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!
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:
Letting someone know about a patients HIV + status is a professional courtesy that healthcare workers extend to each other for extra precautions.
I've asked this question repeatedly: those of you who state that you use "extra" precautions if you know that a patient is infected with a blood-borne pathogen -- precautions that you do not use with patients whom you *believe* to be free of these pathogens --
1. What are these precautions?
2. Why/how are they superior to universal precautions in minimizing the risk of transmission of pathogens?
Specializes in Community Health, Med-Surg, Home Health.
I can't believe what this has become; to me, an RN who seemed to show professional concern for a person about to perform an invasive procedure by informing them may be sent to the slaughter house!
At my hospital, I see unit clerks, who usually have no patient access easily obtain the knowledge that an admission is positive for HIV, MRSA, HBV, etc, and the phlebotomist, who is drawing the blood can't know??
the major philosophers and most philosophies in general tend to operate in areas of black and white. Most people operate in this way also.
["Most people" don't think logically about ethical situations but tend to think that the position they support, because it's what coheres to their preexisting system of beliefs, is the only ethical option. Which is why arguing about abortion or euthanasia, or HIV disclosure is unlikely to shift anyone's position. I include myself in "most people" - I've got a Grad Dip and a Masters in health ethics; nothing I read substantively shifted my position on anything, it just gave me better (in the philosophical sense of stronger and more valid) arguments.
What is legal isn't always ethical (it's legal to evict people who have nowhere to go, it's legal to loan people more money than they can reasonable repay then force them into bankrupcy, it's legal to see expired and adulterated drugs in third world companies) and what's ethical isn't always legal. Euthanasia, for example, is legal in the Netherlands and was briefly in the Northern Territory - does that mean its ethical status changes based on where you are?
Is it ethical to lie? Never.
But, with one exception, it's legal to lie. The one situation where it is both illegal and unethical to lie - in the Bible it's the ninth Commandment (eighth if you're Catholic); in the law this is better known as perjury.
One of moral philosophy's greatest and most revolutionary thinkers, Immanuel Kant, agreed with you - he said you shoud never do anything you wouldn't be happy for everyone to do all the time, and that lying was therefore (black and white) never ethical.
Many of his contemporaries had an issue with "never", so Kant clarified - if someone comes looking for you with an axe, and tells me he's going to kill you, Kant says I should tell the truth about where you are because if I lie and you happen to be where I told the murdered you were (knowing that it was a lie) then I'm responsible for your death.
It doesn't take much to construe a realistic scenario where lying is ethical appropriate. The most common one is from real cases during the Second World War - French resistance fishermen would hide escapees in false bottoms of boats. If intercepted by Nazi soldiers the resistance would say they were the only people on board.
So is lying ever ethical? Depends on why you ask. For Kant, never, under any circumstances. For many other philosophers, just like for many non-philosophers, it depends on the circumstances.
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.
If that really was the case, there'd be no need for ethical philosophy at all.
At my hospital, I see unit clerks, who usually have no patient access easily obtain the knowledge that an admission is positive for HIV, MRSA, HBV, etc, and the phlebotomist, who is drawing the blood can't know??
And those people are all behaving illegally and unethically.
Specializes in Community Health, Med-Surg, Home Health.
And those people are all behaving illegally and unethically.
According to who? The administration that is allowing it? If this is what they were told to do, information to obtain, then, who is at fault?
I have to correct the meaning of their access in case it was misinterpeted; the clerks at my hospital were not peeking through the charts at their leisure for malicious purposes, they have access to this information because when admissions arrive, they prepare the charts for the doctors and nurses, including diagnosis, necessary labs, etc... I don't see how they are behaving illegally or unethically based on the fact that at this facility, it appears to be in their job description to do so. If it is wrong, then, I say to blame HR for including this in their job descriptions or the supervisors who are training them.
Perhaps this is my misunderstanding - you wrote that they "easily obtain", which I've construed as discover. I would ask who it is who told them and why they need to know.
And I didn't read anyone posting that the nurse who informed the OP should be "sent to the slaughterhouse" - I've read members posting that they think what she did was unethical and/or illegal, as well as members saying that what she did was appropriate, justifiable and wholly ethical. For those of you in the latter group - do you think the nurse has a duty to disclose this information to phlebotomists?
Specializes in med-surg, psych, ER, school nurse-CRNP.
And those people are all behaving illegally and unethically.
Then I guess all of us here who take the initiative to protect ourselves are as well.
Take me to jail.
But I will tell you this much. Those same administrators and that same facility that have those cockamamie rules and regs will be the first ones to throw you under the train if you get stuck and get sick. They will stop at nothing to prove YOU did something wrong, not they. They will not give a whit less about your rights, nor your feelings, nor how "ethical" they are being. All in the name of the almighty peso.
Specializes in Community Health, Med-Surg, Home Health.
Perhaps this is my misunderstanding - you wrote that they "easily obtain", which I've construed as discover. I would ask who it is who told them and why they need to know.
And I didn't read anyone posting that the nurse who informed the OP should be "sent to the slaughterhouse" - I've read members posting that they think what she did was unethical and/or illegal, as well as members saying that what she did was appropriate, justifiable and wholly ethical. For those of you in the latter group - do you think the nurse has a duty to disclose this information to phlebotomists?
That is why I looked at my post again, because I saw that I did not express that point correctly. And, the reason why I say 'sent to the slaughterhouse' is because, depending on the personalities of the powers that be have, it can very well go that way. I have seen many situations over the years where people are targeted for childish reasons, i.e. "she/he works better than me, is highly regarded, etc..." where they look for any reason to tear them down. Now, here is a HIPPA violation, and that may be all that they need to make this person's life a living hell, and all they did was believe that maybe, this phlebotomist (or anyone) needed to know.
Then I guess all of us here who take the initiative to protect ourselves are as well.
Protect how? And those of you who feel this way (including Angelfire) - do you also think phlebotomists (and lab staff and couriers who take specimens to the lab, all of whom also have a tiny chance of coming in contact with contaminated fluids) should be alerted to patient's Hep B or C status? How about patients who are at high risk of HIV/Hep B/Hep C, like sex workers and IV drug users, but haven't been tested?
Altra, BSN, RN
6,255 Posts
nobody?