The nurse practicum is both an opportunity to learn practical nursing skills and to prove your worth as a care provider. For nursing students entering a practicum, there are many considerations that should be reviewed and understood beforehand. This includes the policies and procedures in place at the practicum site, privacy rules and safeguards, and common sense advice on how to act professionally and ethically in challenging situations. This essay reviews several such challenges and the answers nursing students should be prepared to provide.
¶ … Nursing Practicum: What if Scenarios
The patient requesting information about her husband's test results is perfectly understandable, but in the absence of his permission to release this information to his wife I cannot legally or ethically do so. The minimum necessary standard under HIPAA's privacy rule seems to cover this situation adequately (HHS, 2003). Under this standard, healthcare facilities are required by law to minimize access to protected information. The criteria used to judge what constitutes the 'minimum necessary' standard is that which is required for care providers to perform their duties. Since I have access to this information, I am probably helping to care for her husband; however, providing this information to the wife is not essential to the care I am providing for her.
The burden of proving my worth as a nursing professional during my practicum is my responsibility. I could adopt the attitude that answering telephones is not in my job description, but this would tend to communicate a lack of willingness to be a team player. The success of any organization depends on all its employees chipping in to help it run smoothly and if answering a ringing telephone, especially when asked to do so, can help things run smoother then this makes perfect sense to me. Doing so would communicate to my coworkers and supervisor that I am a team player and capable of initiative.
3. "What you see, hear, or read at the site must stay at the site." (Austin, 2012, p. 158). Nothing could be clearer. Based on the scenario description, I have access to the patient's test results and have been authorized to inform the patient of the results. Her being a friend of my mother has no impact on how this information can legally and ethically be given to the patient. A phone call to the patient represents a private conversation. By comparison, giving this information to the patient in a public place and in front of her family violates numerous ethical issues. The most obvious example is that the patient may not want her family to know she had a pregnancy test.
4. Absolutely not! Looking at the neighbor's medical records without permission violates not only the trust the neighbor has placed in the healthcare facility to protect their health information, but it violates the trust the healthcare facility has placed in me to perform my duties in an ethical and legal manner. Looking at the neighbor's medical records, despite my concern for their health, violates the minimum necessary standard under HIPAA's privacy rule. Under this standard, looking inside the medical record without a legitimate healthcare need, as determined by my supervisor, would be illegal (HHS, 2003). If I'm so concerned about my neighbor's health, I should just knock on their door and express my concern.
5. Patient's rights invariably come before my right as a student to observe and participate in any medical procedures being performed (Austin, 2012). The procedure being performed could be personally embarrassing or traumatic for the patient, especially in front of other care providers whose presence is not required. The patient may have an established long-term trusting relationship with their doctor, which does not extend to other personnel at the healthcare facility. Even if there is the chance that the patient will not remember the procedure or my presence in the room, the patient should have ultimate control over their personal privacy even when under general anesthesia.
6. Taking advantage of the free samples in the sample room, without my supervisor's permission to do so, would be placing my short-term money problems before my long-term career goals. Besides being unprofessional and shortsighted, in the absence of permission it is a form of stealing. Putting my career at risk, after investing years and considerable money into my education, just to solve a short-term money problem makes no sense. If my situation is urgent and I have no other options, I would take the time to explain my predicament to my supervisor. Doing so would demonstrate my respect for the site's protocols and ethical conduct.
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