Finding Your Voice in the Age of HIPAA

By Selena Chavis

Tell your stories. Sharing your experiences as a nurse can help change and better promote the image of nursing, says Suzanne Gordon, co-author of From Silence to Voice, a book that provides practical advice to nurses on how to effectively communicate their stories to the public.

A long-time advocate of the nursing profession, Gordon emphasizes that the typical images of nursing "don't suggest the kind of brainwork that goes into the day-to-day work."

Gordon asserts that the media often misrepresent nurses as caregivers who only hold patients' hands at their bedside. And, she says nurses could be doing more to change the public's perception of nursing. "Nurses don't talk about their work enough," Gordon says. "They often see it as self-serving."

Gordon's co-author, Bernice Buresh, believes that nurses have been silenced for years, and one of the obstacles at play is a lack of understanding about the role of HIPAA (Health Insurance Portability and Accountability Act), a federal law enacted in 1996 designed to protect patient privacy.

"We've heard of nurses being silenced for this reason," Buresh says. "Nurses talking about their work in no way compromises HIPAA. It's such a blanket kind of statement. Doctors talk about their work all the time."

That said, Gordon points out that nurses still have to be careful not to inappropriately identify a patient when communicating with the public. Most often, though, it comes down to common sense.

"Before HIPAA, nurses were always bound by patient confidentiality," Gordon says. "The fact that nurses are so freaked out by HIPAA is a reflection of how poorly HIPAA regulations are taught."

The fear that surrounds HIPAA may also be attributed to actions by a number of government entities in recent months that suggest an uptick in enforcement. In July 2008, a covered entity was required to pay a fine for the first time since HIPAA was enacted. Seattle-based Providence Health and Services agreed to pay $100,000 as part of a settlement with the Department of Health and Human Services. An investigation into the organization was launched by the HHS after the government received 31 complaints.

This event should not evoke fear among nurses in communicating the critical role they play in healthcare, Buresh suggests, but it should reinforce the need to have a clear understanding of where the boundary lines are drawn.

"If you are telling an anecdote, no one is asking the nurse to identify a patient, and there is no reason the nurse should reveal [inappropriate] information," Buresh adds. Offering an example, Buresh points out that if a nurse is telling a story about a typical 60-year-old cardiac patient at a metropolitan hospital and what nurses did to help that patient survive and recover, HIPAA has not been breached.

In the same vein, if a nurse is telling a story about a patient with a rare disease in a small community where the patient could easily be identified, then there may be cause for alarm.

Gordon also suggests that nurses should not always assume that patients do not want to be identified. Nurses should feel comfortable asking a patient to participate in a project with the media.

Patients willing to be interviewed would be asked to sign a release or consent form that is often readily available through public relations or compliance departments. Nurses should simply consult with the appropriate hospital professionals for advice on how to proceed.

"It's not for you to decide that they don't want to be interviewed," Gordon adds. "You can't make the assumption that research subjects don't want to talk to the media. This is the world of Oprah. It's astonishing now how many people want to talk to the media."

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