RN violates patient confidentiality policy to envision work schedule

Compliance with patient confidentiality policies is the first responsibility of each nurse in any setting.

I actually have discussed this topic in several blog posts, including: “What happens when a nurse violates patient confidentiality” and “Protecting patient confidentiality matters.” A breach most frequently occurs when a nurse shares patient information with someone who just isn’t a member of the health care team, or when a patient’s electronic health record is accessed for private reasons when the nurse just isn’t providing care. The nurse has discovered how far-reaching the duty to follow the patient confidentiality policy is in a case Leach v. Iowa Board of Nursing. A nurse who worked in a hospital intensive care unit used distant patient records 11 times when she was not at work. The letters contained private health information, including patient names, ages, diagnoses, medications, and other personal information.

When the supervisor discovered that the nurse had access to the lists, she was questioned. The nurse was checking lists to find out the variety of staff within the ICU and whether she can be required to work her assigned shifts.

The nurse was told her actions were a violation of the hospital’s “information security policy” when employees were in distant locations and didn’t seek authorization. Moreover, the supervisor informed the nurse that any access should be “necessary to fulfill her job duties.” The nurse was disciplined, suspended from work for 2 12-hour shifts and required to repeat a training module on the Health Insurance Portability and Accountability Act.

The principal files a criticism with the state board

After the committee conducted an investigation into an alleged violation of the patient confidentiality policy, probable cause was determined and a hearing was initiated. The nurse received a subpoena for a hearing and was charged with violating her duty to guard patient confidentiality and privacy rights, in violation of the state Nurse Practice Act and administrative regulations. A contested hearing was held, leading to the committee finding that the nurse:

• She accessed patient lists for her own purposes to find out whether she would work the subsequent day or be placed on call.
• I didn’t use the data from the lists for some other purpose.
• He didn’t share this information with anyone else.
• I didn’t read any personal information within the letters.
• He was not authorized to access the lists from the distant location.
• She didn’t need this information to perform her duties as an ICU nurse.

As a results of these findings, the committee found that the nurse’s behavior was unethical based on a “preponderance of the evidence” (weight of proof). Because the board believed that the nurse didn’t understand that her behavior was a violation of its patient confidentiality policy, and the hospital determined that the behavior was not a HIPAA violation, the disciplinary penalty imposed was the least severe punishment – a citation and warning. The nurse filed an application for judicial review of the commission’s decision. The district court dismissed the nurse’s application.

A disciplined nurse appeals against the choice

The nurse asked the appellate court to overturn the district court’s ruling, maintaining that she never shared the data with anyone else and that the board’s ruling finding a violation of the Nursing Practice Act and Rules was “irrational, illogical, or wholly unreasonable.” She further alleged that there was no substantial evidence that she had read any of the patients’ protected health information.

The appellate court made it very clear that the board had the authority to discipline the nurse under the Nurse Practice Act and its rules on unethical conduct. He also emphasized that there was no need to supply proof of actual injury (to the patient).

The court opined that despite the nurse’s insistence on what she had not done, her conduct was a violation of hospital policy designed to guard patient confidentiality. The court also found that she knew or must have known about these rules. The court couldn’t find that the commission’s decision was “irrational, illogical or completely unjustified.” The Board of Nursing has the authority to make and interpret the Nursing Practice Act and its regulations. As a result, the court assessed the commission’s application of the law and facts on this case “through the lens of our deferential standard of review.” The decision of the District Court issued in reference to the submitted application for reconsideration of the case was upheld. As a result, management discipline was maintained.

How to avoid an analogous result

The nurse on this case made an error in judgment when reviewing the ICU patient lists to find out her work schedule. Unfortunately, this error led to serious and expensive consequences. In this case, the nurse could have simply asked for permission to access the lists or, much more simply, called the ICU charge nurse to find out whether she can be needed on her assigned shift. Other guidelines for nurses to contemplate include:

• Please review and follow your workplace’s patient confidentiality policy.
• Know your responsibilities under HIPAA.
• Remember that any violation of your state’s nursing practice statute and/or policy is not going to end in injury to the patient.
• Learn about your nursing practice’s policies, patient confidentiality policies, and other patient privacy policies.
• Knowledge of and compliance with ethical requirements governing patient confidentiality and privacy in accordance with the American Nurses Association Code of Ethics for Nurses including interpretive statements.
• Judicial review of the nursing commission’s decisions is feasible, however it must be remembered that unless the choice is inconsistent with the commission’s powers and powers, it would be upheld by the court.
• Although the discipline will be the least severe, it continues to be discipline that affects the nurse’s work.

Take these courses to learn more about protecting patient confidentiality and your license:

In this course, you’ll find out about parts of HIPAA, especially those related to nurses and other health care professionals and the protection of health care information. Because you play a key role in creating health care information, you play a key role in protecting it.

The primary function of Facebook (and other social networking sites comparable to Twitter) is to permit “friends” to exchange information. In healthcare, Facebook posts can influence the recruitment process, violate patient privacy and end in termination of employment. This module informs healthcare professionals in regards to the dangers of social networks that break down the partitions that separate our personal and skilled lives.

The aim of this course is to tell nurses on how you can best use social media to reinforce their careers while avoiding potential pitfalls

Because practicing as a nurse is a right granted by the state to guard those in need of nursing care, nurses have an obligation to patients to practice in a secure, competent and responsible manner. This requires nurse licensees to practice in accordance with the statutes and regulations of their states. This course provides information regarding nursing practices and their impact on nursing practice.