Patient rights are of utmost importance in healthcare, as they ensure that patients receive ethical and respectful care while maintaining their autonomy and dignity.

QUESTION

In this scenario, you are a nurse working on a medical surgical unit. An internal, local nursing union negotiates with the facility’s human resources department to determine working conditions, wages, and benefits.

You and your nursing colleagues have observed nursing students taking their own personal laptop computers into patient rooms on numerous occasions. While in the patient rooms, students are speaking with the patients. Students are asking patients questions about their medical histories and entering this information into their laptop computers. The students have been telling the patients that they have a classroom assignment to have completed and that these conversations about patient information will be very useful.

As the nurse, you know that the facility has a specific process for obtaining informed consent for these types of patient engagements, and the students are not following that process or obtaining patient consent prior to the interactions. You have even seen students interviewing patients under heavy sedation after surgery, patients with court-appointed guardians, and patients with dementia. Upon exiting the patient rooms, students have been seen printing information from patients’ electronic medical records. Students accessing patient information for personal use is also prohibited by facility policy. You have observed this behavior directly on repeated occasions.

You have reported these student activities to the nurse manager with evidence of the hospital’s policies to support your concerns. Each time, the nurse manager is dismissive of, and perhaps even irritated by, your complaint. They also just changed your schedule to work in the busy emergency department, in which you have no prior experience working.

Prepare a short paper that discusses ethical, regulatory, and legal issues for this scenario. Think about what you would do in that scenario and how you would escalate your concerns about your patients. Additionally, consider if your sudden transfer to the emergency department is important.

Specifically, you must address the following rubric criteria:

1. Importance of Patient Rights: Discuss why patient rights, including the patients’ bill of rights, are important for both this scenario and patients in general.
2. Policy, Standard, Regulation, or Legal Issue With Patient Rights: Explain at least one issue associated with patients’ rights for one or more person’s conduct in the scenario. Be sure to identify any relevant policy, standard, regulation, or law(s) that supports your response. Consider the following question in your response:
   • What is a possible implication of this issue for the students, nurse manager, and the healthcare organization?
3. Ethical Issue With Patient Rights: Discuss an ethical issue associated with patients’ rights for the conduct of one or more persons in the scenario and why healthcare organizations should consider the ethical implications of their actions (especially those organizations striving for a just culture).
4. Escalation: Discuss at least two commonly used ways to escalate a concern if an immediate supervisor is not responsive to a legitimate problem and retaliation ensues in the healthcare industry. You should also identify important resources such as union agreements or organizational policies that can provide methods for escalation.
5. Impact on Organizational Policies: In general, discuss how standards, regulations, and legal requirements for healthcare organizations should impact organizational policies and a healthcare organization as a whole.
6. Just Culture and HRO Principles: Analyze how just culture and HRO principles would address this situation and how healthcare regulations and labor laws can impact a just culture.

ANSWER

Patient rights are of utmost importance in healthcare, as they ensure that patients receive ethical and respectful care while maintaining their autonomy and dignity. In this scenario and in general, patient rights are critical to protecting individuals from unauthorized disclosure of their personal health information, maintaining their privacy, and ensuring that they have a say in their own healthcare decisions. The patients’ bill of rights serves as a guiding framework to safeguard these rights and promote patient-centered care.

In this scenario, an issue associated with patients’ rights is the failure of nursing students to obtain informed consent before engaging in patient interactions and accessing personal health information. This violates the patients’ right to privacy and autonomy. The relevant policy, standard, or law that supports this concern is likely the Health Insurance Portability and Accountability Act (HIPAA), which sets guidelines for the protection of patient health information. By disregarding this policy, the students, nurse manager, and healthcare organization may face legal consequences and reputational damage. Patients may experience a breach of trust and compromised privacy, leading to potential harm and dissatisfaction.

An ethical issue associated with patients’ rights in this scenario is the lack of respect for patient autonomy and the failure to obtain proper consent. Healthcare organizations should consider the ethical implications of their actions, especially those striving for a just culture. Respecting patient autonomy and informed consent is fundamental to ethical healthcare practice. Failing to do so can undermine the trust and confidence patients have in the healthcare system. Upholding ethical principles fosters a patient-centered approach, enhances the therapeutic relationship, and promotes transparency and accountability.

If the immediate supervisor, in this case, the nurse manager, is not responsive to the legitimate concerns raised, there are commonly used ways to escalate the issue. First, the nurse can engage in open and respectful communication with higher-level managers or administrators within the organization. This can involve submitting a formal complaint outlining the concerns and providing evidence of policy violations. Additionally, seeking support from a nursing union, if applicable, can provide guidance and assistance in addressing the issue. Union agreements and organizational policies often outline procedures for raising concerns and protecting employees from retaliation.

Standards, regulations, and legal requirements for healthcare organizations should strongly influence organizational policies. These guidelines provide the framework for ethical and safe practices, ensuring that patient rights are upheld. Healthcare organizations should align their policies with these requirements to create a culture of compliance, accountability, and patient safety. Policies should clearly define expectations regarding patient consent, confidentiality, and the use of electronic medical records to protect patient information and uphold their rights.

A just culture and principles of high-reliability organizations (HROs) can address this situation effectively. A just culture emphasizes fairness, accountability, and learning from errors rather than blame. It encourages open communication and supports individuals in reporting concerns without fear of retaliation. By fostering a just culture, healthcare organizations can create an environment where employees feel comfortable raising concerns and collaborating to improve patient safety. Healthcare regulations and labor laws play a crucial role in supporting a just culture by providing legal protections and mechanisms for reporting and addressing concerns.

In conclusion, respecting and upholding patient rights is essential in healthcare. In this scenario, the failure to obtain informed consent and protect patient privacy raises ethical, regulatory, and legal concerns. It is crucial to escalate the concerns through open communication, utilizing resources such as union agreements and organizational policies. Healthcare organizations should align their policies with standards and regulations to ensure patient rights are upheld and foster a just culture. By prioritizing patient rights, healthcare organizations can provide ethical and patient-centered care while maintaining the trust and confidence of their patients.