Student/Nurse Confidentiality at High School

ruby_jane, BSN, RN · Apr 16, 2018

I have been told that it is not my job to listen to their problems and that they need to go to the counselor only for any issues they have. I tell the kids if they tell me anything that is harmful to themselves or anyone else I must tell someone. But ordinary frustrations with school, home, life, do I have an obligation to share with their counselor? Does that violate HIPPA if I do?

OK... WOW. So, you are not supposed to use your hard-won therapeutic listening skills? Nah. I think that ties your hands.

You're spot on that if there's something that endangers the student or another person you're legally obligated to report. And the parent has a legal right, via FERPA, to any health record (so whatever you put in writing, the parent can see, whether you intend the parent to see it or not).

We work in a need-to-know setting. I would check with the counselor if it's a frequent visiting situation, if there's cutting or known diagnosis of depression, etc. just to make sure you have all the facts. In that case, I think the counselor needs to know and you need whatever info they can give you.

Obligation is a strong word.

Flare, ASN, BSN · Apr 16, 2018

^^ Yaas!

Some of the students are more comfortable coming to me to vent. Some would rather go to the counselor, some would rather go to their math teacher. If it's a matter of a student having issues with a peer or arguing with parents and it's just garden variety stuff, i just let them go and move on. Of course the more serious stuff, cutting, depression, self harm, suicidal thoughts must be shared, but all that stuff steers the conversation in a different direction anyhow.

WineRN · Apr 16, 2018

Obligation is a strong word.

Agreed.

I work close with my two counselors, but I don't know exactly who they are actively seeing at a given time, so if someone comes in having a real tough day due to social/school/home/life issues, I give them a heads up about the visit.

Am I obligated to do this, no, but I choose to do it because I feel they fall under the "need to know" category.

RNschoolnurse · Apr 16, 2018

And I do tell them if they stop by. I do them a heads up if I feel there is a concern in what they told me.

The other day the counselors were all busy. I had a student stop in and he was tearful and said I just need to vent. So, I shut my door and he vented and left within 20 minutes. He said thank you and left my office. I immediately emailed the counselor and let her know that he was in and "vented things to me". She came into my office and flipped out on me, told me I was not "in trouble" and then said to me "I know you just want to help them, but they need to come to me" I told her that she was not available at that moment and I just let him vent. I didn't feel like I did anything wrong nor was I worried about getting into trouble. And all I did was listen to his concerns.

NutmeggeRN, BSN · Apr 17, 2018

And I do tell them if they stop by. I do them a heads up if I feel there is a concern in what they told me.
The other day the counselors were all busy. I had a student stop in and he was tearful and said I just need to vent. So, I shut my door and he vented and left within 20 minutes. He said thank you and left my office. I immediately emailed the counselor and let her know that he was in and "vented things to me". She came into my office and flipped out on me, told me I was not "in trouble" and then said to me "I know you just want to help them, but they need to come to me" I told her that she was not available at that moment and I just let him vent. I didn't feel like I did anything wrong nor was I worried about getting into trouble. And all I did was listen to his concerns.

That counselor needs to get over herself. We are all in this together.

SaltineQueen · Apr 17, 2018

Mental health is just as big of a component as is physical health. You are more than capable. You do not owe the counselor anything about your conversations with kids. But I wouldn't necessarily think it would violate HIPAA because it could be considered "continuity of care."

ruby_jane, BSN, RN · Apr 17, 2018

Mental health is just as big of a component as is physical health. You are more than capable. You do not owe the counselor anything about your conversations with kids. But I wouldn't necessarily think it would violate HIPAA because it could be considered "continuity of care."

High five to Saltine and Nutmeg.... I can't imagine any of my counselors doing that to me. Mostly they're happy to have an extra set of ears and eyes. Old Dude would tell you to shake this off and move along, doing what you've always done.

Amethya · Apr 17, 2018

I do this and if it has to be referred, I tell my AP and she handles it.

NutmeggeRN, BSN · Apr 17, 2018

That counselor needs to get over herself. We are all in this together.

And another thing...

ooh I get so riled up, my frustration level goes thru the roof when I am expected to share and they keep everything close to the vest for "confidentiality" reasons...

3peas · Apr 17, 2018

And I do tell them if they stop by. I do them a heads up if I feel there is a concern in what they told me.
The other day the counselors were all busy. I had a student stop in and he was tearful and said I just need to vent. So, I shut my door and he vented and left within 20 minutes. He said thank you and left my office. I immediately emailed the counselor and let her know that he was in and "vented things to me". She came into my office and flipped out on me, told me I was not "in trouble" and then said to me "I know you just want to help them, but they need to come to me" I told her that she was not available at that moment and I just let him vent. I didn't feel like I did anything wrong nor was I worried about getting into trouble. And all I did was listen to his concerns.

Lesson learned: no more giving her a head's up. It was not owed to her, nor was it required. This counselor is unprofessional and intimidated by your relationship with the students.

bsyrn, ASN, RN · Apr 17, 2018

I have an awesome working relationship with our social worker. She has no problem when kids come to me to vent. I do let her know though.... :)