Monday, December 5, 2011
Nursing history emerged from a tradition of nurses as angels of mercy, selflessly devoting their working hours to care of patients. Although modern nurses don’t like to view themselves that way, there is much truth to that image, even today. We would trust our care to the large majority of nurses we have known. But like all stories, there is another side to it.
Physicians have been criticized for releasing too much patient information on their blogs. Nurses do the same. Allnurses.com claims to be the largest online nursing community with over half a million members, the vast majority of whom are undoubtedly active nurses though membership is not restricted. A recent thread on allnurses.com reveals many disturbing anecdotes. The thread is called “Nine things nurses don’t want you to know.” The first item is: “Yeah, we look......and no, we're not above whispering to our co-workers, "Psst! Did you get a peek at the guy with the foot-long whatsis in 216?" Now the poster said after being challenged that this was a tongue in cheek comment, but other posters in this thread make it clear that similar incidents do happen. Although a few do condemn this as being a serious infraction (probably many more than posted that point of view), still too many seem to consider this behavior just part of the culture.
Comments include a poster who said that she might not comment upon a man’s body parts but knows nurses who do. Another said nurses have always engaged in shop talk and always will, but added that it’s reasonable as long as it is not done in public. After a protest, the original poster commented that it may not be nice to discuss the anatomy of a patient over coffee, such as the guy who needs an extra long Foley, but it happens and it doesn’t help to get upset over it. Another poster recounted having a pre-op woman up in stirrups, and people coming in to view her shark tattoo between her legs. She doesn’t say whether the patient was under anesthesia at the time though that is likely.
In this long thread there were initially no complaints registered but slowly a negative reaction occurred, mostly from posters who are probably not nurses. Two posters challenged the female nurses to consider how they would have reacted had a male nurse written a similar statement about female patient body parts. Others warned that allnurses.com is not a private blog, but goes all over the web and is read by some who look for just such evidence to condemn nurses.
To be fair, a few nurses commented that anything like the first item (the foot long whatsis) had never occurred in their career. We believe both of them. Incidents like this are very individual; they may occur on one floor of a hospital and never in another. It only needs one person to offend. We have never been made aware of an incident like this, but it’s unlikely any nurse would confide this to a physician. What perhaps is most disturbing about this thread is that very few people would be willing to criticize their fellow nurses for actions like this, not to mention report them. This demonstrates a very unhealthy culture of silence at some hospitals where nurses and nurse assistances fear retaliation for reporting incidents like this. It is further reinforced by a recent thread on allnurses titled “And it’s all going to be your fault." Look below this post to see how many nurses agree with this view. In some hospitals, nurses feel they are at the bottom of the pecking order and are scapegoats for whatever goes wrong. They fear any challenge to the powers above.
These gross violations of privacy described in the original post titled “Nine Things” are against the law, but they are not covered specifically by HIPAA. We don’t think the feds have ever brought an action against providers for physical encounters or oral breaches of privacy, though oral transfers of protected health information are covered. HIPAA is almost all centered on digital and printed information protection, not on personal encounters. Yet likely all states have laws regarding personal privacy in healthcare that would cover it. Certainly taking an unnecessary peek at a patient’s genitals is considered sexual misconduct which could result in the loss of license in every state.
There is reluctance in every profession to report one’s comrades. This happens with physicians as well as nurses. A New Mexico otolaryngologist, Dr. Twana Sparks, was disciplined by the state board following years of operating room misconduct wherein she would fondle the genitals of male patients under anesthesia in the presence of the OR staff, making derogatory comments about the patients. The hospital was aware of this and did nothing until one nurse filed a formal complaint. For years the hospital laughed off the incidents. There have of course been many incidents over the years against male physicians though there is perhaps less reluctance to lodge complaints against men for sexual misconduct.
In the initial ‘Nine things’ thread, some patients commented that they avoid medical care because they’d get demeaned because of their obesity. It’s not uncommon on allnurses to read what are called “rants” about obese or otherwise stigmatized patients. This is not to say there are not “difficult” patients who can be rude and overbearing. But some of these rants offer no benefit to the vast majority of nurses who treat patients with respect not only in the hospital room, but also in the break room. It’s hard to reassure anyone that their fears are unwarranted, especially if they have an unusual anatomy or disability.
It’s astounding to us that so few nurses looked upon divulging prurient tidbits about identified patients as a serious infraction. They seem to think that as long as it stayed on the floor or in the coffee room it was business as usual. It is widely accepted now that no information should be divulged unless there is a need to know. Regulations mandate that all hospital staff must be instructed on patient privacy concerns. It seems like they do a very poor job of it. JCAHO should mandate reforms.
Posted by Joel Sherman MD at 6:25 PM