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!
I agree that some people will use any excuse to harm a colleague. I don't think that this falls under the same category as envy, jealousy or dislike, but I can certainyl see how this could be used that way. That, however, isn't a good enough reason to disregard the law. I think the OP's employer is handling the situation in the bext possible way - not isolating any particular member of staff but educating all staff about what their legal obligations in this area are.
Specializes in Community Health, Med-Surg, Home Health.
Thanks for clarifying :) If there's a legitimate reason for knowing that's different from the way I read your original post.
I still don't understand how practitioner's practice changes if they know a patient's HIV positive.
To be honest, I don't see how it can, either-if they are always following universal precautions. However, I know that there are many situations, where under the best of intentions and circumstances that things slip up. I know that the law is the law, so to speak, but I don't think that this law always has the best interests of those in the front lines. This is why I would say that we should protect each other. This, to me, has nothing to do with reducing the quality of patient care or discriminating against them. In fact, anyone who does decide to discriminate should be disciplined, in my opinion. But, to me, anyone that is hired to do an invasive procedure does have a right to know.
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.
And you may lay to that.
Absolutely! Imagine hearing, you surely got TB not from caring for your TB patient but from riding the bus to work. It happens.
Legalities aside, I find it a bit insulting to think that by a fellow staff member warning me to be extra careful it should be inferred that I would ever use that information in an illegal way to harm someone.
Seems to me that the people who might be inclined to gossip, because I'm not naiive enough to think that everyone takes their vow of confidentiality seriously, are the ones that would be snooping through charts anyway and that is a whole different problem for the facility to investigate. It is my belief that those rotten apples are few and far between.
Specializes in Community Health, Med-Surg, Home Health.
I agree that some people will use any excuse to harm a colleague. I don't think that this falls under the same category as envy, jealousy or dislike, but I can certainyl see how this could be used that way. That, however, isn't a good enough reason to disregard the law. I think the OP's employer is handling the situation in the bext possible way - not isolating any particular member of staff but educating all staff about what their legal obligations in this area are.
This may be far fetched, but I hope that part of the solution is to allow the phlebotomist to be aware, because this person is involved by performing his/her job. If this will lead to educating personnel further on HIPPA, then that is a good thing; because it may be that it is a misinterpetation on who that facility deems as having a right to know but I sincerely hope that this nurse is not penalized for trying to look out for the welfare of her collague.
Specializes in med-surg, psych, ER, school nurse-CRNP.
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?
I absolutely do. May be wrong and y'all can flame me all you like. Heck, I've had my intelligence and education called into question already for not agreeing with some, I'm surprised we haven't touched on my ancestry yet, . But, this does not change the way I feel. Anybody that comes into contact with blood or body fluids has a right to know (read "need to know"), in my opinion.
I will say that this does not change how I practice.....I treat everyone the same, regardless, I just wish We as healthcare providers had better access to critical info, instead of being held up by some archaic law.
Specializes in Community Health, Med-Surg, Home Health.
Legalities aside, I find it a bit insulting to think that by a fellow staff member warning me to be extra careful it should be inferred that I would ever use that information in an illegal way to harm someone.
Seems to me that the people who might be inclined to gossip, because I'm not naiive enough to think that everyone takes their vow of confidentiality seriously, are the ones that would be snooping through charts anyway and that is a whole different problem for the facility to investigate. It is my belief that those rotten apples are few and far between.
You're part of the care team, it is okay for you to know this information. I don't think it is a hipaa violation.
PS: If you do take this to CC and they find some sort of violation happened, they will not just issue this nurse a warning. They will terminate him/her. That's the kind of lesson you'll be teaching her. There's no slaps on the wrist for this kind of stuff.
I'm not going to attack anyone's ethics, education or intellect. However I am surprised to read, Angelfire, that you do agree that a specimen courier has a legitimate right to know that the specimen they're carrying came from a sex worker who hasn't been tested, but may be positive, for HIV/Hep B etc.
I actually just tried this - said to one of our orderlies, who came to collect a path specimen, "would you want to know if that came from a patient who might be HIV or Hep B positive?"
He said "Aren't they all?" So he wouldn't treat the specimen any differently? "Uh - no. I don't plan on injecting or drinking any of them."
Show me one ethical problem that is not black and white...
You are saving a baby from a burning building. There is a door to get out, but it is locked from the outside. The only way to get through is to kick the door open...
If you kick the door open, you are committing a criminal act (property destruction, vandalism, or something).
If you don't kick the door open, you and the baby will soon die of smoke inhalation.
Would it be unethical to kick that door off the hinges and escape? Remember, you'll be committing a criminal act (and therefore acting unethically according to your logic).
PS: If you do take this to CC and they find some sort of violation happened, they will not just issue this nurse a warning. They will terminate him/her. That's the kind of lesson you'll be teaching her. There's no slaps on the wrist for this kind of stuff.
I agree and with or without a name if they want to pursue it they will find out. I hope/think that coworkers should have the respect to speak to the person in private for something like this before going to management. We really need to be team players and that doesn't include hanging someone out to dry without warning especially when their intentions were to help you. My good reputation with my peers is important to me and if you think lips are loose with regard to HIV status see how long it takes for it to get around that someone reported a fellow worker for something like this.
. But, this does not change the way I feel. Anybody that comes into contact with blood or body fluids has a right to know (read "need to know"), in my opinion. 
talaxandra
3,037 Posts
I agree that some people will use any excuse to harm a colleague. I don't think that this falls under the same category as envy, jealousy or dislike, but I can certainyl see how this could be used that way. That, however, isn't a good enough reason to disregard the law. I think the OP's employer is handling the situation in the bext possible way - not isolating any particular member of staff but educating all staff about what their legal obligations in this area are.