Nursing Ethics: Patient Confidentiality and the ANA Code

Introduction: The Ethical Dilemma

Two nurses are close personal friends of a hospitalized patient. One of the nurses became so concerned about this patient that she accessed the patient's medical records and shared her findings with the other friend. Neither nurse was assigned to the patient, and thus neither had authority to access her chart. Nor are they blood relatives of the patient. The first nurse now faces the dilemma of either reporting the confidentiality violation or keeping quiet about it. The offending nurse has promised never to repeat the act. The first nurse also feels concern for her colleague, who is a single mother and the sole financial support for herself and her two children. The first nurse must decide correctly and fairly.

Three provisions of the American Nurses Association Code of Ethics apply to this case (ANA, 2001). Each provision addresses a distinct aspect of the situation: patient privacy, professional accountability, and collegial support.

ANA Code of Ethics Provisions

Provision 3.2 on confidentiality is bound up with the patient's fundamental right to privacy. It is a nurse's duty to keep all patient information confidential. The patient's well-being and trust will be compromised when this rule is violated. It explicitly prohibits access to patient data or its inappropriate or unauthorized disclosure to any person who has no right to the information (ANA, 2001).

Provision 3.5 of the Code on Acting on Questionable Practice mandates the nurse to remain alert and take appropriate action when a healthcare team member engages in actions or practices that compromise the rights or best interests of the patient (ANA, 2001). Her response should be guided by the Code, professional standards, pertinent laws, and the hospital or facility's policies and procedures. The offending colleague's attention should be drawn to the violation and its potential detrimental effect on patient welfare and the integrity of the profession. When such a threat exists, the appropriate next-higher authority should be informed, and proper procedures should be implemented in addressing the violation (ANA, 2001).

Provision 3.6 of the Code on Addressing Impaired Practice underscores the nurse's duty to protect the patient and extend assistance or support to a colleague whose practice may be impaired in some way (ANA, 2001). The troubled colleague may consult the appropriate supervisor, or the reporting nurse may help connect her to the resources she needs in order to restore her to an optimal level of functioning (ANA, 2001).

Nursing Ethical and Legal Principles

One foundational nursing ethical principle is confidentiality, which holds that patient information entrusted to a health professional on duty should not be revealed to or accessed by others who are not authorized or entitled to that information (Nursing Help, 2011). At the outset, this specific principle appears most directly applicable to the case. Other nursing ethical principles include autonomy, informed consent, veracity, beneficence and non-maleficence, justice, paternalism, fidelity, respect for others, and utility (Nursing Help, 2011).

Nurses and other health professionals are expected to give the utmost importance to the principles of confidentiality and the broader public interest (Fullbrook, 2007). Common law embodies and mandates these obligations. However, in the digital age, maintaining and assuring the confidentiality of patient information has become increasingly difficult. Regulatory bodies, such as the Nursing and Midwifery Council, have devised new rules and guidelines to adapt to emerging trends in communication, embedding them in their respective codes of professional conduct. Some sectors have suggested that rules and regulations on confidentiality may need to be either expanded or made more flexible with respect to securing, retaining, using, and transmitting information (British Medical Association, 2005, as cited in Fullbrook, 2007).