Within practical contexts, ethical conduct of employees is as important in nursing as it is within any other professional field. Nurses are required by occupational guidelines to provide care towards patients in the most ethical manner possible. The basic precepts of nursing ethics emphasize that nurses should not employ actions that will inflict either physical or emotional injury to their patients. This means that employees within a healthcare facility, which include the nursing fraternity, are obliged to uphold high level of standards in creating sustainable relationships with patients. According to Perron and Pronsati (2012), those high standards should be guided by a general tendency to act in a respectful and compassionate way. In actual practice, nurses are required to strictly adhere to a code of ethics. Failure of nurses to follow ethical guidelines in relating to patients and other stakeholders within a healthcare setting may result in punitive action. Typical punitive actions include revocation of practice license, suspension from work and even termination of employment.
Workers Fired in Tucson, Arizona
In order to appreciate application of ethical standards within a practical workplace, we will consider two different cases relating to punitive actions from unethical practice by occupational nurses. In January 2011, three workers from a hospital in Arizona were fired for snooping on a patient’s medical records. On the issuing of official report regarding the incident, the hospital’s management asserted that the nurses rode on their curiosity to unchartered unethical zones. Hensley (2011) says that as a result of their snooping, the employees violated a zero tolerance policy adopted by the hospital on patients’ privacy. Supposedly, the affected nurses were trying to get in touch with information relating to the shooting of a congressperson who was hospitalized within their workplace. During subsequent legal proceedings, one of the fired employees admitted to violating ethical policies and pleaded guilty of breaking federal laws relating to medical privacy.
Apart from application of ethical policies within an actual workplace, nursing students are also required to demonstrate significant adherence to ethical values. In January 2011, one case being heard within a district court Kansas features a 22 year old student of nursing seeking an injunction against her college for being booted shortly before her graduation. In what the student calls a momentary lapse in judgment, the school found her unethical for posting a photo of placenta on Facebook. The photo was online for three hours until the student was advised by her colleagues to remove it. Sandler (2013) says that according to an official report from the college’s director of nursing school, the student in subject displayed unprofessional behavior contrary to what is expected of individuals undertaking a nursing program. Although the student removed the photo from her timeline, she was not able to secure her re-admission into the nursing college. Consequently, her unethical behavior at school placed her future career potential as a registered nurse at a blurred position.
Ethics in Health Insurance Portability and Accountability Act, HIPAA
Based on the two exhibits, one can acknowledge the fact that ethical values plays a significant role in guiding both nursing students and registered nurses in their respective undertakings. In this context, both students and employees within the nursing field should subscribe to ethical standards outlined within HIPAA and other medical privacy Acts. In school, all nursing students are practically required to undertake HIPAA training before completion of their program. Delphia (2013) asserts that upon completion of the training, both undergraduate and master’s students will be assessed in order to ascertain their knowledge on ethical values within HIPAA structure. In a healthcare setting, all registered nurses will have the responsibility of ensuring that their professional conduct conforms to provisions of HIPAA guidelines.
In case you are coming across HIPAA provisions for the first time, it would be appropriate to outline some of its basic principles touching on upholding ethics within the nursing field. First, HIPAA is a federal law that strives to protect privacy information of patients within a healthcare facility. During academic programs, nursing students learn about Protected Health Information, PHI, and the special rights enjoyed by patients within a healthcare institution. In addition, students learn about professional obligations of a registered nurse in complying with HIPAA standard of ethics. According to Delphia (2013), HIPAA assert that individuals’ health information should be protected from access by unauthorized parties. In relation to Tucson Hospital’s case, the fired nurses violated ethics of nursing informatics by gaining access to unauthorized information. In this case, the congressperson’s Protected Health Information landed into unsafe hands; hence resulting in violation of medical privacy policies.
In relation to the student’s photo of a placenta within a laboratory setting, HIPAA steps in such contexts by prohibiting reception, use and disclosure of medical information in an unethical manner. In case one must disclose medical information to the public, he or she should consult with relevant privacy officers for guidance and permission. In this case, the student in the case violated HIPAA privacy guidelines by failing to seek guidance from the teaching staff prior to uploading the offensive photograph. Perron and Pronsati (2012) says that apart from seeking guidance, the HIPAA module offered in nursing programs emphasize that individuals within the nursing profession should be at the forefront in advocating for ethical practice in relation to reception, use and disclosure of medical information. Apparently, the student in subject failed to uphold the required level of ethical standards. At this juncture, it is evident that the two cases features instances where individuals within the nursing field failed to maintain ethical standards as provided by federal guidelines like HIPAA.
Similarities in the Cases
At this point, it is worth acknowledging the fact that both cases deals with abuse of medical information by individuals within the nursing profession. Both students and practicing nurses have a responsibility to safeguard patient’s information. In case these individuals are authorized to access such information, they are charged with the responsibility of using them ethically. In modern healthcare settings where technology plays a significant role in managing information, professional responsibility of nurses in handling of PHI becomes indispensible. Perron and Pronsati (2012) agrees that as opposed to traditional techniques of storing patients’ medical records, use of electronic systems in modern contexts increases risk of unauthorized access from unwanted parties. On the other hand, presence of comprehensive social platforms like Facebook facilitates sharing of information to a wide range of consumers. In this regard, both Tucson and the student’s cases revolve around the use of technology in violating ethics of nursing informatics.
Differences in the Cases
On the contrary, the two cases differ on the intention of employing unethical conduct in their respective roles. In the first case, the three workers fired by the hospital’s management had the intention of obtaining and selling information relating to the injured congressperson. In this case, the nurses’ curiosity to access unauthorized information was motivated by the mere need to acquire monetary proceeds from their actions. After receiving medical data from the hospital’s records, the three staff members leaked the information that was later published on one of the leading newsletter. However, the student did not intend to use the placenta photo for financial gain. Sandler (2013) says that in fact the student singled out that incident as a momentary lapse of judgment. The difference in intention behind the two unethical practices sets a contrast between the registered nurses and the student. In this case, the nurse compromised the element of confidentiality of patient’s information as emphasized within the HIPAA provisions. On the other hand, the student did not compromise on confidentiality, but exercised relaxed adherence to ethical standards expected of nursing students.
Authorized Access to Health Records
After identifying the conspicuous unethical incidences within the two cases, one might want to know the staff members who are allowed to have access to patient’s medical records within a healthcare facility. Inasmuch as all health workers within a given facility have the responsibility to protect information, it would be hard to trust all staff members. Therefore, ethical guidelines provided within the HIPAA framework states that system users within a facility should protect data in regards to accuracy, privacy and damage. According to Delphia (2013), administrators who are in possession of login details to patient’s records are responsible for ensuring protection of information from unauthorized eye, both inside and outside the organization.
Currently, tough protection measures are usually employed in order to deter any attempt to acquire information through unorthodox means. Such protection measures include the use of security cards, voice and finger print scanners together with login details to every system within a hospital. Only the doctor and nurses responsible for treating a patient can have access granted through all these barriers. As an ethical obligation, these authorized personnel are advised to jealously guard their username and passwords in order to professionally protect information from prying eyes.
Limits when using Electronic Health Records
Despite the fact that nurses and doctors responsible for a given patient are authorized to access medical information, they are limited to using them in a compromising manner. For example, medical staff are allowed to disclose medical information to parties like health insurers, employers and advanced medical service providers. In addition, Protected Health Information contained in electronic records may be disclosed to judiciary and law enforcement agencies for purposes of administering justice where necessary. Apart from state agencies and business associates, disclosure of information to any other party is prohibited and requires the patient’s consent. According to Delphia (2013), this means that doctors and nurses are limited to disclosing electronically stored medical records to third parties outside the covered entities perimeter.
Advantages of Ethical Practices
Employing ethical practice in nursing benefits the healthcare facility, but most of all, ethical treatment of individuals is to the advantage of patients. In most cases, diagnosis and treatment of certain medical conditions requires patients to tell of their previous social ordeals, which may be ugly and shameful. In such cases, patients will be required to tell the truth without fear of being judged by the hospital’s staff. In such cases, information gathered from patients’ testimonies should be treated with the highest level of confidentiality possible. According to Leslie (2011), ethics of nursing informatics asserts that medical staff within a facility will not take advantage of informational vulnerability of patients. Therefore, practicing good ethics benefits patients by maintaining their dignity despite telling of ugly truth from past circumstances.
Disadvantages of Unethical Practices
Despite the positive aspects of nursing ethics, professional conduct that undermines provisions stipulated within the HIPAA framework presents disadvantages to patients. In the case of Tucson, the fired employees accessed and disclosed unauthorized information without the patient’s consent. The leaked information ended up on public domain, thus enhancing vulnerability of the congressperson. This behavior lies contrary to the practice of informed consent, which should be respected by all nurses in their professional duties. In an event that a patient is incapacitated, nurses are required to follow an advanced directive obtained earlier from the patient. According to Leslie (2011), this directive outlines the manner in which patients will be treated in case they cannot make informed choices. Therefore, unethical practices that do not adhere to principles of informed consent risks subjecting patients to unwanted paternalism.
The two cases provided a platform through which we could appreciate the role of ethics in a practical workplace. In addition, the cases also enable one to understand importance of professional conduct both in educational programs and within the field. At this juncture, it is undeniable that ethical behavior is indispensible from the nursing practice. Consequently, this will encourage nursing students to take modules on HIPAA with keen attention.
Delphia, T. (2013). Informed Consent and Advance Directive in Treating Patients. Journal of Nursing Ethics, 4(12), 17-21.
Leslie, J. (2011). How Patients Benefit from Ethical Healthcare Practices. The Journal of Professional Nursing, 15(3), 5-7.
Perron, M. & Pronsati, S. D. (2012). Applying ethical policies in clinical settings among nurses. The American Journal of Nursing, 9(2), 12-17.
Hensley, S. (2011, January 14). Snooping Tucson Hospital Workers Fired in Records Breach. Health Inc. Retrieved from http://www.npr.org/blogs/health/2011/01/14/132928883/snooping-tucson-hospital-workers-fired-in-records-breach
Sandler, J. (2013, January 22). Nursing Student is expelled over Facebook Photo. The Kansas City Star. Retrieved from http://m.columbiatribune.com/news/nursing-student-is-expelled-over-facebook-photo/article_bb67da09-ce08-5d6a-9560-8720b0960576.html