I'm working in the lab of a large hospital while waiting to start the nursing program at my local community college this fall.
I was on phlebotomy tonight and before one of my draws the patient's RN pulled me aside outside the room (in the hall) and told me to "be careful because she's HIV positive." Another phlebotomist related that the RN had also advised him of the patient's HIV status before he drew the patient earlier in the evening.
As a phlebotomist, you'd have to be point-blank stupid not to approach every draw as if the patient had a blood-borne pathogen. That's why we have things called personal protective equipment and universal precautions. A patient's HIV status is and should be irrelevant when it comes to drawing blood since you should be taking the same degree of precaution with every draw that you do.
I believe that the RN needlessly compromised the patient's right to confidentiality, especially with such a highly confidential diagnosis. In addition to what seems to be to be a serious breach of ethics on the part of the RN, it also sounds like a big, glaring HIPPA violation.
I'm not even in RN school yet and it's setting off alarms with me. Am I off base in my assessment of the situation? I'm seriously considering reporting it to our compliance officer, my motivation not being to "nail" the RN, but rather to take advantage of the situation as a teaching opportunity for the RN, and also advocate for the patient who probably has no idea that her confidentiality was breached.
Any thoughts from you seasoned professionals would be most appreciated!
if it's criminal, it's certainly illegal, but unethical???
while hipaa violations clearly spell out the penalties involved, there are certainly enough ambiguities in hipaa law that would be near impossible to prove malificent intent.
only those involved in pt's direct care, would likely be upheld in a court of law.
anyone outside direct care, would and should be implicated.
but because ethics are values that cannot be 'proven' one way or the other, direct carers are operating under the premise of 'i have a right to guard/protect my safety.
'it is my human right', and feel extremely confident that a precedent would be set-
if one hasn't been set already.
so no, it really isn't that black and white.
ethics never is.
and the law is such that a nurse providing direct care, could contest that she did indeed, have a right to know.
First of all ethics are usually black and white. Ask lawyers.
Now then....this is priceless.
Also, it tells me you have never done an ethics class in your entire life
Show me one ethical problem that is not black and white... If it is criminal it is unethical. Apparently you have never encountered a real life ethical problem. The only time people think there is a shade of gray is when they let 'personal' beliefs cloud the issue. This isn't about personal beliefs. It's about the law. What is it about not telling people about a HIV status because they aren't doing anything that would require them knowing 'to protect the patient' do you understand?
Seems quite clear to me. It's called only seeing what you want to see. That is not an ethical question but one of motives. The issues doesn't take protecting you into account. You demanding it should doesn't make a lick of difference.
Black and White :) I welcome you to disprove that. I won't hold my breath.
anyone can have a needle accident, but i would bet my bottom dollar that you were more cautious with that patient because of the info. anyone would have.
okay...fork over that bottom dollar. i wasn't any more cautious than i am with any of my patients. i know you might find that hard to believe, but when i'm drawing blood, i make sure i'm hyper-focused on what i'm doing. primarily that means performing a blood draw that is as trauma free as possible for my patient, and the safest for both the patient and myself.
frankly, since this is a forum for professional healthcare workers, i'm shocked that nobody seems to be aware how fragile the hiv virus is and how difficult it is to contract hiv via accidental needle stick. all this "the phleb needs to know to protect him" pablum really seems to be misplaced. this is why i stand by my original statement that i don't "need to know" if i am following proper procedure. even then, if through some freak accident i am exposed through an accidental needle stick, the chance that i'm going to contract hiv is very slim:
needle sticks: a study of over 2,000 health care workers has been underway for several years to assess the risk of their exposure to people with aids. over 1,000 of these workers had a needle stick accident with a needle that had been used on a person living with hiv. the rest had some sort of mucous membrane exposure, such as being splashed in the face with blood or vomit. of all these people, only 21 show signs of being infected with hiv (as determined by the antibody test). one of these people was a nurse who had multiple needle stick accidents, including one where she tripped and fell on the depressor of a syringe full of blood, and the entire contents entered her body. another was a lab worker who was working with a test tube of infected blood which broke and cut his finger, exposing the infected blood to his bloodstream. this study shows that hiv is quite difficult to get.http://www.sfaf.org/aids101/transmission.html
the rate of occupational transmission from an hiv-positive source is believed to be 0.3% for a percutaneous exposure and 0.09% for a mucous membrane exposure. the rate of transmission from a hepatitis b-positive source to a nonimmunized host is 6-24% and 1-10% for exposure to hepatitis c.
Show me one ethical problem that is not black and white... If it is criminal it is unethical. Apparently you have never encountered a real life ethical problem. The only time people think there is a shade of gray is when they let 'personal' beliefs cloud the issue. This isn't about personal beliefs. It's about the law. What is it about not telling people about a HIV status because they aren't doing anything that would require them knowing 'to protect the patient' do you understand?
Seems quite clear to me. It's called only seeing what you want to see. That is not an ethical question but one of motives. The issues doesn't take protecting you into account. You demanding it should doesn't make a lick of difference.
Black and White :) I welcome you to disprove that. I won't hold my breath.
Stanley, while I agree with just about everything you have posted in this very lively thread, I don't agree with you that ethics in general is black and white. Ethics is actually more of a philosophy, a discipline that is actually sort of fluid. There is a branch of ethics called deontology that focuses on what is considered right or wrong and tends to see things as black and white.
That being said, the area of nursing ethics is somewhat narrower and hinges pretty much on the RIGHTS OF PATIENTS, particularly when it comes to issues of privacy and confidentiality:
Nursing ethics "emphasizes autonomy of the person being nursed over paternalistic practice where the health professional seeks to do what they believe to be in the person's or society's best interests. Codes of conduct for nurses tend to be written in the ethical framework of deontology and are therefore based on the rights of the patient and the duties of the nurse rather than on utilitarian concerns of the consequences justifying the action." http://en.wikipedia.org/wiki/Nursing_ethics
Stanley, while I agree with just about everything you have posted in this very lively thread, I don't agree with you that ethics in general is black and white. Ethics is actually more of a philosophy, a discipline that is actually sort of fluid. There is a branch of ethics called deontology that focuses on what is considered right or wrong and tends to see things as black and white.
That being said, the area of nursing ethics is somewhat narrower and hinges pretty much on the RIGHTS OF PATIENTS, particularly when it comes to issues of privacy and confidentiality:
Nursing ethics "emphasizes autonomy of the person being nursed over paternalistic practice where the health professional seeks to do what they believe to be in the person's or society's best interests. Codes of conduct for nurses tend to be written in the ethical framework of deontology and are therefore based on the rights of the patient and the duties of the nurse rather than on utilitarian concerns of the consequences justifying the action." http://en.wikipedia.org/wiki/Nursing_ethics
Yes, but ethics or should I say deontology is almost always defined by a society's set standard of behavior, which is actually pretty rigid. Also, the major philosophers and most philosophies in general tend to operate in areas of black and white. Most people operate in this way also.
Is it ethical to cheat? Never.
Is it ethical to lie? Never.
Is it ethical to double deal in business? Never.
Is it ethical to report a private meeting because it would assist in solving a crime? Always.
If a person wants to kill themselves is it ethical to help them? If it is illegal no. If it isn't illegal yes.
Is it ethical to refuse to treat patients of a certain background? No
Is it ethical to break the law to protect human rights? Yes
Is it ethical to let a coworker know that they should be extra careful around a HIV patient? No
Is it ethical to refuse to work somewhere because they won'y let you tell HIV status? Yes
I am having trouble thinking of a situation where it would be grayish and not black or white.
There is right and wrong. There is never a case of in between. It is or isn't. Even situations that people confuse. At the heart of that situation it was either right or it wasn't. The same goes with ethics. It is ethical or it isn't. There is no semi-ethical state.
'Currently the job of regulation of nursing personnel in relation to nursing ethics is left up to state, provincial, and national regulatory bodies' (from same Wiki)
The ethics of the situation have been set by our relevant regulatory bodies. They can be changed but it will still either be ethical or unethical. The fact that they can change however does not make it grayish. Morals change as do ethics and laws, but they can't be right and wrong at the same time. The thing about ethics is that they are not created by personal beliefs. They are created by society. The reasons that we say certain things are unethical, are unethical because we said so. Not because they were and we realized it.
As it stands at this moment in time, disclosing HIV status to protect yourself and other nurses is unethical. It's wrong. It's illegal. Should it be that way? Maybe not. But it is. If they make HIV status reporting mandatory then not reporting would be unethical.
"Spreading 'data' and 'information' related to someone's HIV/AIDS status is a CRIME. That makes you a criminal. As we all know... criminals should have no place in nursing."
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oh lord, now i'm a criminal. :/
i guess i have no choice but to quit nursing now.
here's my take on it: it may be against the law (to be honest, i really don't know what my state's law says) but i'm sure going to protect those that are doing invasive procedures by telling them, and i sure do appreciate being told about it in report. i'm not willing to abide by that law if it means putting myself at risk when i could give/be given a "heads up." Universal precautions is not fool proof, from say, a drop of blood being flung up into my eye during an IV stick.
What is it about not telling people about a HIV status because they aren't doing anything that would require them knowing 'to protect the patient' do you understand?
A healthcare provider's "need to know" private healthcare information is not limited solely to "protecting the patient". There are legitimate reasons for a healthcare provider to need to know a diagnosis that have nothing to do with patient protection, including research, billing, 3rd party payment, referrals, etc.
I think the majority of persons understand that IT IS THE LAW.
The dialogue in this thread is mostly all about the ETHICS of such a law.
The law vs morality debate.
Hardly anything in ethics is clearcut 'black and white'.
RN's are educated professionals and do not see this issue as being ' black and white'.
And nor should they. Most of them have taken ethics classes and are used to having active debate with others regarding controversial issues.
I am sure most of the RN's on the board don't appreciate being slammed, being called a 'criminal' from a person who is not even a nurse. Take some ethics classes and walk a lot of miles in our shoes before you judge us.
Emergency first responders...that's also stupid because if it's an emergency, chances are you aren't going to know the status of your patient until AFTER a spill has already occurred.
The law cited said that first responders could request HIV testing if they were exposed to fluids in a way likely to transmit the virus. Stanley even said that having a drop of blood fall on your shoe didn't count. The law in Michigan (as cited above) does not say all first responders have a right to know a patient's HIV status prior to anything.
pedicurn, LPN, RN
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