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!
as an aside, I have worked in an ICU in the late 1980's as the PRIMARY RN taking care of HIV trauma p'ts and have had this information intentially withheld from me, on several occasions.
This was in the days before needleless lines, where we used to piggyback lines into sidearms with needles. Also no antiretrovirals then.
In my opinion, it was a serious violation of my civil rights. Many RN's who worked in those conditions are angry about this.
You both are mistaken. There exists no such right to be informed. You can't just make up rights. You have a responsibility to practice universal precautions. Knowing someone has HIV won't make you any safer. If it does, you aren't doing your job right in the first place.
People need to stop making up rights. You have no right. Your only right is to quit nursing and move to a 'less dangerous' job. You can try to challenge it but it will be an exercise in futility. The Supreme Court routinely knocks down these short-sighted and selfish demands. For good reason...
P.S. If you worked in unsafe conditions, that was your choice. This is America and you can vote with your feet. Feel unsafe? Walk...
I'm pretty surprised that anyone would consider reporting something like this without speaking to the person first but thats just my two cents.
I agree that things need to be changed because I do feel that knowing HIV status for someone that is working with their blood is important. No doubt we treat everyone as possibly + but that isn't really the point. Safety is very important and not just for our clients, imo.
Wow...interesting! The responses seem to be all over the map. Sorry, but I have to agree with most of what StanleyRN2B has written.
For everyone who seems to think it's my "right" to know, I think you're a bit misguided. How many patients do you treat who might be HIV positive but undiagnosed? Or have hepatitis and are undiagnosed? I think you'd probably find the answer surprising.
If you're not approaching every situation with the same care you'd approach an HIV-positive patient then you're lacking in both your clinical skills and common sense. It's none of my business if a patient is HIV-positive or has hepatitis if I'm doing my job correctly.
It's different, of course, with situations like c-dif, MRSA, flu, meningitis, tuberculosis, etc. I NEED to know about those situations so I can take proper precautions not to infect other patients or myself with these easily communicable diseases.
What I've decided to do is make the compliance officer aware of the issue but without identifying the RN (truth is, I can't recall her name anyway). I still think it's an ethics and HIPPA breach. And yes, I think there's a lot in HIPPA that is total and utter nonsense, but I think there are some good components to it, and protecting patients from this type of breach of confidentiality is one of them.
In my opinion, it was a serious violation of my civil rights. Many RN's who worked in those conditions are angry about this.
Civil rights are rights that are bestowed by nations on those within their territorial boundaries. Civil rights are given and can be taken away.
By definition, if you know someone is HIV+ and you disclose it to another nurse then YOU are violating someones civil rights. The United States has given them that right to nondisclosure and NOT given you a civil right to be informed. Period. If you know you may discriminate against them. You may tell some that does. If you tell you are not only a criminal, you are a civil rights violator. That is not an opinion.
You should report that nurse. You'd report them if they violated a civil right related to race or gender or religion. They violated the patients civil rights and broke the law. Why all the concern for a common criminal???
At one point we should take universal/standard precautions against everyone.
On another point, why don't we have a right to know? If I am inserting an IV into someone, I believe I deserve to know what I am putting myself at risk. If an accident was to occur, patient jerks his arm, etc, will the Hospital pay for my medical bills for the rest of my life?
But that patients right to privacy overrides safety I guess doesnt it?
I was a CNA for many years and this subject always stops me. A nurse can report to me regarding a patient, but must leave out the fact that the patient is HIV pos. Why? I'm here to care for this patient regardless of their HIV status. Having a complete pic of my patient helps me do my job better. Every nurse has always taken me aside to tell me. I appreciated that. Was I more careful, maybe. It gets so busy that I try not to cut corners, but sometimes situations crop up and there's a glove box (but its empty) and here's a pt that needs to be cleaned up. After a few years, I make sure my rooms are stocked, but in the beginning most CNA's run around playing catch up all night.
I hope to see laws change to incorporate all healthcare personel that come into contact with patients.
It doesn't sound like the RN was being gossipy, it reads like she was just giving you a heads up. Sure is a controversial subject.
Specializes in med-surg, psych, ER, school nurse-CRNP.
Or what about the ones who are mad that they are infected and are on a mission to infect as many people as they can, just out of pure meanness. Does their right to "privacy" negate my right to protect myself against someone who is a walking biological weapon?
I'm not as bad as some people I know, "put them all on an island and leave them", but I firmly believe that I have a right to know what I am walking in to.
Police officers deal with dangerous people every day, too. They never know when someone has a gun. Does that criminal's right to privacy trump that officer's right to know that he has a gun? Or should the policeman find another "less dangerous" job if he does not want to deal with that?
At one point we should take universal/standard precautions against everyone.
On another point, why don't we have a right to know? If I am inserting an IV into someone, I believe I deserve to know what I am putting myself at risk.
Universal precautions (e.g. gloving when there is a risk of blood/bodily fluid exposure) are sufficient to prevent the transmission of HIV, HCV, HBV and other blood-borne pathogens. This is why these precautions are to be practiced universally.
If an accident was to occur, patient jerks his arm, etc, will the Hospital pay for my medical bills for the rest of my life?
I'd suggest that for your own peace of mind, you investigate your hospital's P&P on needlestick/exposure injuries. I'd bet that there is a specific standard practice to be followed. You probably are instructed to immediately notify your supervisor and report to the ER and/or Employee Health for a blood draw and counseling. The patient is probably also asked for a voluntary blood draw to determine the presence or absence of blood-borne pathogens. If the patient refuses, there is a also a specific policy in place to proceed appropriately. In the worst-case scenario, in which you contracted illness from a blood-borne pathogen from a patient during the normal course of your duties at work, yes, the hospital would indirectly pay for your medical treatment through its workers' comp insurance carrier.
But that patients right to privacy overrides safety I guess doesnt it?
No, it doesn't. Safety means using appropriate precautions, and understanding and accepting the risks. No one is forced to work in health care.
Was I more careful, maybe. It gets so busy that I try not to cut corners, but sometimes situations crop up and there's a glove box (but its empty) and here's a pt that needs to be cleaned up.
I'm stunned that you would clean up a patient without gloves, and frankly, hope that you are not caring for my family member. Gloves provide 2-way protection between patient & caregiver.
If the patient has a known HIV infection, then any caregivers that will be doing any type of intrusive procedures (ie, the RN, and the phleB!) need to know. It's an added layer of protection. Instead of trying to "nail" this RN, stop being a damn tattle tale, grow up, stop trying to cause drama, and appreciate you were given the heads up.
If the patient has a known HIV infection, then any caregivers that will be doing any type of intrusive procedures (ie, the RN, and the phleB!) need to know. It's an added layer of protection. Instead of trying to "nail" this RN, stop being a damn tattle tale, grow up, stop trying to cause drama, and appreciate you were given the heads up.
Can you explain what the "added layer of protection" is? Are you suggesting that universal precautions not be followed with patients you *believe* to not harbor any blood-borne pathogens?
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pedicurn, LPN, RN
696 Posts
as an aside, I have worked in an ICU in the late 1980's as the PRIMARY RN taking care of HIV trauma p'ts and have had this information intentially withheld from me, on several occasions.
This was in the days before needleless lines, where we used to piggyback lines into sidearms with needles. Also no antiretrovirals then.
In my opinion, it was a serious violation of my civil rights. Many RN's who worked in those conditions are angry about this.