AnonymouseRN

Update: I documented thoroughly and professionally, and by "professionally" I mean: exlcuding the HIPAA violation and only including details of the care coordination encounter with the other nurse. The CNA in question was actually an RN, a brand new one. Not an aide. I was mistaken on that fact. My supervisor did a "report of contact" with me where he emailed me after "counseling" me following receipt of a complaint from the family member who gave him the name of the nurse who told her so he could verify what happened with her -as the family member had no clue how grievous a hipaa violation this was-; at which point he contacted our privacy officer who told him it was "unintentional disclosure" of patient information and advised him to counsel me and document teaching with me about making sure I protect patient information so it doesn't happen again. I was livid when I received that email from my boss this morning. Before I came to is job several months ago I was a hospice clinical director and right before this, an administrator in the private sector for some time. I started as a CNA and worked my way up, so CAHP and joint commission taught me well. He's brand new to leadership so I guess they haven't taught my boss as much yet. I won't make an assumption but I know regs like the back of my hand and I keep my experience to myself because I'm not in leadership anymore and I have no reason to beat anyone over the head with it. What makes me furious is that I called our privacy officer and recited the rule regarding incidental disclosure including the inclusion of language SPECIFIC to discussions at nurse stations and asked her why she told him to counsel me and then send me an email about why I needed additional HIPAA training about this. Her reply was that she was told the incident occurred in a hallway and not at a nurse's station or she never would've told him to do that. I thanked her, then spoke with HR who told me it wasn't a big deal at all, reminded me that I'm a union employee and he can't use that stupid email he sent me against me in any form or fashion and then told me to reply with corrections including the fact that it occurred at a nurse's station and my conversation with the privacy officer and to hold on to it when it came time for my raise here soon in the event that I "feel that I should need it". He then told me to call our union rep. My boss is known for being a dirty SOB and he has a horrible reputation. I won't say much except he doesn't report sentinel events to anyone...just not a good guy. Instead of leaving nursing altogether I took this job and I'm going to stick it out. If it gets bad I can make a lateral move and I'll do so should I feel the need arise. I certainly won't be the first. I'm generally not this angry at all and try to figure out always how I contribute to negative outcomes should they arise. But after getting that email this morning and being talked to Like I'm some kind of moron after a long week I guess I'm venting and I'm won't take this one sitting down. Hopefully that's the last I hear of this. In the interim, I spoke with the nurse I received report from, her facility has suspended the other nurse pending investigation and I've filed an allegation of breach of HIPAA with my own agency. Who happens to be the federal government, simply because I'm aware of the breach and policy dictates that I have to report knowledge of a known breach.

Thanks for all of your replies. I can't control the patient's family or anyone else but I can change me so I appreciate the insight. And I won't be giving or receiving report at a nurse's station ever again. I was in the wrong for that knowing how small this town is, incidental disclosure or not. I work for the federal government so I can apply for a job under a different supervisor and it looks like I need to do that as this isn't the first time I've been in a dangerous situation with out of control patients or their families.

I appreciate you taking the time to reply. I actually had no idea that the CNA was listening until I got the call later on. I looked up once and saw her behind the nurse's station, saw her walk away and then continued talking not realizing that she was actively trying to hear us talk. She wasn't anywhere near us when we started, otherwise no way would I have willingly let anyone hear any of that. I guess I should've made that more clear.

I have a sticky situation that I've never seen before and I'm looking for some insight. I'll try to stick to the facts. 1. I'm a case manager for a government agency and I coordinate, oversee and perform care for vulnerable -usally geriatric- patients in the community. 2. I've had this patient for several months now with pretty grievous abuse and repeated violations of patient responsibilities I outlined with the family when the patient was admitted. They agreed to our policies in writing and have been gently reminded multiple times since admission. 3. Pt. Is cared for by a grandchild with some serious anger issues. Constantly threatening and initiating legal action (not against us), refusing to allow patient to receive pain meds resulting in violent and aggressive behavior directed at us - I'm talking drawing blood-, granddaughter constantly screaming and cursing at us. 3. Our program manager refuses to discharge anyone, Including this one, with one FNP actually quitting our program because they couldn't stand the abuse anymore. 4. Pt. Revoked hospice at family request this weekend, again, as a result of gangrene escalating to sepsis to LE complicated by PVD and 100% dependence for bed mobility. 5. As is customary, I went to the hospital to coordinate care with the hospital staff and spoke with the patient's assigned nurse at the nurse's station. 6. While nurse and I were together, speaking in lowered voices in what I was confident was incidental disclosure....... 7. ....I was unaware that one of the CNA's working on the unit had come into the nurse's station and was hovering to eavesdrop on our discussion. 8. Charge nurse was saying some pretty crappy stuff and I was agreeing with and validating her frustrations. Not bad mouthing anyone, just listening to her vent and telling her that she wasn't the only one who'd dealt with all of the above referenced behavior from the patient's family. 9. Aforementioned CNA happened to be a close friend of patient's really angry family member. 10. I received a call this evening from said family member screaming at me, repeating the conversation the nurse and I had almost verbatim. She admitted that the CNA was her "best friend" and the CNA told her everything. I got the family member calmed down and rational somehow by the grace of God by the time the conversation was over but I'm pretty angry myself. I'm pissed that my boss allows us to be treated this way. I know it's "part of the job" especially at end of life. It is what it is but I as a former hospice administrator and an RN, I have a zero tolerance policy for yelling, threatening and otherwise abuse of staff. It's one thing to vent and work though grief. Quite another to threaten staff, scream, curse, and otherwise bully them and attempt to intimidate with fear. This CNA violated HIPAA. I'm concerned that this could somehow be turned against me and I take HIPAA pretty seriously because that's just what we do. Not sure how to proceed as far as telling my boss, who is very open in letting us know he doesn't care and doesn't appreciate us making waves. Lay low, be quiet and "grow the program" (increase pt. Census). How do I handle this? What should I have done differently ? Thanks in advance for insight. ***edit: I work in an Interdisciplinary care model very similar to hospice except that we care for patients across at every stage of disease and life, so we frequently discuss and care plan for patient and family behaviors and responses to interventions. Just to clarify that I wasn't gossiping or bad mouthing anyone. No name calling or any of that.