Published
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!
You don't need to know and neither do I however I would prefer to know simply because I would try to focus a bit more on my safety. I know we don't know who may have it and isn't diagnosed etc. but if we do I would prefer to know, thats all.To me its no different than being more focused when I am transferring a frail elderly person. I am more careful than with someone young in better physical shape. Not that I'm man-handling or throwing anyone around in the bed, just that I am more careful with someone I know is frail. So to me its not about universal precautions its about my focus which I know should always be 100% but if anyone here wants to say their focus is always 100% I'm gonna spit tea across my keyboard.
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.
You articulated my feelings better than I ever could have. Correct...the nurse considered this phlebotomist as a professional and alerted her-that is all. And, as Jules stated, sure, if you do have a head's up, you may proceed with even better caution. I don't care, no one follows each and every protocol each and every time to the letter. When the unexpected occurs, we have had to become creative and improvise. It shouldn't decrease the level of patient care we plan to render, but heck, there is nothing wrong with making sure I go home in one piece to protect my family, either.
Bottom line, as canoehead stated the question was should the RN be reported. I would NOT report this nurse. Nurses, CNAs, phlebotomists, physicians, everyone here and even more have opportunities to practice invasive procedures, may it be fingersticks, injections, initiate IVs, wound care, the works...and therefore, I can see giving a head's up. Things like this make people who do care and have honorable intentions shirk back. I sure would want to know.
We manage to both respect the law and to give each other a heads up where I work.
We have code for passing the info on...
' REMEMBER UNIVERSAL PRECAUTIONS'. We say this at handover,and/or write on the board. When we see this on arrival for a shift it means a p't on our shift is HIV positive.
I thank my coworkers for doing this - nice Drs and nurses :heartbeat
It's simple, pretty effective and doesn't get anyone into trouble.
I know to be extra aware regarding the potential for error
i don't believe that laws that single out a certain segment of the population for special treatsment are right
if you think that you have a right to know the status of someone with mrsa, flu, hep c, c-diff but the nurse was wrong to tell you of hiv satus??this doesn't make any sense
if the nurse is going to be reported how about the two phelotomists shouldn't they be reported as well and their files flagged??
if you don't know the name of the nurse and you report it all the other nurses on that floor are suspect and painted with same brush.
a lot of nurses will act with the best of intentions in trying to have the back of coworkers,
we had some problems at a ltc facility where there were hiv patients and because of the and no one could report that to other patients and their families with the result that there was three women who were hiv neg on admission and hiv pos at a later date..i am sure glad that i didn't have to make that phone call to relatives
i do agree that nurses need to keep their mouths shut no matter what the circumstances...in a matter that is in the courts now is a nurse who worked at city jail and a prisoner came thru that was accused of molesting a child - she knew the neighbors of the accused and told them, well the charges were dropped and now she is being sued for slander and was fired, now she has to fight for her license, doesn't have a job and may lose the case in court
We manage to both respect the law and to give each other a heads up where I work.We have code for passing the info on...
' REMEMBER UNIVERSAL PRECAUTIONS'. We say this at handover,and/or write on the board. When we see this on arrival for a shift it means a p't on our shift is HIV positive.
I thank my coworkers for doing this - nice Drs and nurses :heartbeat
It's simple, pretty effective and doesn't get anyone into trouble.
I know to be extra aware regarding the potential for error
I have seen this done when we have had to call security for combative patients. It is sort of unspoken that this is what it means. Very effective.
just kind of an aside. i am all for confidentiality and universal precauations. but sometimes that does not work.
heres a scenario. young woman in the ED for fatigue. went to start some IVF. i had a the patient had no known TB, MRSA, etc, etc, so i was following my universal precautions and had on just my gloves for starting an IV. i knew the woman was HIV positive, because she was a frequent flyer but had never been combative. i didnt see any need for gown, goggles, etc.
patient gets irate at the thought of a being admitted, and spits on me. in my eyeball.
now i am not an RN or LPN. did i still need to know that this young woman was HIV positive? yes. because although getting the virus this way was highly unlikely, her saliva entered my body through my eye.
she was HIV positive. i flushed my eye at the eye wash and had to get tested for HIV 3 times. i followed universal precautions. i now wear goggles for all IV starts.
i am thankful the RNs and LPNs i worked with shared that the patient was HIV positive with me. they were protecting me.
Sorry I did not respond sooner, MLOS, running errands. As a reason why everyone should be made aware of a pt status, here's a good example. Normally, a dietary aide, a volunteer, etc. would not need to know, according to the vast majority here.
Well, what if said aide went into a room and the patient asked for help with a procedure? This could be throwing away tissues that could have blood or other body fluids on them, helping them to the bathroom, where they could be exposed to body fluids, etc. These aides maight not be as stringent about gloves or handwashing as nurses or CNAs. Another thing, goggles are not typically a part of universal precautions, nor are masks with a splash guard. What if a CNA went to empty a bedside commode and it fell? It could splash in her eyes. (Been there, done that). I especially like the above post about spitting in the eye. Further emphasizes my point.
I am not saying that we should treat them like pariahs, but I am not comfy with the bare minimum of "universal precautions" as a catch-all, simply because it just sometimes is not enough.
Also, how many here have seen docs walk in, fiddle with a pt, and never glove? THEY definitely need to be told, especially if all they do is squirt that foam handwash between patients. Just my reasoning, and it may or may not hold water to y'all. I'm with the gal from Down Under. I'm sick of Big Brother telling me I DON'T have a right to information to better protect myself, just because it might embarrass someone.
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?
You really think HIV+ patients want to infect other people because they are miserable .......that sounds a bit extreme to me. You should treat all patients with a high regard of respect no matter if they are HIV positive or negative. And confidentiality is very important and should be respected by all staff members. You should always be aware and take precautions with every patient because you never know, you are responsible for keeping yourself safe . But knowing if someone is positive or not shouldn't make you more cautious ,that should already be THERE in your everyday nursing practices .. ALWAYS prepare for the worst and HOPE for the best!!!!!!:heartbeat
You really think HIV+ patients want to infect other people because they are miserable .......that sounds a bit extreme to me. You should treat all patients with a high regard of respect no matter if they are HIV positive or negative. And confidentiality is very important and should be respected by all staff members. You should always be aware and take precautions with every patient because you never know, you are responsible for keeping yourself safe . But knowing if someone is positive or not shouldn't make you more cautious ,that should already be THERE in your everyday nursing practices .. ALWAYS prepare for the worst and HOPE for the best!!!!!!:heartbeat
No, hon, I did not think that.........until the patient TOLD me that that was what he intended to do. I never said every HIV+ person on the face of the planet was on a mission to infect others. But the sad fact is, some ARE. And who said that I did not respect them? No one, because I DO. I could care less what you have, I just don't want it. And I don't think that anyone has the right to tell me that I should not have access to information that I feel is crucial. That's just how I feel, and not everyone will agree.
Well, I agree that it SHOULD be our right to know the dx, but it isnt. We are not supposed to give out such information, although Im sure there is a discreet way to do so without directly saying it. Im sure she was trying to be thoughtful to you, but she was in the wrong. Even in our patient's charts, the HIV test results are sealed so we cant see it. I dont agree with it because labs may be off due to the illness and if we are already aware of the dx, it would be expected. KWIM? I treat ALL sticks as if they were HIV positive because even if they arent dx'ed with it, they may still have it. Im not saying that I agree with it, but it is HIPPA violation to disclose such information to anyone. I have stuck patients while knowing they were HIV positive and if anything it made me MORE nervous and could actually increase the risk of a needlestick due to the actual stress of it. Be safe and treat them all as if they have it.
I agree that we should be treating any patient as if they might have HIV (as in always using universal precautions).
Concerning legality, I don't believe that the nurse was in the wrong. It isn't a breach of patient confidentiality to tell members of the care team.
FTR there have been instances of HIV+ people infecting others on purpose.
Editing to add that I am surprised that some of you aren't allowed to know status. We are.
pagandeva2000, LPN
7,984 Posts
I really think that the RN was trying to respect you are a health care professional by giving you a head's up on the condition of the patient. It seemed that it was done discretely, so, I don't see the reason to possibly place this woman's job in jeopardy.
Yes, it is true that we are supposed to practice standard precautions. But, it doesn't seem the same to me as telling the unit clerk, dietitican, food service worker, unit manager or anyone who is not directly going to be exposed to blood or body fluids. You are practicing an invasive skill on a patient, after all, and the RN recognized that. There are plenty of nurses who would have blown off your value as a member of the health care team, and it doesn't seem to me that this one did.