labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, December 31, 2007

Answering With The Man In Mind

I have had several women in my last few shifts that seemed very interested in what was going on on the unit. This usually stems from them starting off in our triage room, which is essentially a throwback from the days of wards. The triage room is just one large room, one bathroom, and curtains as the only means to privacy. We do have those white noise makers, but no one ever turns them on (except me) and if they are on they mysteriously are shut off.

So anyone who enters our triage room knows they are not alone. They listen to what is going on in any one of the "bays". Typically it is family members and friends who are the most interested, given that the woman they are with is in labor and quite uncomfortable and could give two shits about anything else. When one of those laboring women starts asking questions about everyone else in the room, I find it curious.

Anyhow, I have worked some busy shifts lately, and have not been very timely to all of my nurse calls. For instance, I am in the middle of getting a mom out of bed for the first time after her c-section, and she ends up nauseous and faint while in the bathroom. My lovely nurse phone (picture a circa 1989 cell phone) that must be carried around so that everyone can keep track of my every move all shift long-including bathroom breaks...yes we are expected to answer the damn phone while sitting on the pot- rings from another of my patients room. I had help with me at this point so I could step out of the bathroom with my patient to see what the other patient needs. It's only something minor, and so I tell her that I'd be in to see her in about 10 minutes.

I get my faint c-section mother back into bed, get her settled, and head over to the woman who called me. The first thing she asks me was what was I doing. I told her I was with another patient. And she presses me for details. I tried as vaguely as possible to answer her, saying that I was with someone who wasn't feeling well.

This leads into questions about what was going on on the floor in general, how many woman did we have in labor, how many babies were already born today, etc etc. And the times I have been asked these things I wonder how much do I answer? What would violate HIPAA policy? And how often can we say, "I can't answer those questions because of HIPAA policy" before sounding like puppets for The Man?

I guess where I am going with this is that I don't necessarily think any of these questions are out of line, sans the 'what were you doing when I called?' question, but if I say that we had 3 babies born or we have one woman in labor does this constitute a HIPAA violation? My interpretation is no. I'm not divulging who came in, what their names are, any health information about those babies or women, or even what room they are in.

Yet we as nurses feel compelled to say, "I can't answer on grounds of HIPAA". And what if we give the general answer that we have one woman in labor, we then get asked, "Is it her first baby?" Many times I won't know this anyhow, but is it illegal to answer yes or no? I mean, could someone deduce who that woman is from knowing if it was her first baby? How many women come in in labor with their first baby? Thousands!

I'd like to get your opinions on this, and if you are a nurse how do you handle these questions?

11 comments:

Andrea said...

I HATE those stupid specktralink phones. They would always ring during a dressing change or a code brown or some really inopportune time. I always told my patients that "I'm caring for YOU right now, whoever that is can call back." My friend just dropped hers in the toilet the other day. And yes, I've taken telephone orders while sitting on the toilet going poo.

I currently work in an ICU where a lot of rubber-necking goes on with visitors. The other day I had a patient's wife asking me about a man down the hall who was looking particularly gruesome. I answered that "Yes, he's very ill, but to respect his privacy, I can't answer any questions." Sometimes the families get to know one another in the waiting room, so I direct their questions to each other if possible. Otherwise, it's vague stuff like, "Yeah, that patient is quite ill." or "Yes, that's a ventilator/CRRT machine/whatever".

AtYourCervix said...

I'll answer in a vague sort of way. I usually get the "how many other women are having babies tonight?" or "is the unit busy tonight?"

When I get the "did so-and-so have a boy or girl?" that's when I claim HIPAA. Usually, the person knows that the other patient is here - and in what room - because their friends or relatives. I usually just tell the dad to go knock on the door to find out (and they never take me up on that!).

momomany said...

I'm one of 'those' moms that will ask questions about other patients but not in an interoggative or accusative manner. Usually it arises from knowing of a crisis with another mom either from triage, walking the halls or overhearing staff, or the actions of staff (like running from my room to another). I never want to know details, it is more of a "Is she OK and are you OK?" I have had staff divulge details to me about other patients, completely without prompting from me, honestly, I'm sure violating HIPAA. Happens almost every time I have a baby, and has actually gotten 'worse' with the last few. Maybe because I am a grand multip and they need to do next to nothing for or with me, I have a pretty open, friendly personality, or because I make an effort to make my nurses job as easy as possible..most nurses tend to get chatty with me. I am pretty much the anti-thesis of the primip-prima-donna, I speak the language, I think some nurses just get really (maybe too) comfortable with me.

PE Mommy said...

My first daughter was born in a university hospital in Belgium. I was the "sick" patient on the floor. Even through the mag haze, I was told that I went faster than the other mom in labor with her 6th kid. Somehow all the other moms found out that a lot of attention was being spent on me as I was so ill. I was also told that I was the only one "allowed" an epidural that night. They don't believe in those in Belgium!!! I got mine before they started labor.

My second baby, was an emergency induction. They told me that they had all the mommies that were due to deliver in June in. I was the first July mom in (dd was born 6/28 and I had been due 7/30). They also told me there were 5 women in labor, alot for this small rural hospital. I wanted an epidural which didn't work. They told me there was someone in front of me. So I was surprised when the guy came in in shorts and a tshirt straight in from home. I said I thought someone was in front of me. Oh she is already pushing. Umm yeah, could hear her screaming down the hall.

As a patient, it is new and mysterious thing. I guess it calms us down to think of something other than our own issues???

DisappearingJohn said...

I don't think it is a HIPPA thing at all, but I don't think those types of questions should be answered, either; at least the specific ones. I've always tried to use the, "I try not to talk with my patients about all the other patients, that way no one's privacy is violated. When you're on the floor, you can talk with each other, but then its up to each of you what you share....

I wouldn't have a problem saying, "We've got 4 mom's now, two of which recently gave birth" so they know you're busy, but also know you care about their privacy, too

A.J. said...

I was in the hospital for six weeks before I had my son at 35 weeks. I spent so much time there I found myself asking a lot of questions. I tried not to be pressing or ask questions that may be inappropriate because I worked in health care myself at the time. (Fired while hospitalized so two people off the street with no experience whatsoever could be hired for the same amount it cost the company to pay me. I guess I was needed anymore after nearly five years and using my credentials to gain accreditation. They still haven't notified the AASM that I was terminated three months later. The fact that they are no longer in compliance might have something to do with that...) ANYWAY, some nurses seemed upset and annoyed that I asked questions, getting flustered by them while others answered vaguely and others yet may have given a bit more information than they should have. I asked questions like, "Another c-section, huh?" when my nurse came in in surgical attire. "Did the number of patients go down?" when the charge nurse wanted to move me out of the LDR room I had been in for three weeks (read: acquired a lot of stuff) because there were only three open LDR beds. I laughed and joked about screaming women with my nurses. I asked if the other patients in pre-term labor were still doing okay. When my son was in NICU, I had trouble not looking at other babies. I was given a set of rules and one of the rules was, "Do not look at any baby other than your own." I was scolded frequently for brief glances or looking at an infant as the nurse who was feeding it talked to me about mine. I understood HIPPA and blahity blah blah but I found myself a bit annoyed with the scolding because I would often come in to nurse at the same time as a mother of twins and nearly every time she would be standing over my son's isolette and no one said a word to her. Ah well.

Labor Nurse said...

Several commenters reminded me something I notice some of our nurses and doctors doing without any patient prompting: informing the patient they are with where they fall in line in regards to who's how many centimeters dilated, who's pushing, who'll likely be pushing next, etc etc. I've never witnessed any of these staff people divulge names of the other patients, but on occasion I have heard a doctor or nurse mention room numbers. Like, "You and room 6 are both 6 centimeters... I wonder who'll be pushing first?" (Like it's some sort of competition) I do think this type of information is crossing the line...I can just imagine one of these days there will be a ballsy family member waiting outside room 6 for one of that woman's family members to get even more info!

We also do not have a locked unit. Most L&D's are locked, but for whatever reason ours is not. This invites all sorts of transients in our halls (anyone remember the gang that was present for one of it's "homies" births?) that have varying degrees of curiosity.

I personally don't know how anyone can not look at what's going on within an ICU or NICU. Everything is open. Even I would be glancing at all my surroundings while walking through. Perhaps those units should require visitors and staff that don't work on the unit to wear the horse blinders on to ensure we aren't sneaking any peaks.

danielle said...

Interesting dilemmas. In the NICU I work at - we tell the chatterers that if the other family wants to answer your questions that is ok but we cant - becuase we protect the other persons privacy jsut as we protect theirs.

But I also play dumb too sometimes cause it gets so old..."oh I really dont know/remember"...

I understand - having babies is fun and exciting and everyone wants to share stories...but....

Margaret said...

I have a lot of kids and don't remember ever asking staff about the other women in labor. And I would have felt it less than professional for staff to discuss my labor with anyone other than me or my family.

Anonymous said...

My understanding is that HIPPA only applies to electronic transfers of information...not verbal. I think the whole "HIPPA" thing is getting SO overblown! There should be courses to educate health care providers on it. Of course I found a "simplification" of the HIPPA rules for consumers that was 101 pages long. SHEESH!

Basic client confidentiality rules would apply to verbal transfers. Given that, I don't think that vague answers to questions would be problematic ("we have 6 women laboring right now."). But specifics...people should understand that you can't tell them that the mom in room 303 just passed out in the bathroom!

Anonymous said...

for pete's sake who really cares if you tell someone else how many centimeters they're dilated or what number baby they're having? it's not like you're naming names and even if the inquiree DID know the person's name, it's not like they asked the STI status!