My best friend is now a patient on the floor I work on

[EmergencyChocolate]

I am a nursing student and part time CNA, and my best friend is now a patient on the floor I work on - in fact I was initially assigned to her but had to refuse. I am confused on what I can and cannot know or do according to HIPAA. I know I can't look at her medical chart but if I happen to be working one day and I happen to overhear or notice something regarding her condition and her care (I.e she threw a tantrum, had a seizure, had a bladder scan done, or even just saying she's better or worse) )can I tell her family and friends about it? How would it be any different from a concerned visitor giving her family and friends an update when visiting for the day? What questions can I ask the staff regarding her care if anything?

To complicate matters - I can't ask my friends permission to share information because she is disoriented and unresponsive. I know the power of attorney but she is out of state. A friend also came to visit today so she knows I work on that floor and I'm not sure if she's told anyone that I work there and if so, they might be expecting me to give them updates while I'm there.

I asked the charge nurse and other experienced nurses about it but they were a bit stumped. Feedback is appreciated - I've been a bit distant because I'm not sure how involved I can get now - thanks.

[RN403, BSN, RN]

I would just keep my lips zipped. It is a tricky situation and if I were in your shoes I would just keep quiet about your friends condition. When asked about how she is doing I would simply state that you cannot discuss her care or condition at this time. Even as a visitor, I would still probably keep my lips zipped. You could slip up and spill information that you learned while on duty as a CNA/student on the floor and not what you learned as a visitor.

There is nothing wrong with visiting your best friend while off duty but when it comes to speaking about her care or condition with anyone I would personally lock my lips and throw the key right away. Tricky situation. Hoping for a speedy recovery for your friend. Best wishes.

[Here.I.Stand, BSN, RN]

You may hear incidental disclosures. You may ask only what you need to do to do your job. You may not discuss it outside of her care--outside the hospital with people who don't need to know.

[amoLucia]

My Dad had an old Army motto - "keep your eyes closed, your mouth shut, and never volunteer". Best to keep out of everything as much as you can. It's going to be tough for you as you personally care about your friend's well-being.

Might you want to consider a temporary reassignment to another unit while she's a pt on your unit?

Also, I believe each facility should have a designated HIPAA Compliance Officer, usually someone in HR. Ask for their advice as soon as poss to avoid any type of compromise.

Will send positive wishes for your friend and you.

[akulahawkRN, ADN, RN, EMT-P]

I like the suggestion of temporarily being reassigned to a different floor. If that's not possible, I would highly advise that you follow the practice of "what goes on in the hospital, stays in the hospital." If you absolutely must provide care, even if incidental, do only what you must... do NOT look at the chart unless you're required to for your job. Whatever you see/hear/overhear about your best friend, you must NOT repeat to ANYONE that does not have a need to know about the care provided. That includes the family, other friends, and so on.

I have seen on the floor (and provided care for) people that I know. I make sure that they know that I keep their information private. Once we're no longer in a patient-care provider relationship, I do not acknowledge that unless they bring it up. That way they're in full control of what's discussed and released.

[RschIVF40]

I agree that this is a very tricky situation when it comes to HIPAA and caring for friends. I'm assuming that your best friend was aware before her hospitalization that you are a nursing student, as well as where you work part-time as a CNA? Maybe, maybe not.

In my experience, unless you are "assigned" as her CNA / nursing student, (i.e. because there are no other available staff to cover your best friend on the unit), you would NOT be able to "check" / "follow-up" on her situation for any friends (or family members) as that would certainly be a HIPAA violation. The fact that you are her best friend is irregardless of the situation. Just makes the situation more emotionally challenging to deal with.

I would also NOT share any information with her friends, no matter how well you know them. If they continue to hound you with questions, I'd remind them that all medical information specific to patients if strictly confidential. I'd refer all family member to the attending physician and let your mutual friends know that they would need to follow up with her family. Unfortunately, no matter how well you know your friend or her family, when working in a medical situation, this may be challenging, you need to separate the person you know as "your best friend" outside your work, and start thinking of her and treating her just as you would any "patient".

If your supervisor or nurse manager requires that you cover this patient (your best fiend), because there are no other staff available to cover her, you then would have access to her personal medical information. You'd need to keep any and all of her information confidential and not discuss this information with anyone (just as you would do with any patient). Again, the only time that I've seen hospital staff (i.e. an RN) communicate information to the family regarding a patient, who may be "a friend / best friend" who is hospitalized is if that individual has been directly assigned to cover the patient by their supervisor or nurse manager. Communication with family members regarding a patient's condition may be accepted by student nurses / CNAs depending on your hospital's protocols. In the hospital I work in, this is done by either the registered nurse or the attending physician, as opposed to student nurse / CNA, however, your hospital may have a different protocol / policy regarding patient status communications with family members.

Again, if you are uncomfortable with any questions being directed toward you and/or if you are uncomfortable being asked to care for the patient (since she is your best friend), since confidential information would be disclosed to you, I would decline caring for this patient if at all possible. If not, and your best friend eventually finds out that you were assigned to care for her, (I can't tell from your post when she is conscious or not)...and your best friend gets upset (thinking that you were previ to "confidential" information that she doesn't want you to know, for example: perhaps her labs show something she is afraid of being disclosed to her family (like that you weren't even aware of)....just remind her that all medical information is extremely confidential and that it's not your place to discuss anything with her family (even though you are her best friend and very close with her family) And, just don't mention that you are aware regarding anything you think she may be embarrassed about (if she threw a tantrum, had a bladder scan, lab issue, etc. Just keep her care in the hospital as professional as possible. I would follow your hospital's standard protocols. Again, I would refer any questions from the family to the attending physician.

Hope this helps!

[Esme12, ASN, BSN, RN]

No you may NOT give updates....to ANYONE. You may not "ask" about her care other than what is necessary for you to do your job. You may not report to anyone about her condition. If they ask tell them they need to speak to the POA or the staff who care for her...you will lose your job and it is against the law.

I am sending positive thoughts for your friend recovery.

[EmergencyChocolate]

Thanks for the feedback - very helpful. But what about things I see/learn about when I'm off-duty (i.e she seems more responsive today, still has those tremors, seems a bit more hydrated than before)? If she needs help eating or walking to the commode am I allowed to help her as a friend or am I getting too involved in her care? Even though I'm an employee on the floor, I am a "visitor" for the day. Would HIPAA still apply then?

[imintrouble, BSN, RN]

Thanks for the feedback - very helpful. But what about things I see/learn about when I'm off-duty (i.e she seems more responsive today, still has those tremors, seems a bit more hydrated than before)? If she needs help eating or walking to the commode am I allowed to help her as a friend or am I getting too involved in her care? Even though I'm an employee on the floor, I am a "visitor" for the day. Would HIPAA still apply then?

You know it's a complication situation. You've received excellent advice. You can't provide anybody any information about your friend because of HIPAA. After all the above, you're still asking for a way to get around what you know you need to do.

Why take the chance? Why violate your friend's privacy? Why provide information to people who can simply show up as a visitor, and find out the same things as you?

[klone, MSN, RN]

Put it this way, how could you PROVE that the information you had and passed on to others was gleaned while as a visitor, vs while working. You could not. Therefore, keep your mouth shut, period.

[xoemmylouox, ASN, RN]

Put it this way, how could you PROVE that the information you had and passed on to others was gleaned while as a visitor, vs while working. You could not. Therefore, keep your mouth shut, period.

I agree 100%. Her friends and family should respect the fact that you are in a no win situation. Don't say a word about her at all. If someone asks you shouldn't even say which hospital or which floor she is on.

[T-Bird78]

NO. You're not a visitor, you were privy to the info by overhearing something while working in the facility.