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!
The problem is that you give all these examples where the answer is very clear cut. The fact is that you will come into situations in nursing where the answer is much more difficult to find. We had a patient who was declared brain dead. The family begged us to keep the patient on the ventilator until her son could get home from Iraq in order to say goodbye to her. The policy in this hospital was that the family had 4 hours after the patient was declared brain dead to say their goodbyes (unless they decided to donate) and then "life-support" would be removed. So do we bend the rules and keep the patient on the ventilator for an extra couple of hours, in order to let this soldier say goodbye to his momma while he can still have the illusion that she is alive? Or do we say, "sorry, rules are rules." Rules and laws are based on personal opinions that many (or maybe even just a few) people agree on. You have no right to dictate what is right and what is wrong and what is black or white unless you are God. Laws are flexible. This is why we have a judicial system instead of a police state. And exactly why is it that you and the OP feel it is your duty to enforce the law? Do you feel like you exist on some higher moral plane that the rest of us? If I took it upon myself to report every minor infraction of policy or even law, I would be woefully neglecting my own duties. Get over yourself. This self-righteousness will just come back to haunt you.
Specializes in Community Health, Med-Surg, Home Health.
The problem is that you give all these examples where the answer is very clear cut. The fact is that you will come into situations in nursing where the answer is much more difficult to find. We had a patient who was declared brain dead. The family begged us to keep the patient on the ventilator until her son could get home from Iraq in order to say goodbye to her. The policy in this hospital was that the family had 4 hours after the patient was declared brain dead to say their goodbyes (unless they decided to donate) and then "life-support" would be removed. So do we bend the rules and keep the patient on the ventilator for an extra couple of hours, or do we let this soldier say goodbye to his momma while he can still have the illusion that she is alive? Rules and laws are based on personal opinions that many (or maybe even just a few) people agree on. You have no right to dictate what is right and what is wrong and what is black or white unless you are God. Laws are flexible. This is why we have a judicial system instead of a police state. And exactly why is it that you and the OP feel it is your duty to enforce the law? Do you feel like you exist on some higher moral plane that the rest of us? If I took it upon myself to report every minor infraction of policy or even law, I would be woefully neglecting my own duties. Get over yourself. This self-righteousness will just come back to haunt you.
I wouldn't. Seeing the circumstances and the love a parent would have for a child, I can see. Makes me think of the Denzel Washington movie "John Q". He did NOT want to witness his child die, and was willing to kill himself rather than witness the demise of his son helplessly. He went through the proper channels, he was a blue collar worker who paid taxes and did not receive help for his child. Sure, this was a fictitious character, but how many people did feel this way in every day life?
I'm thinking I wouldn't be able to convict either. Same as if someone killed the person that molested their child. Not that I am above the law but I don't think I could do something that I felt so strongly against. Wouldn't make a very good juror for sure.
Specializes in Community Health, Med-Surg, Home Health.
I'm thinking I wouldn't be able to convict either. Same as if someone killed the person that molested their child. Not that I am above the law but I don't think I could do something that I felt so strongly against. Wouldn't make a very good juror for sure.
I would suck as a juror as well...there was a case on television where a woman did kill her child's molestor and was diagnosed with breast cancer by the time of her conviction and sentencing. My heart was shouting to leave this woman alone. This man was a friend of the family and obtained the trust of everyone. When I am called for jury duty, I pray not to be accepted for cases for reasons such as that (been lucky so far).
The problem is that you give all these examples where the answer is very clear cut. The fact is that you will come into situations in nursing where the answer is much more difficult to find. We had a patient who was declared brain dead. The family begged us to keep the patient on the ventilator until her son could get home from Iraq in order to say goodbye to her. The policy in this hospital was that the family had 4 hours after the patient was declared brain dead to say their goodbyes (unless they decided to donate) and then "life-support" would be removed. So do we bend the rules and keep the patient on the ventilator for an extra couple of hours, in order to let this soldier say goodbye to his momma while he can still have the illusion that she is alive? Or do we say, "sorry, rules are rules." Rules and laws are based on personal opinions that many (or maybe even just a few) people agree on. You have no right to dictate what is right and what is wrong and what is black or white unless you are God. Laws are flexible. This is why we have a judicial system instead of a police state. And exactly why is it that you and the OP feel it is your duty to enforce the law? Do you feel like you exist on some higher moral plane that the rest of us? If I took it upon myself to report every minor infraction of policy or even law, I would be woefully neglecting my own duties. Get over yourself. This self-righteousness will just come back to haunt you.
If you actually read my posts I stated that I wasn't the DON. I report and let the DON 'handle' the law. Get over yourself. It's not self righteousness its a firm belief in what is right or wrong. While that may be a 'personal belief,' the law isn't. Rules are rules and they aren't made to be broken.
Nowhere did I say report every mistake. I said report crimes. A med error is not a crime. Forgetting a treatment is not a crime. If you are OK with people breaking the law that says more about you than it does about me.
I also don't dictate what is right or wrong. Our justice system does. People don't just get to do what they want and not pay a consequence. Sorry if living in a republic doesn't sit well with you.
Shrug... If that bothers you I am sorry, but really... that's none of my business. :chuckle
Better a self-righteous person with integrity than an amoral one without.
This thread seems to have run its course. I bid you farewell. Make the right choice. Not the easy one.
If you actually read my posts I stated that I wasn't the DON. I report and let the DON 'handle' the law. Get over yourself. It's not self righteousness its a firm belief in what is right or wrong. While that may be a 'personal belief,' the law isn't. Rules are rules and they aren't made to be broken.
Nowhere did I say report every mistake. I said report crimes. A med error is not a crime. Forgetting a treatment is not a crime. If you are OK with people breaking the law that says more about you than it does about me.
I also don't dictate what is right or wrong. Our justice system does. People don't just get to do what they want and not pay a consequence. Sorry if living in a republic doesn't sit well with you.
Shrug... If that bothers you I am sorry, but really... that's none of my business. :chuckle
Better a self-righteous person with integrity than an amoral one without.
Rules must be broken in certain circumstances. Otherwise this perfect judicial system of our would not exist. I actually did have the pleasure of reading all your posts and everything you said shows that you see yourself in the role of an enforcer out to make sure everyone is following the letter of the law. I love to discuss and have much more to say, but this is getting stupid. As someone was so quick to accuse earlier in the thread, you are either a troll or delusional. I hope living surrounded by so many amoral criminals doesn't keep you up at night. Later.
Rules must be broken in certain circumstances. Otherwise this perfect judicial system of our would not exist. I actually did have the pleasure of reading all your posts and everything you said shows that you see yourself in the role of an enforcer out to make sure everyone is following the letter of the law. I love to discuss and have much more to say, but this is getting stupid. As someone was so quick to accuse earlier in the thread, you are either a troll or delusional. I hope living surrounded by so many amoral criminals doesn't keep you up at night. Later.
The 200 some odd thank yous from 90 odd posts shows that I am neither a troll or delusional. I actually do see myself as an enforcer. It isn't really up to you to decide which crime is acceptable. I also participate in Neighborhood Watch, help track down molesters that are in places they should not be, pretend to be a little girl online to catch molesters for our local pd, have reported and received a reward from crimestoppers and have turned in my own friend for stabbing someone and having the nerve to try to get me to help him. I guess I am a horrible person. This is stupid... bleh......
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.
Am I still incorrect?
Yes. Proper room placement and choice of providers is done for the protection of the room-mate(s) and healthcare providers, not only for the protection of the patient with HIV. For example, many patients with HIV are also actively infected with CMV. For this reason, some facilities have policies against co-horting an HIV (+) patient with a pregnant patient or assigning a pregnant staff member to an HIV patient whose CMV status is unknown due to the risk to the room-mate's or nurse's health. In this case, the diagnosis needs to be known by the person making assignments in order to protect the well-being of the room-mate and staff, not the patient him/herself. It is a justifiable need to know that has nothing to do with patient protection. And universal precautions will not protect a room-mate.
Research is often conducted by direct caregivers, as you will see when you are actively engaged in professional practice. Disclosure of information to insurance companies is contractually required for claims review and case management, even though these processes often do not benefit the patient.
Physicians are entitled to that info when examining a patient correct? Why are nurses or any staff providing direct patient care not given the same professional respect?
Incorrect. Mandatory reporting only applies to public health agencies that monitor infection rates, prevalence, etc. A person can and does have the right to keep their HIV status from their physician and their insurance company. The "need to know" applies specifically to treatment for HIV/AIDS.
Just wanted to add that I see labeling a nurse as a "tattle tale" for holding colleagues to a higher standard of accountability as childish and less than professional. Do I report every nurse for every infraction that I witness? No, I do not. However, nurses should know the laws that govern their practice, and that if they violate them, they may be held accountable and suffer the consequences. It's a fact, and they have nobody else to blame other than themselves. To place the blame on other nurses by name calling is juvenile. One should only be willing to break the law in the name of ethics if they are willing to be held accountable. It's called "maturity".
Stanley, I've agreed with you on most of your positions in this thread, but I agree with other posters that I don't think viewing ethics in a binary way is very helpful. You've been quick to respond to other posts about this aspect of the debate but not to mine and I would really like to see what you think about what I posted about ethics and the law not always aligning. I'm not saying don't follow the letter of the law, just don't think this is necessarily the same as acting ethically.
:yeah:
BlueEyedRN
171 Posts
The problem is that you give all these examples where the answer is very clear cut. The fact is that you will come into situations in nursing where the answer is much more difficult to find. We had a patient who was declared brain dead. The family begged us to keep the patient on the ventilator until her son could get home from Iraq in order to say goodbye to her. The policy in this hospital was that the family had 4 hours after the patient was declared brain dead to say their goodbyes (unless they decided to donate) and then "life-support" would be removed. So do we bend the rules and keep the patient on the ventilator for an extra couple of hours, in order to let this soldier say goodbye to his momma while he can still have the illusion that she is alive? Or do we say, "sorry, rules are rules." Rules and laws are based on personal opinions that many (or maybe even just a few) people agree on. You have no right to dictate what is right and what is wrong and what is black or white unless you are God. Laws are flexible. This is why we have a judicial system instead of a police state. And exactly why is it that you and the OP feel it is your duty to enforce the law? Do you feel like you exist on some higher moral plane that the rest of us? If I took it upon myself to report every minor infraction of policy or even law, I would be woefully neglecting my own duties. Get over yourself. This self-righteousness will just come back to haunt you.