Re: What it's all about, was Another puzzler

[Guest guest]

Max,

I have found that many nurses are operating under ridiculous HIPAA rules

interpretations, laid down by folks who have a poor understanding of the Act,

usually the nurse educators.

As you may recall, after the original rules were proposed, there was a

moratorium on rule implementations and the Sec of HHS held hearings and changed

them drastically, allowing the free use of PHI for treatment, payment, and

health care operations.

But the original rules did not allow that. In the hospital industry, there

were many folks who became " experts " on HIPAA and sold themselves as HIPAA

trainers. Lots of that training took place before the final rules came out.

So much of the training of nurses was based upon a version of the rules that

was much more restrictive.

I routinely encounter the attitude that an ER nurse can tell me nothing

about a patient I delivered to the ER an hour before, because she completely

misunderstands HIPAA. And it does no good to argue with her, because her nurse

educator is who she believes, and her nurse educator has said that they are

not to release any information to EMS people about patients they've delivered

to the hospital previously.

These nurses have no concept of the allowed uses of PHI, they only know that

they must follow policy, policy that is ridiculous. They never have the

exempt situations explained to them, and most of them have no clue about EMS

operations. So they cannot grasp that an EMS provider would want to know the

outcome of one of her patients.

Given the anally retentive nature of a lot of nurses, one can readily see

how this can occur. Further, nurses are generally not encouraged to think

critically, independently, or to ever question dogma. From the beginning, they

are taught that they are the servants of the physician, must obey the

physician without question, and that all other allied medical professionals are

their inferiors, loutish nitwits, who could never understand what nurses know.

Having been an educator for over 30 years, I would have expected that nurse

educators might have progressed a little in their methods, attitudes, and

mindsets. NOT!

When I was teaching EMS at a community college, I attempted to use some of

the nursing faculty to teach parts of the EMS course, thinking that their

" superior " knowledge and insights would be helpful. WRONG! There were two,

maybe three that were actually great teachers, but most of them were so bad

that

I was enbarrassed for them. Rigid, unimaginative, stuck in a timewarp that

they would not leave.

There is a great difference between nurses who are also paramedics and

nurses who have had no EMS training. Same for doctors. The flight

paramedic/nurses I know are in no way typical of the " regular " nurses that one

encounters

in the ER and on the floors.

Lest I be tarred and feathered, please understand that I'm painting with a

very broad brush, and that there are many, many exceptions to the profile I've

described. But the exceptions are too few.

At one of the hospitals I routinely transport patients to, I regularly

encounter nurses and physicians who are rude, clueless about EMS, and who have

attitudes toward patient care that should have gone out with Florence

Nightengale.

When I teach ACLS to nurses, I almost always find nurses saying things

like, " You know, I've never actually had fun in an ACLS course before. I

learned

more in this recert course than I have learned in all the previous ACLS

courses I've taken put together. " That's because I use teaching techniques

that

are progressive, innovative, fun, and allow the participant to engage in

actual thinking, rather than simple regurgitation of information. Please

excuse

my arrogance, but it's true.

Attempts to bring EMTs and nurses together are usually failures, because the

nurses are not interested, and, after enough unpleasant encounters, most

medics aren't either.

There is so little dialog and interaction between nurses and medics.

There's lacking a sense of team spirit. Nurses too often do not see EMS as

being a

part of the team. Couple that with old fashioned, arrogant doctors, who

disrespect everybody, including other physicians, and you have a system that is

seriously broken.

How nice it would be to be treated as a valued member of a team that

performs a continuum of good patient care. Ironically, some of the worst

relationships exist in those EMS services that are hospital based. Refusal to

allow

medics to perform the skills they can do on the street in the hospital; use of

talented medics as gurney gophers, X-ray taxis, housekeepers, and lackeys.

Invariably these situations exist where the supervisor of the medics is a

nurse administrator.

Now and then there's a bright, shining, example of how things ought to be,

but too often, the star is imploded into the black hole of mistrust,

misunderstanding, and dismissal of perceived inferiors. All in all quite sad.

OK, bash and batter away. I've said my say, and I will say in parting that

when I find a great nurse who actually talks to me, I'm always thrilled and

prompted to do my best to show my best stuff to her or him. My sister is a

great nurse. She understands teamwork, the value of each member of the team,

and that respect is earned rather than mandated. I only wish she were in

charge of all the ERs I deal with.

GG

In a message dated 9/24/2004 6:55:17 AM Central Daylight Time,

bpems@... writes:

What it's about is that there has been a lot of

misinformation and misunderstanding around regarding HIPAA

and confidentiality requirements. We even had one experience

(right after HIPAA went into effect) where a nurse at the

local nursing home called 9-1-1 for an emergency ambulance

and then refused to tell the dispatcher why an ambulance was

needed, citing confidentiality laws as the reason for not

divulging the information.

Fortunately, for us at least, these kinds of episodes have

been few and far between.

Maxine Pate

hire-Pattison EMS

---- Original message ----

>Date: Fri, 24 Sep 2004 00:34:27 -0600

>

>Subject: Re: Another puzzler

>To: < >

>

> What's this about? Chief complaint/diagnosis, hx,

> meds, etc. have always been standard information

> EMS takes down. In the past I got a non-sealed

> envelope, took the copied chart out to get all my

> info. As a nurse, I wouldn't want to turn care over

> to a crew who didn't have the information. If it's

> standard that all charts are sealed, the crew should

> expect a really excellent report from the nurse.

> Meredith

>

[Guest guest]

AMEN!!!! Gene I know you have been around and can hit the nail on the

head.

this is ture as it can be. if you don't believe it work in a hospital and

you will see it everday.

[Guest guest]

AMEN!!!! Gene I know you have been around and can hit the nail on the

head.

this is ture as it can be. if you don't believe it work in a hospital and

you will see it everday.

[Guest guest]

AMEN!!!! Gene I know you have been around and can hit the nail on the

head.

this is ture as it can be. if you don't believe it work in a hospital and

you will see it everday.