What Is HIPAA? Nursing Guide and FAQ

What’s so important about HIPAA? Nursing is one of the many healthcare specialties in which this policy is vital. HIPAA is an acronym for the Health Insurance Portability and Accountability Act and is enforced by the Office of Civil Rights in the U.S. Department of Health and Human Services.

Simply put, HIPAA guidelines for healthcare professionals strike the balance between the necessary communication of health information amongst healthcare workers and the need to maintain patient privacy. Below, we explore HIPAA violations, what happens if a nurse violates HIPAA, and other aspects of HIPAA in nursing.

Who Is Required to Follow HIPAA?

Although respecting a patient’s privacy is expected of all healthcare workers, only certain individuals and entities are bound to comply by law. These groups fall under HIPAA regulations:

• Most healthcare providers, such as nurses, doctors, and pharmacists
• Health insurance companies
• Healthcare clearinghouses
• Any third party that performs functions requiring personal health information
• Entities who specialize in transmitting personal health information for treatment purposes or regional health

What Information Is Covered by HIPAA?

HIPAA protects all individually identifiable health information. This includes:

• Demographics
• The patient’s past, present, or future physical or mental health conditions
• The provision of healthcare to a patient
• The past, present, or future payment for a patient’s healthcare

How Does HIPAA Affect Nurses?

The importance of HIPAA in nursing can be boiled down to trust. A patient’s confidence in a healthcare worker’s trustworthiness could lead to better health outcomes.

When patients know their nurse won’t discuss their private matters with anyone unless it’s related to their care, they’ll be more comfortable sharing information. The more the nurse and other members of the healthcare team know about the patients, the easier it is to make informed decisions for the care plan.

HIPAA Nursing: The Minimum Necessary Standard

According to HIPAA, healthcare workers must only share enough information to fulfill a specific goal, called the minimum necessary standard. This means that nurses and other healthcare workers share the minimum necessary amount of information to accomplish the task at hand.

For example, two nurses are discussing a patient’s upcoming heart surgery. Allergies, the current diagnosis, past cardiac and surgical histories are examples of relevant information. Discussing aspects of the patient’s lifestyle that don’t directly relate to cardiac health such as sexual preference and where they live would be unnecessary.

There’s flexibility in adhering to this standard as long as you do your best to minimize sharing unnecessary information. Healthcare providers can elaborate on what they share with one another to provide sufficient context in the following situations:

• Requests by a health care provider for treatment purposes
• Disclosures to the patient and to others with the patient’s authorization
• An individual’s insurance authorization
• Requests required for compliance with HIPAA Administrative Simplification Rules
• Requests from the Department of Health and Human Services when the information is required for law enforcement and other legal purposes

Accidental Nurse HIPAA Violations

Oftentimes, examples of HIPAA violations by nurses aren’t on purpose. Healthcare workers are people, and people make mistakes. Regardless of this reality, you could still be held accountable should this occur. Some examples of accidental violations you can avoid include:

• Accessing health information of patients for whom you’re not responsible
• Discussing your patient’s health information with a coworker who isn’t involved with the patient’s treatment
• Sharing a patient’s health information on social media
• Leaving patient health information in an area where it can be accessed by unauthorized individuals
• Sharing more patient health information than was absolutely necessary

HIPAA Nursing FAQ

Do you still have questions about HIPAA? Nursing is complex by itself. On top of that, these legal requirements add an extra but necessary layer. Below are some commonly asked questions.

Can I get fired for an accidental HIPAA violation?

It’s unlikely, but it depends on the situation. Many employers recognize the possibility of human error, so they may opt for a meeting with a manager, suspension from work, or additional training on the subject. Ultimately, it’s up to the company’s discretion. If a nurse repeatedly violates HIPAA, they are at risk of being terminated even if the violations were all accidental.

What are the penalties for a HIPAA violation?

The consequences depend on the extent of the violation and your employer’s policies. In cases of gross misconduct, you could lose your job and be reported to your licensing board. On the lighter end of the spectrum, you may only receive a verbal warning or be required to complete a HIPAA training course.

Nurses who’ve intentionally breached HIPAA may have to pay a fine of as little as $100 and up to $50,000. If you’re dishonest about the role you played in the violation, the penalty can rise to a maximum fine of $100,000 and up to five years in jail. If you attempted to sell, transfer, or illegally use protected information for personal gain or to harm another, the penalty is a maximum fine of $250,000 and up to 10 years in jail.

What do I do if I’m accused of a HIPPA violation?

Regardless of the situation, be honest. Dishonesty will only worsen the potential repercussions. If you’re fortunate enough to only receive a verbal warning, take it seriously. If you’re assigned HIPAA training, complete it.

Even if you’re not required to complete extra training, consider educating yourself for your own personal knowledge. Set aside time to think of what you could’ve done differently, but don’t beat yourself up over it. Just make sure you apply the lessons you’ve learned to future patients.

In the event legal action is taken, be open to the possibility of hiring a lawyer. If you’ve bought malpractice insurance, you can check to see if it will be of any assistance given the circumstances in your case.

Will a HIPAA violation appear on a background check?

Yes, a documented HIPAA violation will appear on a background check. The violation itself and the consequences will be available to the public record.

HIPAA: Nursing Wouldn’t Be the Same Without It

Confidentiality is paramount to nursing, and HIPAA helps ensure that it’s respected. Take the integrity these policies instill wherever you go. Put your new knowledge to good use when you find a nursing opportunity that supports your ideal lifestyle.