I need some opinions. The other night I was helping out in PACU. (I am usually in ER or Preop, but occasionally go to PACU when needed) I was asked by another nurse to transport her patient upstairs. The patient was early 30's female, very nice, always saying thanks when people helped her. We talked as I took her to her room. She had surgery for a cancer recurrence, so we talked about the surgery, her young kids, her family, etc. It was shift change, so I ended up having to wait with her for quite a while to see her nurse, the PACU nurse has to have face to face time with the receiving floor nurse. During this time we chatted some more. Then I left when her nurse got there.
The next day I was off. I was thinking about this patient and how nice she was. I called her room to check on her. I just let her know I had been thinking about her, and asked how she was doing...get well soon, etc. She seemed very appreciative.
A few days later I told her PACU nurse that I had spoken with her. This nurse was very offended with me and said I had broken HIPPAA (sp?) laws by calling the patient to check on her. Is this true? I just thought I was being nice. When I had my daughter, the L&D nurse called the next day to check on me. I know hospitals can be lonely places and thought one might like to hear a friendly voice and know someone was thinking of them.
Specializes in OR, public health, dialysis, geriatrics.
Did you violate HIPAA? Okay, let me ask a few questions, did you look up her contact information in the hospital computer system after you were no longer involved in her care? Did you look up her lab work, her medical history, call her at home? Most likely the answers to these questions are "No."
You did not violate HIPAA by being friendly when a patient most likely needed it. HIPAA doesn't stop us from being friendly and kind. HIPAA does stop us from accessing patient information when not involved in their care or sharing that information we do know with others.
What about nurses that date patients? Marry them? What you did was just fine and showed that patient that people care.
Although I am very careful to not initiate a conversation with a former patient that I may bump into in, say, the supermarket, I do not deny that person the right to greet me first. Can I get fired if they hug me? If they turn to their shopping companion and introduce me? Would the hospital have me turn and run in the opposite direction?
Yes, there is certainly a difference between a professional relationship and a personal one, but sometimes the lines blur. If someone I know is admitted to my unit, it is appropriate to refuse to be assigned to her. If her nurse needs assistance and I am the only one around, if possible I would ask the patient if it is okay with her that I assist.
These are two things that happened to me, both more than 25 years ago. I worked in acute dialysis, and was scheduled to be the off-unit person one day. The pt turned out to be one of my nursing school instructors. I did my job, she was quite ill, we spoke only briefly. I then had to treat her mulitple times after that. She told me later that she was very comforted by seeing someone she knew, someone she could trust, so she felt she could relax while I was there.
I lived for a while overseas, and worked in a neonatal ICU. On one of my days off, a woman I knew gave birth to a baby with multiple problems. The prognosis was grave. When I went to work the next day, I saw the baby (only 2 of us worked in the unit most days) and could easily see it was deformed. The mother came to the nursery to see the baby, and literally fell into my arms in tears. The next night, at someone else's home, the father asked me if I could 'help the baby die'. We all knew that the baby was going to die fairly soon, he just wanted it to be over. I told him that I couldn't do anything to harm the baby in any way. He cried, too, for his wife's agony, and the baby we all knew that wouldn't live much longer. The baby died before I worked again. My coworkers knew that I was familiar with the family, and offered me support. It was so sad at the time.
Should we never visit friends/family if they are patients where we work? Mt dad has his open heart surgery at the hospital where I trained, and I knew many of the staff. What then?
And, by the way, I never solicited my products to the patients - that would be crazy! But I went to the meetings with my former patient, and we became good friends.
Good sense needs to prevail here, and we need to stop using HIPAA as the almighty shield when it doesn't apply.
I agree with this. This has nothing to do with HIPAA. HIPAA's been whipped, beaten, and misused until it borders on meaningless.
HIPAA - Health Insurance Portability and Accountability Act.
Title I protects consumers from losing their health insurance when they lose or change their jobs (our not-really-a-friend COBRA reform came from this) and also limits the amount of preexisting condition restrictions group policies can place on policyholders. It also limits the number of days group policies can count as "continuous coverage" in an attempt to reinforce that companies' preexisting condition requirement. For example, if you work for Company X, use their group plan, and are diabetic, and you take two weeks off and go over to Company Y, Company Y's insurance company CANNOT, under Federal Law, force you to wait sixty days for coverage for your diabetes because you have less than 63 days of a break from continuous coverage. I busted an insurance company for trying this with me, and they were truly p.o.'d for being called out on a violation of Federal law. (There are exclusions, but they're few and far between).
Title I is the "Portability" in HIPAA.
Title II is the "Accountability" of HIPAA. Title II defines offenses regarding health care and sets up penalties. There are five rules: the Privacy Rule of 2003 (PHI falls under here, along with payment history and a person's medical record), the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.
Interestingly enough, HIPAA does not restrict medical professionals from disclosing PHI to family members over the phone (bet most folks don't know that - and any hospital who's terminated a nurse because of that and has cited HIPAA as the sole reason is one hundred percent wrong - feel free to go to the Department of Health and Human Services website and look it up). It does not restrict nurses from visiting patients on other units. It actually has very little to do with the relationship of RN to patient or of MD to patient (except when it comes to administrative stuff like billing and encoding and National Provider Identifiers). It has everything to do with what insurance companies try to do with people's PHI and EPHI (electronic PHI) and regulates how that information is shared and obtained.
A patient is certainly able to claim their PRIVACY has been violated, but in reality it all has nothing to do with HIPAA. Hospitals have overinterpreted (and in many cases incorrectly interpreted) the law until its actual intent is completely obscured.
Wow, what a sad day in nursing when an act of decency, compassion and commitment to relieving the suffering of others is interpreted as not only violating a privacy law, but an a nurse having a "boundary issue".
It sounds like some nurses DO have boundary issues. They have decided to remove the REAL human element from their work in order to avoid some of the more painful issues we all must face in helping sick people. They set such cold, wide boundaries that they literally have no warmth or personal connection to their patients anymore.
That's great for being a paperwork queen/time clock puncher, but as for being a nurse--well, that's just sad.
Ask yourself, would you rather have a nurse like you taking care of your elderly grandma, or someone who treated her like she was a "core measures goal" and nothing else? Keep on being that kind of "inappropriate", as far as I'm concerned.
Wrong! Wrong! Wrong! Obviously you have no respect for your fellow nurses and give them no credit for their selfless commmitment to the wellbeing of their patients. The nurses make sacrifice everyday for the patients and their families. Some are fired, disciplined, and arrested, like the nurses in Texas who were arrested and charged for advocating for their patients! Nurses already give too much of themselves and it is not that they do not want to give more but the price they pay for such a commitment is too great. Protecting each other outside of taking care of patients and their families should be our goal. To encourage a behavior, even if it is caring, which endangers a nurse is irresponsible and I am sure you will not, after your inconsiderate urging, contribute to her legal fund. Please stop the madness and be real!
I was told it was a HIPAA violation to inquire on a patient's status by any means (by contacting the patient or his/her family, asking staff, or searching hospital records) when the patient been transferred from your department.
Your heart was in the right place, but the action was not professional. Where I'm from, violating patient privacy is grounds for termination.
You know time they are a changing and things that were acceptable once are now frowned upon.
My mother in law is a kindergarten teacher. She relates that once she freely touched her students hands and arms and even gave the occasional hug. Today she has to be more careful and is certainly not allowed to hug a child.
I dont know if it is a sad reflection of society that a nurse can not follow up and give a caring call to a patient but it is a reality we all must accept.
I am sure you meant well and kudos to your good intentions, but in the future, remember where the line is drawn, personal calls are a no-no; call only if that is part of your job description, or get permission first.
So here's a question: why can't I as a nurse who took care of a pt go back to work the next day and look up that pt's status/labs/dx, etc? I'm looking at it from a learning perspective; if the pt's dx was up in the air when I last cared for him/her, I'd like to know if my guess was right. From what's being said here, it sounds like a violation. I don't see why.
So here's a question: why can't I as a nurse who took care of a pt go back to work the next day and look up that pt's status/labs/dx, etc? I'm looking at it from a learning perspective; if the pt's dx was up in the air when I last cared for him/her, I'd like to know if my guess was right. From what's being said here, it sounds like a violation. I don't see why.
From my understanding: because you're only allowed to access patient's records for their benefit (their care)....not your own curiosity.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I'll put out the flames for you if you are flamed:). You make important points. 1. HIPAA is here to stay so we need to protect ourselves 2. Even if HIPAA did not exist it only takes one complaint from a patient or family member to put oneself and employer at risk. So don't do it! No need to avoid former patients but avoid present patients when one is not assigned to them especially if one is not at work. I love your thing about pics of mom and baby:dncgbby:
Thanks. . .surprisingly I barely got singed! That FB pic of nurse and mom at end of chemo party actually happened to someone. I think one of her Facebook "friends" (yeah, right) turned her in, because the mom had no objection to the picture. That is another not very pretty after effect. Rivalries and bad blood in the workplace have resulted in one employee turning another in to the authorities not so much out of concern for the hospital's legal issues or the patient's privacy concerns, but as an act of spite. All in all, it is better to err on the side of caution, as it's an entirely preventable cause for the loss of one's job, especially with the economy the way it is now.
So here's a question: why can't I as a nurse who took care of a pt go back to work the next day and look up that pt's status/labs/dx, etc? I'm looking at it from a learning perspective; if the pt's dx was up in the air when I last cared for him/her, I'd like to know if my guess was right. From what's being said here, it sounds like a violation. I don't see why.
It might be different in a learning hospital where the focus of care is on both the patients benefit and the students learning but as a nurse who has also been in the shoes of a patient I would consider it a violation of my privacy to have staff who are not currently caring for me- read my chart just for the curiosity aspect or to see if she was right about a diagnosis. OTOH you might see something that the nurse on call doesnt and that could be beneficial for the patient.
In any event if we are erring better it be on the side of caution.
Most hospitals have phone systems that allow direct calls from the outside to patients' rooms, using the first 4 numbers for the hospital, with the room number following.....
I agree with all the people reinforcing your action as correct. These days patients need every "warm fuzzy" we can give them. Unfortunately some nurses don't follow through with patients unless they're getting paid for it, and when someone else does that from the goodness of his/her heart, they diss that.
We've been told not to take our work home with us, and that could be where some dissenting nurses are coming from.....but if the OP was concerned and truly wanted to hear the patient say she was OK, that's fine. However the OP needed to clarify that it was her need to find out how her patient was doing, not that she was worried about the patient, thus making the patient think that her condition was more serious than she'd thought it was.......and it could have given signals that she wanted to continue the friendship, and that could be more in the "fuzzy" boundary field. Still OK, and it could have been interpreted as a "mixed signal".
That sort of thing is more likely to occur early in one's career.
As a childbirth educator, I called my students 2 weeks after their EDC if I didn't hear from them, to know how their birth experience had been; and remind them about the reunion that was scheduled at the end of their classes. If they asked about other students' experiences, I'd say that they could talk to that person about it at the reunion. When a tragedy occurred and a baby was very ill or deceased, I asked that parent if I could share that with the class, and what they'd like the other students to know. They always gave their permission verbally, and said that the details could be revealed by me. Usually classes became quite bonded during the series.
The whole reason behind HIPPA, was insurance companies' need to get information about patients' treatments, so they could pay their bills (and charge higher premiums if an illness occurred that could be called a preexisting condition).
Most hospitals have phone systems that allow direct calls from the outside to patients' rooms, using the first 4 numbers, with the room number following.....
I agree with all the people reinforcing your action as correct. These days patients need every "warm fuzzy" we can give them. Unfortunately some nurses don't follow through with patients unless they're getting paid for it, and when someone else does that from the goodness of his/her heart, they diss that.
We've been told not to take our work home with us, and that could be where some dissenting nurses are coming from.....but if the OP was concerned and truly wanted to hear the patient say she was OK, that's fine. However the OP needed to clarify that it was her need to find out how her patient was doing, not that she was worried about the patient, thus making the patient think that her condition was more serious than she'd thought it was.......and it could have given signals that she wanted to continue the friendship, and that could be more in the "fuzzy" boundary field. Still OK, and it could have been interpreted as a "mixed signal".
That sort of thing is more likely to occur early in one's career.
As a childbirth educator, I called my students 2 weeks after their EDC if I didn't hear from them, to know how their birth experience had been; and remind them about the reunion that was scheduled at the end of their classes. If they asked about other students' experiences, I'd say that they could talk to that person about it at the reunion. When a tragedy occurred and a baby was very ill or deceased, I asked the couple if I could share that with the class, and what they'd like the other students to know. They always gave their permission verbally, and said that the details could be revealed by me. Usually classes became quite bonded during the series.
The whole reason behind HIPPA, was insurance companies' need to get information about patients' treatments, so they could pay their bills (and charge higher premiums if an illness occurred that could be called a preexisting condition).
I respectfully disagree with what you said about a nurse who respects the professional boundaries of her job as dissing "good" nurses who truly care about their patients even if they are not getting paid for it,( and I am not convinced that that is what the OP meant- BTW almost all the nurses I know end up doing proffessional work after hours and for nothing) and also with what you claim to be the "whole reason" behind HIPPA and dont think you can compare your follow up call to your students with a nurse calling a former patient just to say Hi and How are you and did my hunch pan out.
Yes it is up to the nurse on duty to give the warm fuzzy caring approach as needed and sometimes I have to take a harsher approach depending on the situation... but at the end of the day if the patient wants to keep in touch, let it be the patients prerogative. If you happen to pass the patient in the hall it is appropriate to say "HI, how are you?" but better to respect the patients privacy over the nurses curiosity.
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Did you violate HIPAA? Okay, let me ask a few questions, did you look up her contact information in the hospital computer system after you were no longer involved in her care? Did you look up her lab work, her medical history, call her at home? Most likely the answers to these questions are "No."
You did not violate HIPAA by being friendly when a patient most likely needed it. HIPAA doesn't stop us from being friendly and kind. HIPAA does stop us from accessing patient information when not involved in their care or sharing that information we do know with others.
What about nurses that date patients? Marry them? What you did was just fine and showed that patient that people care.