Regulations affect nearly all professionals from various fields including nurses and their practice, licensure and education; these regulations are always either external or internal. External regulations include laws, rules and standards formulated by legal authorities to govern the entire nursing body, while internal rules refer to the professional self-regulatory laws or principles that govern a nurse.
This case study portrays a direct violation of the HIPAA privacy regulation rules since Dr. G discloses patient E’s personal health information (PHI) to Mr. H who has no permission by the patient to access his PHI. This rule states, “covered entities should not use or disclose individually identifiable health information to any party unless authorized by the individual or permitted under the regulations” (George et al, 2008).
According to the 13th rule of the New York State Public Health Laws (PHLs), the patient’s PHI and records should be kept private and confidential but this was violated. The patient acted within the law by refusing to be put in ventilator (rule 11). Dr. G also violated rule 10 by allowing Mr. H who is not a legal signatory to the patient’s medication records to sign against his wishes and to authorize him to be put in a ventilator.
In as much as we witness a typical violation of HIPAA privacy regulation rules, in this case, Dr. G actually acted within the nursing code of ethics that emphasizes on the value of a patient’s life, protection from pressure and proper decision making over the strict observance of nursing regulations (Tschudin, 1992). This means that in a situation where strict observance of the rules might lead to fatal impacts; it is advisable for the doctor or registered nurse (RN) in-charge to execute decisions that would save the patient’s life at all costs. To save his brother’s life, Mr. B was justified to go against the details of the agreement he signed and to authorize the use of a ventilator. However, the impacts of such decisions on a RN could be devastating because they should document and report all occurrences to the administration according to the stipulated regulations.
The state where registered nurses have the liberty to make essential decisions in line with their extent of practice and readiness to act is referred to as nurse autonomy. This area of practice largely clashes with the Board of nursing regulations, but they both work for the greater good of the patients. Moreover, Stewart & Dock (2006) verified that Nightingale Florence supported autonomy by quoting her vow that
…I will do all in my authority to maintain and raise the level of my work, and will hold in self-belief all private matters committed to my custody and all family issues coming to my understanding in the practice of my vocation. With faithfulness, I will attempt to assist the physician, in his work, and dedicate myself to the wellbeing of those devoted to my care.
Nurses have a solemn responsibility to document and report all the daily occurrences when they are on duty. However, in a scenario where there is a breach of their regulations and codes of conduct, it becomes a very heavy task to record the daily incidents (Williams & Merrell, 1994). This is usually a period when the nurse’s levels of integrity, accountability and transparency is checked, for instance, when a casualty is brought in from an accident scene having lost a lot of blood, an immediate blood transfusion should be conducted on him contrary to his will and wishes against blood transfusion. In this case, both the doctor and the nurse should record and be held accountable for their practices on the patient, since their autonomy was based on ethical codes of saving the patient’s life.
References
George, F., Indest III, & LLC. (2008). Florida Nursing Law Manual. Florida, USA: Altamonte Springs.
Merrell, J., & Williams, A. (1994). Participant observation and informed consent: relationships and tactical decision making in nursing research. Nursing Ethics 1 (3): 163–172.
Public Health Law (PHL). n.d. Patients’ Bill of Rights. 2012. Web.
Stewart, M.I., & Dock, L.L. (2006). A short history of nursing: from the earliest times to the present day. (4th ed). Michigan: G.P. Putnam’s Sons.
Tschudin, V. (1992). Ethics in Nursing : The Caring Relationship. (2nd ed). Oxford: Butterworth Heinemann.