN happened to have reported to your school. Almost giving 30 units of insulin instead of 3 could have killed the patient. If the school or agency RN feel that any part of your student practice is unsafe, they have the right to inflict whatever penalties are outlined in their handbook, and make sure that the next time they let you practice you are safe to do so. They have to go by the "what if" or "almost happened" because if they waited until the patient was actually harmed to inflict a penalty on a student then it would be too little too late. The general rule for HIPPA violations is that the patient or legal proxy have the ultimate say on what can and can't be involved in their care. If you are ever in a situation where you need to consult another RN, student, or practitioner who is not already involved in the patient's direct care, just pop in and ask the patient if it is ok. For example, sometimes I feel better if a second set of eyes looks at a particular situation involving one of my patients. It takes two seconds to ask something like, "Mrs. Smith would it be OK if another nurse on this floor came and took a look at your IV with me?"

Pharmacology was definitely NOT my best subject in Nursing school. Truthfully, you may not remember much of the information on many meds even after graduating. That being said, you should always research why your patient is getting a medication and what it will do for the patient if you don't already know. In your career as a nurse, an MD may write an order and you discover that it is totally bizarre. For example, a patient who came in with low blood pressure who is ordered a strong dose of a powerful narcotic. YOU will be responsible if that patient takes a turn for the worst, and legally, you are in just as much trouble as that MD because you gave it. You really do have to have a sound reason to back up why you do EVERYTHING in nursing. The way that I practiced this was to explain to all of my patients what each med was for when I gave it. Like " Mr. P, this is Labetolol, the pill for your high blood pressure." This way, I got into the habit of remembering why I was giving it and what it did, and the patient could ask any questions about it. I wouldn't waste any time researching that HIPPA issue in too much detail, because even if that never happened, they could have totally made you sit out for the insulin issues alone. Just make sure to really step it up for next time so that they have nothing to say about your flawless student practice.

[Esme12, ASN, BSN, RN]

The fact of the matter is I always double check my insulin with my nurse prior to administration. The fact that she caught it at the med station before I was able to is what I am getting in trouble for. In reality, we are still talking about a hypothetical situation any way you slice it.

In reality...this is NOT hypothetical.....this REALLY happened.

This is considered a "near miss" and is reportable. The Joint Commission calls this a Sentinel event. http://www.jointcommission.org/assets/1/6/2011_CAMOBS_SE.pdf ....and a BIG DEAL for facilities. It it likely that the nurse at the bedside was unaware of the seriousness of this "hypothetical" situation and when her manager heard of the incident...the proverbial feces hit the fan.

The anatomy of a near miss

A near miss implies that a catastrophic event (sentinel event in JCAHO terms) has nearly occurred. A “near miss” is actually a poor name – a “near hit” would be better. Alternatively, a “good catch” could be used since a catastrophic event has been prevented. However, near miss is universally understood and will be used here.

In the IFTF manual a near miss is shown as a cascade of events whereby a sentinel event has been prevented due to a detection and recovery sequence. In the figure below, if either detection or recovery fail, the sentinel event (the next event = event B in this cascade) occurs. Thus, detection and recovery play a key role in a near miss. The sentinel event is also the effect of the prior event.

Figure 1

Error event Cascade

Are you sure the nurse wasn't reprimanded? This is one of the reasons nurses are reticent to take on students with their full load of patients. This should have been reported to your instructor immediately and addressed right then and there....evaluating what went wrong with corrective actions discussed.

You have much to learn about nursing and the whole process involved.

Quote from RCiantar: but this is a first offense and there is no pattern of malicious behavior at any facility

This can be perceived as A caviler, and possibly a reckless statement.....

Quote from RCiantar: I have almost 3 years of clinical experience, administering many units of insulin within that time frame.

You don't have clinical experience....you have classroom time.

I KNOW that this isn't what you want to hear......This is what is concerning your school. You need to develop your ability to see responsibility and fault in your actions. FEAR....FEAR of making a mistake, FEAR of hurting someone, FEAR of being wrong.....FEAR that you might not be perfect enough is what keeps your patients safe. I double checked EVERY insulin syringe I filled for 35 years. I double checked all calculations for 35 years. I looked up EVERY drug I didn't know for 35 years before I gave it. I am a very good nurse....some have said I am the smartest nurse they have ever met (clearly they lead sheltered lives) but I am always hyper vigilant to the point I annoy myself.

Some people call me anal retentive or obsessive compulsive.....but it has saved my behind many times especially when you add in surrounding chaos and distractions. I call it humility in realizing I am not perfect and I don't know everything.... but my patients expect me to be without flaw. It's my responsibility to fulfill their expectations. Have I ever made mistake....heavens yes! But I owned them.... immediately.

It's what makes me a good nurse.

This is a real ever present danger for nurses. Even one mistake can ruin many lives....even if it is your first one......Sad story for all nurses -l

nurse's suicide highlights twin tragedies of medical errors

Kimberly Hiatt killed herself after overdosing a baby, revealing the anguish of caregivers who make mistake

photo courtesy Lyn hiatt Kimberly hiatt, a longtime critical care nurse at Seattle children's hospital, committed suicide in April, seven months after accidentally overdosing a fragile baby.

This is not the schools fault for the way they handled it. This is not the nurses fault for handing you the wrong syringe. This is not really about the supposed HIPAA violation and the vent for there is always an educational exclusion....unless of course your discussed patient specifics with your fellow student and the son complained. It's not about who's side the school was on....because after all you made the mistake.

It's about not recognizing the "wrong syringe" was given to you...however both and 3 and 30 insulin syringes have 30 clearly marked and there is a huge difference between 3 and 30.

It's about identifying what went wrong, taking responsibility for your actions, evaluating the situation, recognizing you have a lot to learn, and looking for ways to make yourself a better nurse.

Do I think the vent incident is HIPAA? No...but that is not what the real issue is.

Article: The answer: Is this a HIPAA violation? - HIPAA and Nursing ...

Stop placing blame or pointing the responsibility elsewhere.....own it, learn from in, become a better nurse.

[springchick1, ADN, RN]

I don't think this really has anything to do with HIPAA. We don't do preclinicals on our patient. We come in that day, get report and the do VS and assessment. We DO NOT give meds if we do t know what they are. Period. If it has to be given stat answer e don't know what it is and we'd not have time to look it up, we don't give it. We let the nurse do it. We can go with them and ask them questions about it, but under no circumstances are we allowed to give it.

At the hospital where I work, an incident report would have to be filled out over the insulin situation. It IS a med error even though it was caught at the nurses station. And would you have checked it again at the bedside? Two med issues in one day would result in us getting dismissed from the program. Have you had any other issues on any other days? Three Us over the course of clinicals for us results in removal from the program. So did you have any issues on ither days?

My concern is the lack of responsibility that you are taking. "The nurse handed me the wrong syringe". "I didn't have time to look up that med". That isn't going to hold up in a court of law if you get sued for harming a patient.

[tuxedopenguino]

RCiantar,

Thank you for sharing your situation. I have learned a lot from your post and everyone's responses. I'm sorry to hear you have to repeat the semester, I wish you the best of luck! I'm sure you will do your best!

[proud nurse, BSN, RN]

When you're in clinicals, you must do everything by the book. Don't do anything without running it by your instructor. Chances are the nurse you're working with doesn't know the policies of the school, and you do not want to be at the mercy of her going to bat for you as a student. She will not put her career on the line to stick her neck out for you.

The insulin situation has been beaten to death, and there's nothing more I can add to what everyone else has said.

Sitting out of clinical for a semester isn't just what you feel as punishment. It really is time to reflect on how to be a better student, and on to a better nurse. If you would've been allowed to continue, you'd probably be nervous and lack confidence knowing in the back of your mind that you're being watched like a hawk and under the microscope. Maybe even some of the nurses would think of you as unsafe and not want to precept you. You never know. In the long run, I think this will make you a more cautious nurse and come back next semester better than ever. Use the time wisely!

[Benedina]

Telling the OP that it has nothing to do with HIPAA when her school IS telling her it is concerned with HIPAA strikes me as unhelpful.

Telling the OP that she did, in fact, commit a HIPAA violation strikes me as unhelpful.

I wouldn't presume to know what the OP thinks, feels, and intends with respect to the insulin error. Since the OP has gotten more than enough advice about that situation, I'm going to limit my response to the HIPAA issue.

OP: nothing in your account suggests a HIPAA violation except (to me) one small detail: don't ask your precepting nurse but your clinical supervisor for permission. He or she is the one to make the clinical decision about whether or not it's appropriate. In my clinical rotations, set in teaching hospitals, permission would almost certainly have been given--but the clinical supervisor would have set it up. In fact, he or she would have gone to the patient herself, asked permission to bring in a gang of us, and then done so. We discussed, without identifying information, EVERY patient each of us had at clinical conference. That's what clinical conferences were for.

However, in my opinion, either your clinical supervisor should have spelled this out before clinicals or your precepting nurse should have answered, "I really don't know if it's okay or not with your supervisor. Ask her/him." Students are expected to ask, but you did ask. I think you should have received a different answer, but I think you acted responsibly with the answer you got.

To other posters: student observation of patients not directly assigned to them is fully covered by HIPAA. Some examples of policy from assorted institutions:

Observers in the clinical setting

On occasion, observers may be present in the clinic, operating room, or other patient care areas. These individuals must first sign a HIPAA compliant Confidentiality Agreement.

From the University of Chicago Medical Center:

...physicians and staff can use PHI, without a patient's written authorization, to teach medical residents, medical students, nursing students, and other clinical students or trainees, subject to the following guidelines:

1. The Use and Disclosure Must Be Internal: The PHI must stay within the UCMC (Medical Center and BSD)
   
   • It can not be shared outside the UCMC (including to students, faculty, and staff of non-BSD parts of the University of Chicago), at professional meetings, conferences and lectures, and for non-UCMC courses, etc.
     

1. Minimal Information: The amount of PHI used must be the minimum amount necessary to conduct the training.
   

And so on.

I think the best advice you received, OP, was to "double down," as it were, with this second chance.

From the heart: best of luck to you in surmounting this difficult challenge.

Dina

[Ruby Vee, BSN]

I never once said it was "no biggie" that the nurse caught it after I pulled the needle out of the vial. You need to stop putting words in my mouth and assuming how I feel or reacted. I told you that I felt horrible for what I did but I always double check my insulin with the nurse BEFORE I administer it to the patient. She just happen to catch the error at the med station. If we are going to talk about hypothetically administering 30 iu's to the patient, than we must hypothetically consider that I would of caught it bed side before administration. I feel that this situation was poorly handled by my school's end and so do other of my nursing friends who have been in the practice for quite some time. I don't feel like I am immune from the situation, but this is a first offense and there is no pattern of malicious behavior at any facility I have ever been to in almost 3 years of clinical experience, administering many units of insulin within that time frame. Stop assuming I don't care, you don't know me, don't pretend like you do.

You're right. I don't know you. I'm assuming your first thought was for yourself because you never expressed any concern at all for the patient you might have killed until someone called you on it. Then you said "I felt horrible about what I did." You've said that a couple of times now, but you haven't elaborated upon that nearly as much as you've elaborated upon how unfair the whole situation is to you. You haven't indicated that you understand that 30 units of insulin could have KILLED her, or worse, just made her a vegetable. From your lack of expression of concern for the patient, I concluded that you didn't care about the patient. And nothing you've said in your subsequent posts leads me to believe that you actually do care. Nor does anything you've said convince me that you understand the enormity of your errors or the potential consequences.

[Ruby Vee, BSN]

I still see no concern for the patient you nearly killed. From what I know of you by reading your posts on the internet, your psyche will be just fine.

We all make mistakes. ALL of us. What matters is what we do after we make the mistake. A good nurse will set about mitigating the damage to the patient immediately -- telling the doctor, the charge nurse, the preceptor, the manager, drawing appropriate labs, giving appropriate meds. etc. A good nurse is horrified at the harm or potential harm to the patient and THAT's where the focus is. Even after pages of posts telling you about the enormity of the error, you still don't get it, and I've seen very little concern expressed for the patient.

Until you understand the enormity of your errors (and there were several) and focus on what you could have done to some innocent person under your care, you aren't ready to be a nurse. I know I'm going to be accused of being harsh, but I don't think you'll understand it soft pedaled, and I have reservations about you understanding it at all.

[Trip_McNeelyRN2b]

I still see no concern for the patient you nearly killed. From what I know of you by reading your posts on the internet, your psyche will be just fine.

We all make mistakes. ALL of us. What matters is what we do after we make the mistake. A good nurse will set about mitigating the damage to the patient immediately -- telling the doctor, the charge nurse, the preceptor, the manager, drawing appropriate labs, giving appropriate meds. etc. A good nurse is horrified at the harm or potential harm to the patient and THAT's where the focus is. Even after pages of posts telling you about the enormity of the error, you still don't get it, and I've seen very little concern expressed for the patient.

Until you understand the enormity of your errors (and there were several) and focus on what you could have done to some innocent person under your care, you aren't ready to be a nurse. I know I'm going to be accused of being harsh, but I don't think you'll understand it soft pedaled, and I have reservations about you understanding it at all.

Yes because the internet is a very solid medium for detecting someone's true emotion. That is asinine to presume that I felt no remorse over the insulin mishap, but whatever, I am tired of explaining myself to you because you seem to be dead set on believing that I don't care or have remorse or that it didn't really affect me. Your first response to me was negative and you started critiquing my grammar.

[Ruby Vee, BSN]

Yes because the internet is a very solid medium for detecting someone's true emotion. That is asinine to presume that I felt no remorse over the insulin mishap, but whatever, I am tired of explaining myself to you because you seem to be dead set on believing that I don't care or have remorse or that it didn't really affect me.

If someone's first concern were for the patient, it seems they would at least MENTION that in their original posts. But you're right, I cannot detect true emotion over the internet. You have not yet expressed an understanding of the enormity of the insulin error or any remorse for what you might have done to that patient, but I could be wrong in concluding you don't actually understand or feel remorse. I'm concerned in that you seem more focused on the effect your error had on YOU than on the patient.

My last bit of advice for you, and I hope others will tell you that I'm right -- when you're being counseled for a medication error or near miss, what your supervisor is looking for is: 1) an indication that you fully comprehend the potential consequences to the patient, 2) an indication that your primary concern is for that patient, 3) an indication that you're genuinely sorry about putting that patient at risk, 4) acceptance of your responsibility for the error without excuses and 5) an indication from you that you've thought about what led you to make the error and a plan for preventing it from happening again.

Good luck with your semester off and I hope you go back to school with a better attitude and excell in your clinicals.

[Esme12, ASN, BSN, RN]

MODERATOR NOTE:

We need to be respectful of each other in our responses. We can disagree without being disagreeable

[OCNRN63, RN]

Hey zeus&lincoln, thanks for the response. My entire cohort had no clue that allowing another student into the patients room for educational purposes was a HIPAA violation. It was never relayed to us as students that this was an issue, and we were all caught of guard when I got nailed for it, not an excuse, but I think my school or similar agencies should of done a better job at relaying all facets of HIPAA violations to us as students, who are in a learning environment and don't have the experience as other nurses do. Pertaining to the insulin, It was caught at the med station and never made it into the patients room. I always double check with the nurse pertaining to insulin right before I administer it. Relating to the medication we were hanging, after report she immediately went into the patients room to start hanging meds so I didn't have time to prepare and research the medications. So I asked her what a particular medication was that she was hanging (even though I had a good idea what it was used for, I wasn't 100% sure). Had I had at least 30 minutes to prepare before we started hanging meds, I would of had enough time to research what medications my patients were on, but this was accomplished immediately after report and they had a huge issue that I didn't know what the medication was. My school's supervision said that I should of sat out and told her "no", that I needed to sit there and research the meds first, but I was merely trying to learn and be involved, tagging closely to my nurse. I have had zero disciplinary issues at my school and have had a plethora of clinicals under my belt, well into my senior year. I never denied that I made mistakes, but I feel that I was unjustly punished for a 1st time offender.

You're fortunate you were allowed to return to the program. Had you done those things in your senior year at my programs, you would have been expelled--no possibility of coming back, ever. Instead of complaining, you should be thanking your lucky stars they let you return.

In real life, you don't get 30 minutes to research a med. You look it up and learn what you need to know quickly. In real life, you need to know what meds your patients, yes, patients, are on.

Your "plethora" of clinicals matters not one whit; your classmates have had the same clinical rotations as you have. It's not impressive to say you have had no disciplinary issues...that should be expected.

​These are serious issues. It seems like you fail to grasp that, and you're making a lot of excuses. You need to smarten up and learn from this. The next time there might not be someone around to catch you when you fall.