Five years ago, Jane Doe* was an inpatient at the XYZ Psychiatric Medical Clinic, being treated for long-standing cocaine use. Hers was a voluntary admission; she’d never been arrested, charged, or convicted of a crime.
After her discharge, Jane made a number of life-changing decisions, among them to pursue a nursing care. She entered and graduated from a 4-year nursing program and now works as a staff nurse in the critical care unit at St. Elsewhere Hospital. During the application process, she didn’t mention her previous problem with substance abuse. When asked during her initial interview whether she’d used drugs in the last 5 years, she truthfully answered, “No.”
Sisella Roe*, RN, works with Jane. Actually, Sisella first encountered her when Jane was a patient at XYZ Clinic and Sisella was working her way through nursing school as a certified nursing assistant. Jane doesn’t remember Sisella, but Sisella remembers Jane well.
In recent months, the ICU where they both work has fallen under scrutiny because an unusually large amount of controlled substances have gone missing, triggering an investigation. No one has been accused of impropriety, but Sisella suspects Jane is “using” again. She has no proof. No one, including Sisella, has seen Jane take anything. But Sisella thinks Jane acts “strange” sometimes. She wonders whether she should go to her manager to report what she knows and how she knows it.
Jane, for her part, is fully aware of the unit’s problems regarding the missing controlled substances. And she’s petrified. She wonders if she should divulge her past drug use to her manager and explain that she has been in recovery for the last 10 years since her voluntary hospitalization at XYZ Clinic.
So the questions before us are: What should Sisella do? And what should Jane do?
This case opens a can of worms. The first problem we need to address is Sisella’s. Although Sisella was a nursing student when she met Jane, there’s no question how and where she learned of the confidential information she acquired about her. Therefore, she owes Jane a duty of confidentiality. This duty holds because Jane was her patient, even though at the time neither woman was an RN. And this duty would hold even if Sisella hadn’t become an RN. Most assuredly, the privacy regulations of the Health Insurance Portability and Accountability Act (HIPAA) require her to keep private the information that came to her through her employment at XYZ Clinic. Moreover, as a nursing student, she’s bound by the ANA Code for Nurses, which also requires nurses to keep patient information confidential. Thus, she should not divulge information about Jane to her manager.
Moving on to Jane’s quandary: Jane would be well advised to tell her supervisor about her history of cocaine use, especially in light of the current investigation on her unit. Also, she should assure her supervisor she was completely honest in her employment interview—that she answered honestly when she said she hadn’t taken illegal drugs in the past 5 years. She also may want to volunteer for a drug screen. She should do these things not because she has to, but because doing them will help her avoid even a shadow of suspicion.
If, perchance, Sisella discloses confidential information about Jane to her unit manager and reveals how she acquired this information, the unit manager should counsel Sisella and require her to attend an inservice program on the legal and ethical requirements of confidentiality. The only exception to the requirement for confidentiality would be if Sisella were required to testify under oath before a court of law: nurses still aren’t allowed to claim privileged information.
If Sisella has evidence Jane is using controlled substances now, she should report this to her manager—but without mentioning her knowledge of Jane’s previous problem. If not, she should remain silent and respect Jane’s right of privacy.
Bottom line: When what you know about someone was learned as a result of your employment in a healthcare facility, it is—and must remain—confidential.
* Not a real name
Dr. Leah Curtin, RN, ScD (h), FAAN, is Executive Editor, Professional Outreach, American Nurse Today. An internationally recognized nurse leader, ethicist, speaker, and consultant, she is a strong advocate for both the nursing profession and high-quality patient care. Currently she is Clinical Professor of Nursing at the University of Cincinnati College of Nursing and Health. For over 20 years, she was the Editor-in-Chief of Nursing Management. In 2007, she was appointed to the Standards and Appeals Board of DNV Healthcare, a new Medicare accrediting authority. Dr. Curtin can be reached at LCurtin@healthcommedia.com.
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