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What's a public health RN to do if a new administrator wants non-nurses to job shadow the RN to people's homes during home healthcare visits?

Friday April 11, 2014
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Question:

Dear Nancy,

I work for a county public health department. We have a new administrator with no nursing background. She has decided it would build teamwork if we all job shadowed each other. She wants the highway department worker to make home visits with the nurses and the nurses to visit inspections of wells. I am more than a little hesitant to have a non-medical person accompanying me into someone's home. There are things that cannot be shared and so will either not be addressed or the visitor will have to leave the area. I have been threatened with firing if I don't get with the program and maybe that would not be a bad thing.

Melissa



Dear Nancy replies:

Dear Melissa,

It sounds as though your administrator needs a crash course on patient confidentiality, patient privacy and HIPAA, if your department is a "covered entity" under the act, at the very least. Although the idea may be an interesting one in order to build teamwork, it is at the expense of the patients you see in their homes.

One way to consider handling this is to check with your county public health department's head and/or the legal counsel for the department. One thing they might suggest is obtaining the patient's written and informed consent for any other member of the team to accompany nurses on their visits. If the department adopts a valid consent form, the patient consents, and the consents are made a part of the patient record, then the patient's confidentiality, privacy and HIPAA compliance would
be protected.

Insofar as you getting fired being a good thing, it is never a good thing to get fired from a position you hold. For one thing, the firing may be required to be reported to the state board of nursing. Second, this firing may follow you to other positions. Third, if you would apply for unemployment compensation, the employer may say you were insubordinate in not following the program, so you would be denied unemployment based on the misconduct category.

You can try and raise this issue in the department with someone who can do something about the proposed team building, such as a clinical person in the department hierarchy to whom the administrator answers. If no one will listen to your concerns, you can explore reporting this proposed plan to an outside agency (with the input from a nurse attorney or other attorney in your state). If all else fails, your best protection would be to resign your position. This will not help those patients who are seen by other nurses in your department with non-medical team members, but you will not be placed in the position of breaching patient confidentiality and privacy.


Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.