Non productive overtime

[Minn_RN]

Recently our hospital HR/ leadership team made an announcement declaring that nurses are only to be accessing charts when punched in. Personally to me this is a non issue because I show up literally minutes before punching in, however there are nurses who I work with that get there early (sometimes even an hour early).

* Just curious if any other hospital has this policy?

* If there is a legal issue associated with accessing charts of assigned patients when not punched in?

* What can I do to support my peers who have the desire to access patients charts early?

Thank you all!

[JKL33]

I work mostly with what we label ourselves type Z. We keep it chill and relaxed unless it really matters and then it goes into type A mode.

I have made significant progress to the point that I feel like I could describe myself that way now. The ED tends to cure one of the more toxic/die-hard Type A stuff pretty quickly.

Thanks for the reply.

[JKL33]

....okay, almost. I can almost describe myself that way. :)

[neonn965]

No/wrong.

Aside from being punched in or not punched in, that activity is not a HIPAA violation. It only ever "became" one d/t people with altered intellect being given the role of privacy officer, or fake rules made up to scare and control employees.

Do you have anything to support this? It is 100% definitely illegal in my state to come in off the clock and read through patient charts that I am not caring for.

[JKL33]

Think about this scenario. If a nurse comes in early and starts looking at charts based on what the assignments might be, and then before that nurse's shift begins something occurs where the charge nurse needs to change the patient assignments and that nurse is no longer going to be assigned to those patients, then looking through those charts was a HIPAA violation

No/wrong.

Aside from being punched in or not punched in, that activity is not a HIPAA violation. It only ever "became" one d/t people with altered intellect being given the role of privacy officer, or fake rules made up to scare and control employees.

Do you have anything to support this? It is 100% definitely illegal in my state to come in off the clock and read through patient charts that I am not caring for.

My original post (#4) on this would be in agreement with what you're saying about not being punched in and looking at charts - it's no longer acceptable because then there are a bunch of people recorded as accessing charts when they're officially not even on duty (even though a good argument could be made for an immediately-anticipated "need to know").

But to that idea you attached an example about "what happens if you end up not taking care of a patient whose chart you have looked through in anticipation of taking care of the patient" - which is something that happens not infrequently even when all involved parties are punched in. For example, you get report on an ED patient (admission) look through the chart while getting report, etc, and then the patient goes to a different unit. Or something changes and the admission needs to be assigned to a different nurse. Your post implied that the HIPAA violation in your example was a violation (or a worse violation) because they ended up not taking care of the patients whose charts they had reviewed.

I just wanted to isolate the idea of being in charts when not on the clock from the separate act of retrieving or receiving patient information in immediate anticipation of taking care of the patient. That latter thing is more a matter of the hospital conducting business and exchanging information for a permitted-use reason (patient treatment), and not a HIPAA violation. That is an exact example of the things privacy officers love to cause trouble over - - it "sounds like" something that could be wrong if you really twist things just the right way, and the next thing you know they declare it "something [you] probably shouldn't be doing" or should "find a different way that doesn't involve getting information you don't need [right that milli-instant]." This guessing and blowing things out of proportion amounts to random acts of obstruction of patient care and it leads to infinite other negativity that results when people don't know what they can and can't do and are afraid of being made an example over some simple thing like taking report.

Meanwhile, HIPAA's actual allowances would probably surprise a lot of people (here's an example). Things like an office no longer being able to have a sign-in sheet and "all conversations that anyone could overhear [such as nursing report or basic conversation with a patient in a semi-private room] are HIPAA violations" are other things that are simply not correct. It's worth reading about permitted uses/disclosures (for example, those that are for treatment of a patient), incidental disclosures, minimum necessary (and how it applies), and the like.

[Flatline, BSN, RN]

Do you have anything to support this? It is 100% definitely illegal in my state to come in off the clock and read through patient charts that I am not caring for.

No offense but have you actually read the Health Insurance Portability and Accountability Act of 1996 along with it's pertinent amendments? If not, I would highly recommend it.

First thing you will note is that HIPAA is federal, not state.

Generally speaking, covered entities who are on the health care team can access and review private patient information in the course of treatment. Reviewing charts in anticipation of receiving, but not actually having received yet, that patient for treatment is permissible. Otherwise you would never receive report from the ED, OR, or any other unit you receive patients from.

Review 45 CFR 164.506 specifically.

Fun fact, so as long as you are not accepting federal dollars nor crossing state lines to provide care you are exempt from HIPAA. Really only pertinent to private duty nursing or those nurses who work for or own independent practices.