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 original question was whether to report the nurse. I wouldn't because she went out of her way, and put her job on the line to protect YOU. Whether you needed her protection or not is not the issue. She put herself on the line for your benefit, and IMO you should take it in the spirit it was intended. Don't assume she tells everyone she sees.
When a patient with a known infection tells me point-blank that he is going to "**** up as many people as I can before this thing gets me", well, what else can you say? What other name can you give to someone who deliberately sets out to inflict harm on innocent people he does not know just because he's angry he's sick?
I believe that there is an allowance in the privacy law specifically for this situation, where if an HIV+ person is making credible threats, then the safety of others trumps their right to privacy.
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.
It appears the RN bought it to your attention but if I am reading things correctly a fellow phlebotomist did as well. It seems like the phlebotomist might have shared it in dismay at being told but they broke confidentiality as well. If you are upset with the RN you should be equally upset with the phlebotomist. If it's wrong for one to share it's wrong for the other as well. Might be different circumstances but the result is the same. If they had concerns it should have gone directly to the nurse or her superior.
I would go to the nurse as a courtesy here. I really think she did this to be helpful and kind and probably never realized she was breaking confidentiality. I bet she would appreciate you taking her aside and letting her know how and why you feel the way you do. If she proceeded to do it from there on out I would then go to compliance.
I really think she did this to be helpful and kind and probably never realized she was breaking confidentiality. I bet she would appreciate you taking her aside and letting her know how and why you feel the way you do. If she proceeded to do it from there on out I would then go to compliance.
I disagree. As professional nurses, we should know these things. "I didn't know" is not an excuse for breaking the law. However, I do think that it wouldn't hurt to give her the benefit of the doubt by reporting the violation without singling her out, plus the entire staff could be educated on this issue rather than one person punished, which would serve no constructive purpose.
I would go to the nurse as a courtesy here. I really think she did this to be helpful and kind and probably never realized she was breaking confidentiality. I bet she would appreciate you taking her aside and letting her know how and why you feel the way you do. If she proceeded to do it from there on out I would then go to compliance.
i like this approach a lot.
it respects the intentions of the informative nurse and also warns her of forthcoming consequences.
I disagree. As professional nurses, we should know these things. "I didn't know" is not an excuse for breaking the law. However, I do think that it wouldn't hurt to give her the benefit of the doubt by reporting the violation without singling her out, plus the entire staff could be educated on this issue rather than one person punished, which would serve no constructive purpose.
I agree nor did I excuse her. I stated same as you did to speak with her and educate her first. Ditto for the phlebotomist. Let them know why what they did was breaking confidentiality. If they don't abide in the future move up the food chain.
it respects the intentions of the informative nurse and also warns her of forthcoming consequences.
very cool, batman.
leslie
TY. It's what I would do with a fellow nurse, CNA, etc. I would appreciate it being done for me. It gives people the chance to rectify their mistakes and learn.
The added layer of protection is the knowledge that you must be VERY careful in dealing with an HIV infected patient. Universal precautions are followed with every patient, of course. However, needle sticks do happen.
Agree.
I remember some research... from 1980's, I believe.
It found that nurses in the US had equal/higher occupational death rates than construction workers. This was mainly related to needlestick injuries.
Now we better enact universal precautions and have other measures - but the risk is still there
I'm going to take the same precaution with each and every patient regardless of HIV status, so that information about them should have remained confidential.
In reality, not everyone uses standard precautions 100% of the time. Of course we know we should. But every once in a while, I can't feel that one viable invisible vein with gloves on and I take one off to start the IV. I have seen lots of instances where standard precautions aren't followed exactly to the letter, due to emergencies or difficult circumstances. It isn't because we are dirty nurses or stupid or are being sloppy. We are trying to do our best in patient care. I've seen phlebotomists take off gloves and lay needles on the table and toss them in sharps boxes when they were done. Maybe this nurse didn't know how perfect you are and was just trying to protect you.
I agree nor did I excuse her. I stated same as you did to speak with her and educate her first. Ditto for the phlebotomist. Let them know why what they did was breaking confidentiality. If they don't abide in the future move up the food chain.
I didn't say to speak to the individual nurse first, though I don't completely disagree with that sentiment. My point is, that judging from the debate on this forum, there is a great deal of ignorance regarding this issue among the nursing community. Therefore, it's very likely that the nurse in the OP is not the only nurse doing this. This could very well be a housewide problem, meaning that it needs to be addressed housewide. There should be a P&P in place for this, and staff should be aware of it.
Yes, drawing blood is a risk. Healthcare workers are at increased risk for HIV & other blood-borne illnesses because they perform invasive procedures that have the potential for exposure to bodily fluids. Workers in other occupations don't perform such tasks that increase their risk.
This is what I am questioning: what is it that you do differently with a known HIV+ patient that you don't do with patients whom you *believe* to be free of these blood-borne pathogens?
Universal precautions are (or should be) just that -- UNIVERSAL -- to minimize the risk of accidental exposure to both healthcare workers and patients.
What I would do differently - be acutly aware of human error.
Interestingly, I wonder how many people who support this law have nursed combative bleeding HIV p'ts or nursed certain p'ts intent on infecting others ?
This law is highly political - I note some supporters of it in Australia are firmly in an ideological camp and most are not even healthworkers. Some healthcare workers who hotly defend it are HIV themselves and continue to keep this issue on the burner. Ideology placed ahead of nurses rights. This has mostly not been driven by nurses.
They couldn't give a toss about my rights to be fully informed about risks in my workplace. It's paternalistic, nanny state law driven by lobby groups.
It's my health, my life and I aim to be in the nursing profession for a long time.
I demand to know the risks ....we have been treated like compliant little children for too long
Meanwhile I obey the law....but will work to change it
canoehead, BSN, RN
6,909 Posts
The original question was whether to report the nurse. I wouldn't because she went out of her way, and put her job on the line to protect YOU. Whether you needed her protection or not is not the issue. She put herself on the line for your benefit, and IMO you should take it in the spirit it was intended. Don't assume she tells everyone she sees.