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 you were about to draw blood on a patient who had let's say... CJD, which is always fatal and turns your brain to mush, would you want to be aware of this dx? There seems to be debate on whether the prions are transmitted through blood products and the CDC says the risk is probably low for this.. But would you still want to know or would you not care? Just curious.
Nope, I would use universal precautions. I also would not tell anyone that was not in the know. What? You don't believe? Shrug, maybe it's the military life. Expecting people to follow the rules even when no one's looking. Shrug. Integrity. Some people have it, some don't. Can't force them to have it. I also ALWAYS use 2 people on 2 people lifts even though I can easily lift 250lbs plus with no problem. I always report abuse, even if it was not meant. Yes, I even report myself.
Do I hold others up to my standard. Yes. Is that a reasonable expectation? Probably not. But if I can do it no excuse for them is there?
Does that make me a 'tattle tale?' Maybe, last person I reported lost their license. Was a LPN. Good riddance I say. Only told a resident to shut up and that she wasn't in that much pain. Was it a 'big ole violation' of the law? Not really, but it would have be if that patient was your mother or friend or someone else you knew...
Specializes in Community Health, Med-Surg, Home Health.
Pagandeva. I totally agree with you. And this is the point I am making. How come something like CJD which is much more fatal, devastating, and I would think because of that would carry the same kind of stigma as HIV if not worse... how come something like CJD could be disclosed to healthcare workers but not HIV?
This is an interesting thread to say the least...it shows that people will be who they are no matter the circumstances. I'd like to know, I feel others should and that the laws should be changed, or reviewed on who 'needs to know'. It has also initiated an interest for me to review policy and procedure much deeper in my places of work.
Specializes in Community Health, Med-Surg, Home Health.
Stanley,
I would have reported that too. Anyone who treats a patient like that should not be a nurse.
That, I feel does not show empathy towards the patient...pain is the interpetation of the patient, not the staff. There must have been more behavior to encourage the BON to take away the license.
I would have reported that too. Anyone who treats a patient like that should not be a nurse.
I agree, I would propose that any nurse that routinely breaks patient confidence or any other laws also should not be a nurse. Not to big of a stretch.
To me, there is a big difference between a nurse who is treating a patient badly and one who was just trying to give a phlebotomist a heads up.
Okay, so you say it is illegal. What if this same nurse is a very good, compassionate nurse to her patients and was maybe just ignorant of this rule and was just acting instinctively motherly towards this phlebotomist? Would you really say she does not deserve to be a nurse? Why not just politely educate her instead of pulling the rug out from under her.
Only if knowing will benefit the patient should the direct care staff be told.
You have made this statement more than once in this thread, and it is simply not accurate. Neither HIV disclosure laws nor HIPPA restrict the sharing of confidential medical information only to situations that benefit the patient.
"The need to know" extends to many circumstances that have nothing to do with patient benefit, including room placement, provider assignment, referrals, data collection, research, "blind" reporting to public health agencies, regulatory compliance and insurance issues.
Specializes in Community Health, Med-Surg, Home Health.
You have made this statement more than once in this thread, and it is simply not accurate. Neither HIV disclosure laws nor HIPPA restrict the sharing of confidential medical information only to situations that benefit the patient.
"The need to know" extends to many circumstances that have nothing to do with patient benefit, including room placement, provider assignment, referrals, data collection, research, "blind" reporting to public health agencies, regulatory compliance and insurance issues.
I didn't think of that-so true. Thanks for sharing!
To me, there is a big difference between a nurse who is treating a patient badly and one who was just trying to give a phlebotomist a heads up.
Okay, so you say it is illegal. What if this same nurse is a very good, compassionate nurse to her patients and was maybe just ignorant of this rule and was just acting instinctively motherly towards this phlebotomist? Would you really say she does not deserve to be a nurse? Why not just politely educate her instead of pulling the rug out from under her.
I'm all for education. Honestly though, except for maybe new nurses. How many do you know that 'don't' know about Hipaa? Ignorance is no excuse, well thats what the justice system says anyways.
You have made this statement more than once in this thread, and it is simply not accurate. Neither HIV disclosure laws nor HIPPA restrict the sharing of confidential medical information only to situations that benefit the patient.
"The need to know" extends to many circumstances that have nothing to do with patient benefit, including room placement, provider assignment, referrals, data collection, research, "blind" reporting to public health agencies, regulatory compliance and insurance issues.
Why would they have special providers or room placements other than they needed them? That benefits them. The other stuff does not include direct caregivers... Insurance needs to know and the rest doesn't specifically id the patient UNLESS it is needed. No mention of direct caregivers having a need to know outside of that.
Specializes in Community Health, Med-Surg, Home Health.
Yes you are correct but those reasons DON'T include 'protecting' direct care employees. They are also necessary reasons which I see nothing wrong with.
The big issue here has been can we tell direct caregivers for the benefit of their safety. At this moment in time no. The law can be changed, but that is a different matter.
One thing I am curious about; if you are caring for a patient and a nurse collague came and discretely informed you of their HIV or any other status not documented, then, would you feel that you should report her?
It's not about professional respect it's about professionals behaving that way and obeying the law....
There's no law against knowing if a patient is HIV+ if you are their caregiver. Once you are their nurse, you need to know this information. There is nothing wrong with other members of the care team knowing as well.
Atheos
2,098 Posts
Nope, I would use universal precautions. I also would not tell anyone that was not in the know. What? You don't believe? Shrug, maybe it's the military life. Expecting people to follow the rules even when no one's looking. Shrug. Integrity. Some people have it, some don't. Can't force them to have it. I also ALWAYS use 2 people on 2 people lifts even though I can easily lift 250lbs plus with no problem. I always report abuse, even if it was not meant. Yes, I even report myself.
Do I hold others up to my standard. Yes. Is that a reasonable expectation? Probably not. But if I can do it no excuse for them is there?
Does that make me a 'tattle tale?' Maybe, last person I reported lost their license. Was a LPN. Good riddance I say. Only told a resident to shut up and that she wasn't in that much pain. Was it a 'big ole violation' of the law? Not really, but it would have be if that patient was your mother or friend or someone else you knew...