This paper examines a hypothetical case in which two nurses face an ethical dilemma involving unauthorized access to patient medical records. Using the American Nurses Association Code of Ethics—specifically provisions on confidentiality, questionable practice, and impaired practice—the paper analyzes the competing obligations nurses must navigate. It discusses relevant ethical principles, legal frameworks governing nursing practice across states, and proposes a resolution that prioritizes patient welfare while supporting the colleague involved. The analysis demonstrates how professional codes provide guidance for navigating complex workplace conflicts without necessarily triggering formal disciplinary action.
Two nurses are friends with an inpatient at a healthcare facility. One nurse became so concerned about this patient that she accessed the patient's medical records without authorization and confided her findings to the other nurse. Neither nurse was officially assigned to care for the patient and therefore had no legitimate authority to access her chart. They are not blood-related to the patient. Now the first nurse faces a difficult dilemma: should she report the violation of patient confidentiality, or should she remain silent about her friend's breach?
The offending nurse has promised never to repeat the unauthorized access. However, the first nurse feels conflicted. She is concerned not only about the ethical violation but also about her friend's livelihood. The second nurse is a single mother supporting herself and two children, and losing her nursing license would be catastrophic for her family. The first nurse must decide what is right and fair.
This case illustrates a common tension in professional ethics: the conflict between enforcing rules and supporting colleagues, and between formal obligations and personal compassion. Three provisions of the American Nurses Association Code of Ethics directly apply to this situation (ANA, 2014).
Provision 3.2: Confidentiality. This provision grounds patient confidentiality in the fundamental right to privacy. It is a nurse's duty to keep all patient information confidential. When this duty is violated, the patient's well-being and trust are compromised. The provision explicitly prohibits unauthorized access to patient data or inappropriate revelation of such information to any person without proper authorization (ANA, 2014).
Provision 3.5: Acting on Questionable Practice. This provision mandates that nurses be alert and take appropriate action against practices by healthcare team members that compromise patient rights or interests. Actions should be based on the Code, professional standards, pertinent laws, and institutional policies. When a threat to patient welfare or professional integrity exists, the appropriate next-higher authority should be informed, and proper procedures should be implemented (ANA, 2014).
Provision 3.6: Addressing Impaired Practice. This provision underscores the nurse's duty both to protect the patient and to extend assistance to a colleague whose practice may be compromised. The troubled colleague may consult a supervisor, or the nurse may help her access resources needed to restore optimal functioning (ANA, 2014).
Beyond these specific provisions, nursing ethical practice encompasses several key principles: confidentiality, autonomy, informed consent, veracity, beneficence, non-maleficence, justice, paternalism, fidelity, respect for others, and utility. In this case, confidentiality is the primary principle at issue, though principles of beneficence (acting in the patient's best interest) and fidelity (loyalty to colleagues) also come into tension.
"State licensing and regulatory requirements"
Step 1: Confidential Conversation. The first nurse should speak in confidence with the offending nurse-friend to remind her of the ethical principle she violated. Although the offending nurse is likely aware of the violation, a serious but private conversation reinforces the seriousness of the act. The first nurse should emphasize that both of them risk their careers and livelihoods if the situation escalates. This conversation can serve as both a reminder and a deterrent without initiating formal disciplinary action.
Step 2: Careful Application of Provision 3.5. The first nurse should recognize that Provision 3.5 does not require reporting every access to patient information without authorization. The provision explicitly requires that such access must pose a threat to the patient's health and well-being in order to constitute a reportable breach. In this case, the nurse accessed the information out of compassion and concern for the patient's welfare, not out of curiosity or malicious intent. Both nurses are friends of the patient and genuinely want her to recover. Therefore, the unauthorized access, while inappropriate, does not meet the threshold for mandatory reporting.
Step 3: Facilitate Authorized Access. The first nurse can help the second nurse address her compassion in an ethical way. Both can visit the patient-friend as friends, not as healthcare providers. Alternatively, one or both of them can work to be officially assigned to this patient's care. Once officially assigned, any access to the patient's records becomes authorized and appropriate.
"Broader lessons for nursing professionalism"
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