New to USA and HIPAA..I know this is a violation, why did my NM not back me up?!

[uRNmyway, ASN, RN]

I am new working in America. While we are obviously bound by confidentiality rules in Canada, we do not have actual HIPAA rules.

To give a little explanation, I work for a home health agency. Some of my duties include doing home supervisory visits, and most recently, yearly CNA evaluations. As I was completing one on a CNA that was just...eh...not great, but not as bad as others I have seen, the patient asks about getting transportation for errands. I mention we should bring it up to her case manager, but maybe her CNA could do that for her if it is approved. The CNA then goes off, speaking about how she provides transportation care for (insert FULL other patient name here) and doesnt get paid for her gas. Then she starts speaking about other duties she performs for this patient, and others. She repeatedly uses full names. In front of our very lucid paraplegic young patient. Who is looking at me with a shocked expression on her face.

So I bring this up to my NM to determine course of action. And she tells me just to warn her and let it go. Now I might be new to the US and HIPAA policies and procedures, but I could swear she needs to be formally written up. However, since I am new, I tried to follow her advice, without completely caving. I called up the CNA to explain to her what HIPAA was, and how she broke the rules. She then goes off again, arguing that it was in no way a violation, that as far as the patient knew, she was making up names. Not only was this a ridiculous excuse because A) she was saying very clearly 'I take care of Miss Xyz and I take her to appointments and blabla' B) I happen to know VERY well that we do have a patient by that name, who receives these exact services. I then explain to her why her rant WAS a violation, to which she answers it wasnt, and pretty much hangs up on me.

I was so shocked, spoke to my bigger boss, and decided to send her a letter, copied into her employee file, with copy/pasted from our policies and procedures manual on HIPAA on exact reasons why she was in violation.

Throughout all this, I just kept wondering what in the world I got myself into. Staff who break the rules. Staff who let it slide. Ugh...

[orthonurse55]

Oh brother! You did the absolute completely correct thing! Home Health is a completely different entitiy than working in facitlity and the staff has to be trustworthy. I wondered as I read this if she would have been talking to her other patients about people she sees when you were not present? It is a definite HIPAA violation and also extremely unprofessional. She should be written up and/or fired. I can't beleive the first person you talked to didn't back you up.

Good luck working in the USA. Everyone is NOT like that - thank God!

[Esme12, ASN, BSN, RN]

Welcome to the US and AN!

Yes it's a violation. Yes the CNA needs to be written up AND re-educated. Anywhere else she probably would have been fired....if not at first then for insubordination when she argued with you about HIPAA. Your nurse manager? LAZY.

[nurse2033, MSN, RN]

Sounds like you "get it". Perhaps the culture at your agency is a bit loose with the rules, as evidenced by your NM's reaction. Good job.