Perfect Attendance

Making yourself stand out can help your career advancement and promotion prospects

Perfect attendance, or near perfect at least, will make you standout since so many aids call out on a regular basis. As long as you are not vomiting, running a fever, or been told by a doctor that you are contagious, you should be at work. Other acceptable reasons for calling out include having a child who is ill with no one else to care for them, or a family emergency. Other than that, be at work. If you rarely call out, when you do then your supervisors will know that you honestly could not avoid it and this will get you much respect. The same things go for being on time. If you know that you are going to be late, even if it will only be five minutes, call your supervisor to let them know. This will really be appreciated. If you are not on time than the other aids will begin to moan and groan about the possibility of an extra workload. Plus, if you are always on time and all of a sudden you are nowhere to be found, people will start worrying about you. If you are really in trouble you can be sure that someone from work will come looking!

Do Not Complain

There are always going to be things that you do not want to do; extra tasks your supervisor lays on you, switching lunch or break times, staying over or coming in early, etc. If you must complain, do it in your mind. No one likes an aid that walks around grumbling about having to do this or that. It gets pretty annoying and shows their lack of ability to be a team player. If you are not a team player, you will be recognized by the higher ups, but not in a good way.

Take Some Initiative

When you are at work and have some down time, find something to do. Granted there is not a lot of downtime as a CNA, but when you have a spare second, see what needs to be done. This can be as simple as restocking necessary items, answering call bells for other aids patients, and help other aids get their work done. After all, you know what it feels like to have a bad day and fall behind in your duties. Once you do help someone else, don’t tattle tale to the nurse that you HAD to help so and so do their work. This undermines the reason for you taking the initiative.

Offer to Train New CNA’s

Though it is sad, many aids do not want anything to do with having to train a new worker. If you know this to be the case in your facility, step up and offer to take the newbie under your wing. This shows that you are willing to take on more responsibility and that you care about getting more qualified aids on the hall for the best interest of the patients and the rest of the staff. If you are the kind of person to make this type of offer, you are also the kind of aid that will show the newbie the RIGHT way to do things. This keeps the “bad influences” away for the time being; at least long enough to get the aid trained properly so that there will be less bad habits picked up later down the road.

Finally, ask the nurse what you can do for them. This may put you out a bit, but if you want to become indispensable then you will not mind taking on some more tasks in order to rise to the top.

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

No Call, No Show

Not showing up for work without calling in could get you fired immediately!

As a CNA, the most important thing you can do is show up for work. This may sound like a no brainer but you would be surprised at how many people overlook this important aspect of their job. If you pull a no call, no show (not showing up for work and not calling in to tell your supervisor you will not be coming in) at most facilities, you will be fired immediately. But, there are some facilities that allow you to build up three no calls, no shows before you are fired. In my opinion this is absolutely insane but (fortunately) I do not make the rules. If I did you would be gone after the first offense. Each facility will have a handbook outlining their policies on this rule.

Calling Out Too Often

Having worked as a nursing assistant for so long, I can tell you that once I arrive at work, mosey on over to the nurses station and look at the schedule, my heart drops every time I see a call out. Being short just one aid can throw all the other aids off for the entire day since we have to pick up the extra slack. If you are calling out once a week or more, you will be fired. This is not McDonalds where the worst that can happen if you don’t show up for work is that customers may have to wait longer in the drive through. This is a medical facility where if you don’t show up, the care that people receive is less than desirable because there are not enough hands to do it all properly. So, COME TO WORK or find another job where your presence is not missed as much when you feel like sleeping in.

Poor Documentation

Many CNA’s think of documentation as optional and unimportant. I know because I was one of them when I first began in this line of work. I quickly found out that I was wrong and should not have been following the influence of the other aids. Thankfully I was never caught doing it wrong and I was able to correct my behavior before it was too late. When it comes to documentation, you have to write up vital signs, fluid intake and food intake. The latter two can be difficult because some of your patients are fed by others and sometimes their trays are picked up before you get to see them. The key is to try your best to see the trays before they are taken up. If you don’t make it, ask the patient if they are able to tell you, or find the CNA that fed the patient or took up the tray. Yes this can be aggravating but it is also very important. The nursing staff must be aware if there are any dietary changes or if fluid intake is too low. And finally, you must document baths and showers. If your patient got a bed bath, mark that down. If they got a shower, mark it down. If they refused a bath or shower, document this as well. You may think that no one is checking up on your documentation, but you would be wrong and then fired.

Abuse and Neglect

The most important reason for getting fired was saved for last. I have a lot to say on this topic but will try to keep it short. In all my years of work I have seen some pretty terrible things. One of the worst was a CNA who was changing a patient who had their 5^th bowel movement of the day. The patient was total care, could not move and could not talk. The aid closed the door and I was in there with the other patient. They then began to talk horribly to the bed ridden patient, saying things like “I can’t believe you shit on yourself again! You are so effing disgusting! This is the last time I am cleaning you up today!” I was enraged. This poor woman could hear and understand as she was being belittled and handled roughly, but could not respond. Had I not been there, this aid may have kept her job and abusing patients for the rest of her miserable life. Of course this is not what happened though as I reported her and she was immediately fired. The bottom line is NEVER abuse (verbally, physically, sexually) or neglect a patient. Treat each one as if they were your mom, dad, grandma or grandpa. And if you hate your family and would treat them badly, this is not the line of work for you. Not only can this horrible behavior get you fired, it can cause you to lose your license and be prosecuted both civilly and criminally.

P.S. With most every person on earth having a cell phone nowadays, the majority of facilities have ruled that you cannot even carry your phone in your pocket during work hours. Read your facilities handbook on this topic because getting caught with your phone just once can cause you to get fired.

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

Although this list could continue on to infinity, we came up with 5 essential habits that will make your nursing experience a whole lot easier.

Look Things Up

You had to memorize a lot of basic formulas in college, as well as numerous definitions, signs and symptoms.  When you come across something you have to think twice about, do not think twice about looking it up.  Nearly every RN I’ve ever encountered walks around with a pocket handbook of some sort.  Don’t be afraid of what co-workers will think if you do too!

You are ultimately responsible for your patient’s health and well-being.  Make sure you are giving them the care they deserve- care that is free of human error or other more common mistakes.

 Trust Your Instincts

Don’t ignore that little voice in your head, you know, the bossy one that talks too much.  Far too often, it’s this voice that keeps us out of trouble.  Your instincts consist of your inner self-talk, which can help you make the right choice.  So, when you’re in the middle of patient care, and your inner voice says, “do this, not that”, take a second to listen to your voice of reason.

 If You Don’t Know The Answer, Say So!

Try putting yourself in your patient’s shoes.  Most of us have been patients at one time or another, so it shouldn’t be too hard to see things from their side of the bed.  I have witnessed nurses answer patients question with information they could not have known at the time.  Specifically, a patient once asked when his surgery was scheduled for the next day, to which the nurse replied, “It’s usually at 9am”.  She was simply going by what time the average surgery took place in her mind, but didn’t really answer her patient’s question.  What should she have done?  There are times when the answer, “I don’t know, let me find out”, is perfectly okay.

Always Carry The Essentials

There are several things a nurse should never leave home with, and these include: a marker, several pens, a watch with a dial, and a stethoscope.  These few things should be on you at all times, because you just never know when you might need them.  As a nurse, you will need these items nearly every minute of your workday.  We suggest keeping several pens at work, because you’ll be scrambling to find one at work when the ink runs out.  Whether you work in a nursing home, hospital or Dr.’s office, finding a decent pen, is like striking gold in Alaska- most places do not keep extra pens lying around, and for that they are priceless.

Ask For Help

This may seem like such an obvious thing to do, but I find that most people do not know how to ask for help.  Also, don’t mistake asking for help, with delegating your work.  Although both may decrease your overwhelm, you must be sure you are delegating work appropriately.  If you need help doing something, make sure you ask the most qualified person.  In other words, don’t ask another nurse if she can stop what she’s doing to get one of your patients a glass of water.  Remember, ask the most qualified person to help you with a task- and once you’ve caught up, don’t forget to return the favor!

We forget that it’s not so much the uniform people notice first-hand- it’s us! If you want to look good, start by adding a little extra oomph! in what really matters most- you!

1.     Moisturize

Moisturizing at night, and then again in the morning can do wonders on tired skin.  I notice that on days I go to bed without doing this, I wake up looking tired, worn, and unhealthy.  Give yourself and your skin cells an extra boost by using a moisturizer that fits your skin type- apply nightly and right before you leave for work.

2.     Skip the powder

The air in hospitals or nursing homes is usually a bit dry. Oxygen tanks and venting systems pumping through the air continuously, can wreak havoc on your skin.  Powder can make skin look dry, and chalky- especially as the day progresses.  Trade in your powder for tinted moisturizer or liquid foundation.

It isn;t so hard to look awesome while at work!

 3.     Keep cuticle moisturizer in your locker

The one thing patient’s certainly notice, are your hands!  You’re hands reveal many different things- including your commitment to your self-care.  Many hand moisturizers aren’t enough to tackle the harder skin around the nails.  My trick is to slip a small tube of cuticle softener in your pocket, and apply it whenever you can- while your waiting on a patient, on your break, going over a chart.  It less than a few seconds, you’ve saved yourself from overworked, dry, cracked cuticles.  Some tubes of cuticle cream even come in cases the size of a quarter.

 4.     Go for gloss

I have sometimes seen RN’s and CNA’S wearing bright colored lipstick.  Let’s face it, we’re not on a runway show here, and we don’t want to make patients think we’re crazy for wearing “fire engine red” lipstick.  Trade in your lipstick for something more subtle- like a tinted gloss.

 5.     Wear your smile

A smile can brighten up any look- instantly.  Not only does it drastically improve your look, but it also improves the way others see you- being on the receiving end of a smile is always great.

6.     Tame Stress Breakouts

You’ve worked back-to-back shifts all week, you’re exhausted, and it shows!  Stress can cause unwanted skin eruptions when we don’t expect them.  Eating foods rich in beta-carotene can help rejuvenate skin long term- so you can fight problem skin before it occurs.

 7.     Keep bad hair days at bay

Bad hair days are usually remedied by tying hair back into a ponytail, or braid.  Keep you’re hair shiny and healthy with this at home remedy:

-1 ripe avocado

-1/2 cup coconut milk

-3 teaspoons of olive oil

Combine all ingredients together and stir well.  Heat up the concoction on the stovetop until warm.  Apply the mixture at the end of roots, and work outwards toward the ends.  Leave on for at least 30 minutes, and wash out.

Rule 1: If the patients chart says to turn every two hours – DO IT! Never skip a turning. Many aides will do a sloppy job of it or skip it altogether because most patients who requiring repositioning this often cannot talk to tell on them. They simply mark the chart that the job was done and go on their merry way. I realize how difficult it can be to turn a bedridden patient. They are usually very stiff and hard to move. Pillows and wedges must be put in place just so and this can take a large chunk of time out of your schedule, but it MUST be done. Not only will you lose your job, and possibly be charged with negligence, the patient will get bed sores and any other number of ailments because of not being turned properly.

Rule 2: If you must use a lift to get your patient up and the instructions on their chart say that two people must be present to perform the task, get another person in there with you. I know how hard it can be to get help unless you are part of the elite CNA club at work, but you are not there to make BFF’s; you are there to take  care of your patients and if you have to piss a few people off to do it then so be it. If you ignore the instructions and do the task on your own, and something goes wrong, you are in big trouble and your patient can be injured beyond repair.

Rule 3: NEVER EVER talk about your patients with people outside of the loop. Their information is confidential and the law frowns upon sharing of information. Do not go home and tell your friend that Mr. Jones has a penis implant or that Mrs. Jackson has an STD. Your friend may know someone who knows someone who knows one of these patients and word spreads like wild fire about “juicy” details. This can actually land you in jail in some states so think twice about gossiping about your patients – even to other staff members. And NEVER look through a patients chart. That is confidential information that is for the RN’s use only. As a CNA you have no reason to look through it. They are very tight on this with all the new HIPPA laws in effect so tread carefully and do not let your curiosity get the better of you. You might want to read up a detailed post we’ve done about Social Media Posting Guidelines

Rule 4: Never eat off of your patient’s meal tray – even if they insist. This is a huge no-no! That food is for them no matter how hungry you happen to be at the moment. If you are caught eating off a patients tray, the least trouble you will experience is getting written up. And speaking of meal trays, pay attention to what your patients have consumed. I have seen too many aides simply pull numbers out of thin air when doing their chart work. It is important for the nurses and doctors to be able to see the true amount of food and liquid that the patients are taking in. There is a good reason for charting this info and it is part of your job- so do it!

Rule 5: Never make up numbers for your patients vital signs. Usually it is at the end of the shift when these are taken and we are ready to rush out the door to sweet, sweet freedom. However, we have to take and chart them for a good reason. A patient can actually DIE if you make up a number for their BP. What if their BP is twice as high as it normally is? This can mean so many things and if the nurses don’t know about the extreme change they cannot do anything to prevent tragedy.

Pay attention to all the rules and regulations of patient care. Your license if important but the patient’s lives are of a much greater importance than your license.

This is an expert post written by Tanya Glover, CNA. Some of her best work includes Annoying Things That Nursing Home Patients Do and Working With Other CNA’s

One fantastic option where you can put your skills to good use is as a home health worker. Most agencies will take on employees that are non-licensed but they pay less, so don’t skip your certification classes. The hours are usually pretty good and you almost can set your own if need be. In nursing homes you have a huge amount of patients to care for, but with home health you have only a couple regulars that you get to know and come to love. The money can also be pretty good if you can get a gig in a private pay agency. This is where you want to be!

One place you can work is in the home of a patient. The hours are generally good and the work isn't as taxing as working in a hospital or nursing home.

Another place to use your certification is in a hospital.  While these jobs can be hard to come by they are worth searching out. The money is fantastic and the benefits are nothing to sneeze at either. Plus, in a hospital your duties are totally different than in a nursing home. Sure you may have to give baths and change diapers, but the diapers are not always on adults for once! There are several areas for you to work in a hospital and the bulk of the job is taking vitals and answering call bells. It is a cake job and this is why the turnover is so low. Don’t let that stop you from trying though! Go for the gold!

Next in line are doctor’s offices. Again, these can be hard to come by but are totally worth the effort to get one. A doctors office is probably the highest paying place for CNA’S there is. Again, this is why the turnover is so low. The perks are huge though so keep submitting applications and cross your hard working fingers!

Finally, if you really want to be independent you can become self employed. Of course you could start your own home health company, but that takes a ton of work and there is so much red tape to cut through that if your own company is not a true passion for you, you want to skip this. Instead, advertise on craiglist.com, your local newspaper and social networking sites. Post ads around town and pass yourself around by word of mouth that you are on the market for private care. This is a very competitive field so do not ever have a set price. The key is feeling out what the client can pay and what others are charging for the same job. Trust me; I have experience in this area. I have both hired and been hired in this area. Here are two stories from each side of the fence:

1. During my time in the home health sector I lost one of my clients and needed to supplement my income. Since there were no clients in my agency to be had, I advertised that I was looking for a private care patient. A gentleman called me about his uncle who needed help at home. He said that everyone he spoke with was charging $13 to $15 per hour. So to land the job I put in my bid for $10 per hour. For the work I was needed for I honestly thought this was a fair wage; especially since it was under the table. I worked for this man for 2 months until he passed and in that time I was pulling in $200 per week for 20 hours per week. Not bad at all!
2. My mother-in-law needed a CNA to take the hours that the state would not pay for. We advertised on craigslist and found someone who was willing to work for what we could afford to pay which was $7 per hour. Even though our minimum wage is $7.55 per hour, this was a great deal seeing that the hours were plentiful and in the long run she was making more since it was non-taxed. Again, not a bad deal.

So, if the nursing home life is not for you, do not despair for there are many other opportunities awaiting the person who is willing to put themselves out there!

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

When I come into work at 7am, the first thing that I do is go to the nurses’ station to find out who my patients for the day are. I carry a note pad and pen so I can write down this list. Once that is done, I go to the soiled linen room and pull out my laundry cart. This is the most important accessory that you can have during your shift. I rip out the paper that I have jotted down my patient list on and tape it to the top of my laundry cart.

How to avoid getting drowned in an endless stream of patients

By doing this I have a clear view of my room numbers and I can cross off the patients whom I have already provided care for. The next thing I do to prepare for the day is get enough towels and wash cloths for all of my patients and lay them in their rooms for later use. By this time it is about 7:15 and I have enough time to provide full care for one patient before the breakfast trays come out. I choose the easiest patient to work with; this is usually one that either A.) Does most of their own self care or B.) Is easy to lift and very cooperative. The meal trays arrive about 7:45 and it is time to feed the patients. Once everyone has eaten and the trays are pushed back to the kitchen, it is about 8:40. Now I have at least 9 more patients to care for before 11:45 when the lunch trays arrive.

The best way that I have found to get such a large amount of work done in the three hours I have to do it in, is choose your patient order carefully. Go for the patients who are easiest to care for first. You will be able to get them washed, dressed and up in their wheelchairs more quickly than the others and this will leave you more time for the more difficult patients. Next on my list are the patients who are immobile. They are not self sufficient but are also not total care. These are the patients who require you to use a lift to get them out of bed. Once they are ready to go, move onto your total care patients. These take the most time because they cannot assist you at all. They also do not get out of bed much so you must take time to ensure that their skin is intact and they are placed just right. You will have to turn them every two hours to ensure their health and safety. After they are all set, the lunch trays are on their way and you get to do it all over again! The good news is that once lunch has passed all you must do is rounds to makes sure that everyone is still doing okay before the next shift comes in. It takes time to get this schedule down pat, but once you do it will seem like second nature to you!

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

As adults we should be able to work well together and get along. The problem is that not all adults have gotten this memo and sometimes the nursing home can feel like a high school. I have found that working with the other aids requires an understanding of how we are all divided into groups.

The first group is the category that I fall into. These CNA’s are in this field because they honestly enjoy taking care of other people. They go to work each day knowing that even though the work can be tough and frustrating, it is where they want to be. They do their job – with a smile most of the time – and only ask for help when it is needed. They also give help without being crabby about it. This is the best type of CNA to have on the team.

The second group. Next in line is the CNA that is very skilled but is doing their job only because they cannot find work doing something else. This type of worker can be cold with the patients even though they are doing the actual work properly. They get cranky when they are asked to help someone else but have no trouble asking themselves. You will generally find these type of CNA’s in a group together because misery loves company.

The third group is the CNA’s who have very little skill and little to no desire to be there. The main reason that they are is that they need a job. These aides are always running   behind and always seem to need the assistance of another aide to do even simple tasks. They may be nice, but it does get annoying to have someone constantly asking for help when everyone has a patient load to take care of.

Hopefully you are in the first group, and assuming that you are, I have some advice for you on how to get through your days without having a breakdown.

• We all need help with a patient sometimes. If the person is too large it may take two to turn them. If the use of a manual Hoyer lift is required than the rules state that two people must be present. Even though you know that the aides on your hall will get snippy with you and you may not like asking, just do it. Keep in your mind that you are doing your job the way you are supposed to and it is never okay to risk you or your patient’s safety just because your coworkers need an attitude adjustment.
• Keep in mind that you are not there to make lasting friendships. Your purpose it to provide quality care for your patients. Getting along is a good idea but you do not have to become best friends.
• Having a bad attitude is not illegal. However, if you ever see any of your coworkers doing something that could be considered verbal or physical abuse (even it if just boarders on abuse) report it immediately. Don’t worry about being unpopular with the staff; worry about doing the right thing for people who can no longer protect themselves.

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

When you show up for your shift and begin working on getting all of your patients cared for (and you typically have at least 10 patients each day), the overwhelming feelings can hit you right off the bat. You glance at your patient load and find yourself groaning out loud when you see that Mrs. Annoying is on your list for the day. The first few times you worked with Mrs. A, you thought that she was just so cute and sweet. However, as time goes by you find that she is only cute and sweet when you are jumping for her! This is the type of patient who rings her call bell for the slightest thing and expects that you drop everything you are doing to come help her choose a yarn color for her newest project or put her earrings back in her jewelry box. You will find that there are several patients like Mrs. A and you will get at least one of them every shift you work.

Residents can leave you feeling like this sometimes

Another annoyance that you will find in many nursing home patients is their ability to talk- and talk and talk some more. At first it is endearing. You find them interesting and love to spend time chatting. However, when you really need to get to your next patient, Mr. A will no longer be fun and interesting. In fact, he will be- well, annoying! It is totally understandable that patients in nursing homes crave conversation, but when you have a job to do it can be very difficult to feign interest. Especially when you know you only have another hour before lunch and three more people to bathe, dress and get in wheel chairs!

The most annoying nursing home behavior in my book is the Dawdler. This is the sweet old lady (or gentlemen) who takes her time doing everything. Of course I do not expect an aged person to sprint across the room or dress themselves in seconds flat. What I mean by the Dawdler is the patient who wants you to show her everything in her closet before making a choice on what she wants to wear that day. She takes 10 minutes to wash her face and can never get her blouse to feel quite right. She is the patient that everyone dreads finding on their list and for good reason!

I am in no way trying to be disrespectful of the elderly people in the world. I could imagine that if I were made to live in a nursing home that I would want to keep company for as long as I could too. I would want things to be my way because I have lived an independent life up until it was no longer possible. I may would even want to pick though all my clothes before deciding what to wear since I had this option while living at home. It is easy to empathize with nursing home patients who have found themselves in a secured environment with restricted abilities. However, no matter how much I empathize with them, they can still be quite annoying – and who empathizes with me? I have to do the work of two people in only a few short hours! Overall, I love my patients but just like with my children, they can get pretty annoying. The key is holding onto your sanity while still making them feel important. This is a tall order but one that can be filled by the right person.

Expert Contribution by Tanya Glover, CNA
She writes candidly about the things she encounters while working as a CNA. Some of her popular articles include Goldilocks and the Three Nursing Assistants and Nursing Home Personalities 101 

 The Appropriate Use of Social Media in Nursing. Social media and electronic communication is quickly becoming a common workplace tool, used professionally and personally in blogs, social networking sites, forums and chatrooms. In the health care field, social media must be used in a way that maintains patient confidentiality and privacy. Inappropriate use by nurses has led both to disciplinary action and to more serious consequences when the media becomes involved. Not only does this negatively impact the nursing profession and harm patients, it can put a nurse’s career and license at risk.

When it comes to social media, nurses must follow appropriate guidelines so that they can use it without breaching patient confidentiality. Social media holds many potential benefits for nurses. Forums, blogs, and networking sites are places where nurses can discuss difficult or emotional events with peers. They can vent and receive helpful advice and support from colleagues, friends, and others. Nurses are encouraged to use journaling and reflective practice for professional growth, and the Internet offers many opportunities for this.

Confidentiality and Privacy
When it comes to social media, it is easy to disclose too much. Not only is patient privacy violated, but the coworkers can be negatively impacted. Although nurses are expected to understand confidentiality and privacy legislation, they often do not comprehend its application, particularly regarding social media. The importance of privacy and confidentiality cannot be understated, since it impacts trust not only in the nurse-patient relationship, but that of the whole profession.

Key concepts:

1. Any patient information gained during the course of treatment must be safeguarded by the nurse and used or shared only for health care purposes
2. Informed consent must always be obtained
3. Personal information is entrusted to the nurse and must be treated with dignity and respect
4. Many nurses make the mistake of thinking they have respected privacy by removing patient name and obvious identifiers. This is not true. If information has been shared with someone who is not authorized to receive that information, it is a violation of confidentiality. It is also extremely easy to identify a patient with even the smallest and most insignificant piece of information, particularly via the Internet.

Another common mistake is to assume that when something is sent privately to an individual or posted on a closed forum, it will remain private. Remember: once something is posted it can (and will) be shared with anyone. Deleting does not mean it is removed.
Here are a few examples of how nurses can get into trouble with social media. Some cases are fairly obvious, most are not done with malicious intent, but all have serious consequences.

Sharing something about your patient could get your license pulled and worse, leave you at the mercy of a lawsuit.

*Two nurses photographed an x-ray of a patient with a object stuck inside his rectum. They independently posted the picture on Facebook. There was no patient identifying information. The media was tipped off by another employee. Although the pictures were immediately removed, both nurses were fired.

*in a small community nurses regularly spend their breaks relieving stress by sharing information with family and friends about all shift activities, including death tolls, patient demographics, and diagnoses. Although no names are used, patients can often be identified anyway. Concern was expressed in one message about a cancer patient who was on a new medication. Word got around to a relative, who subsequently made a comment to the patient about the caring nurses who were so knowledgeable about the medication. The patient was upset, but because she could not identify the source, the trusting relationship with all her nurses was tainted.

*a nursing home worker in a facility for dementia patients received an email photo of an elderly woman’s nude backside. The source could not be identified, so she forwarded it to several colleagues. Soon it became a topic of amusement, with some staff betting on the patient’s identity. Supervisors and the media became aware. The sex crimes unit was called in and the whole facility was placed under investigation. The patient was eventually identified and the family launched a lawsuit. Although the originator of the picture was never identified, all those who forwarded it were disciplined.

*a nurse in an emergency room got permission from a patient to take pictures of his injury. She shared these on a nursing forum with her nursing friends for learning purposes. Although the patient was not visible, the type of injury made it clear who he was. The nurse was disciplined.

*a student nurse working in the pediatric unit took a picture of a very cute four-year-old who was fighting cancer. She posted the picture on her Facebook page, expressing to her fellow nursing students how excited she was to be working in pediatrics with such a special patient. The photo was brought it to the attention of administration. Because the hospital and the patient were able to be identified through the picture, the student nurse was found in violation of HIPAA. She was expelled, and the nursing program was barred from using the pediatric unit for teaching.

Where did these workers go wrong? It may be easy to see how confidentiality was breached, or where conduct was unprofessional and unethical. But what about cases where employees thought they were using the information to benefit?
For nurses to use social media in a professional way without breaching patient privacy or confidentiality or violating privacy legislation a number of guidelines must be always followed when using social media and personal media devices:

1. Nurses have an ethical and legal obligation to maintain patient confidentiality and privacy at all times.
2.  No information or images of a patient should be posted or shared with anyone unless that individual is involved in matters relating to patient care.
3.  No information gathered via the nurse-patient relationship should be transmitted if it might violate privacy rights or lead to embarrassment.
4.  Never mention a patient by name or post any identifying information, no matter how insignificant it might seem.
5.  Always think about potential risk. What could happen if the information got into the wrong hands?
6.  Never speak disparagingly of a patient.
7.  Do not make disparaging comments about coworkers or employers.
8.  Never assume privacy of communication, even on a closed forum.
9.  No patient images or pictures should ever be transmitted by electronic media.
10.  Do not take pictures of patients on personal devices.
11.  If pictures of patients are required for diagnostic or treatment purposes, follow employer guidelines.
12.  Always maintain professional boundaries in any patient/nurse contact.
13.  Report any confidentiality or privacy breaches promptly.
14.  Understand and comply with employer policies regarding social media.

Advances in technology have transformed health care, and electronic and social media hold great potential in nursing communication. Before using these, however, nurses must be aware of potential problems that can occur if patient information is disclosed through social media. The consequences are serious for everyone involved. Nurses who use social media in a conscientious and professional way and do not violate patient confidentiality or privacy will be able to use alternative media as an effective practice tool.

References:

https://www.ncsbn.org/Social_Media.pdf

http://www.wisn.com/Nurses-Fired-Over-Cell-Phone-Photos-Of-Patient/-/9374034/8076340/-/1466umb/-/index.html

http://www.kitsapsun.com/news/2010/feb/12/state-gives-kitsap-health-rehab-a-deadline-after/?partner=RSS

About the Author:

Debbie Jabbour is a Canadian writer with broad life experience and grandchildren who keep her forever young. After enjoying a successful career as a professional musician, she returned to university and earned a Bachelor in Psychology/Communications and a Masters in Applied Psychology. When writing, she draws on her insight into human nature, approaching topics with a sense of humor and a keen interest in history, politics, culture, and the arts. Her work has appeared in several online magazines and blogs. Debbie’s personal philosophy is rooted in the words of Nietzsche: That which does not kill me makes me stronger.