lilajan

During an interview, at a large teaching hospital, I was asked by the nurse manager how I would deal with a charge nurse younger than myself. When called back for a peer panel interview, two questions were asked regarding working with and being supervised by younger nurses. Several other, more subtle remarks, were made during a unit walk through and conversation with the Clinical Nurse Specialist. A position was offered, but only on nights (we need more experience on that shift). Ultimately, I passed on the opportunity.

Those who wear bracelets or other jewelry to identify a health issue, have made the choice to have that information on their person. It is their decision to have that information easily available for anyone to see in the event of an emergency. I have had family members request we "not put all those stickers all over the place in the room" when their loved one had a DNR or AND status. As one lady stated "we know Momma is going to die, we just don't want it to be the first thing everyone sees when they come to visit." In our facility, DNR/AND stickers are posted with the chart and on the assignment sheet at the nursing station (well out of public view). In the ICUs those stickers are posted at the charting desk outside each room.

I must question your statement that immunization status is not considered PHI. Any information regarding the care of the patient, including medications, is PHI. Whether or not Mr. Smith takes an asprin each day and why, is as private as his diagnosis. Vaccinations are medications and I take exception to the policy that we can, and do, disclose this particular med administation and no other. Would you post any other medication, given to or refused by a patient, on the door?

Stickers for patients, identifing vaccination status, seems to me a bit intrusive. More than one patient has stated they felt "forced" to accept the vaccination and resented being questioned by each staff member who noticed there was not a sticker present. As a nurse, I am required to ask if a patient has received information regarding the availibility of the vaccine and to give accurate patient education stating the benefits and risks. My concern is when patients and family members tell me they feel "punished" and "repremanded" if they refuse. No other vaccination status is posted or addressed in such a public manner. In response to isolation signs on doors and charts, yes those are in public view. But, those signs do not identify a specific organism, and no public notices are posted stating what organism is related to specific types of isolation. Personally, I have resigned myself to the fact my PHI has become public. You state patients have a right to know whether or not their health care worker is vaccinated. I have to disagree with that statement. If a patient has the right to know if I have received the flu vaccine, then that patient could also claim to have a right to know about any other immunizations I have received, and any other information related to my delivery of care -- for example, wheter or not I have screened positve for TB, MRSA, Hepatitis, or HIV. Each time I have to explain to a patient, family member, or co-worker why I have not been vaccinated, my PHI becomes public . Truly, patients are at more risk from visitors and family members who do not wash hands before and after each encounter and who are frequently in much closer contact (hugging, kissing, sharing food and drink) with patients than any health care worker.

I'm looking for input regarding the posting of flu vaccination status in an obvious, well seen location. If patients who receive the vaccine have stickers/labels posted on their chart, door, or ID band, would that be considered a violation of their privacy under the guidelines of HIPAA? Is this posting of information unaffected by posters/flyers/notices posted in open areas such as hallways, patient and family waiting areas, lobbies, and the cafeteria stating that those individuals who do not have a sticker/label posted have not received the flu vaccine? Just curious to hear what others think.