Provision 3

Within the context of the nurse-patient relationship, information about the whole of a patient’s life may be communicated to nurses. Nurses exercise moral discernment to distinguish between clinically relevant information and personal information that does not need to be shared. Nurses protect recipients of care from unwanted or unwarranted intrusion. Privacy is the right of the recipient of care to control access to, and to disclose or not disclose, information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed. Nurses safeguard the right to privacy for individuals, families, and communities. The nurse creates an environment that provides sufficient physical privacy, including privacy for discussions of a personal nature. Recipients of care may disclose sensitive information regarding abuse or trauma during clinical care or research processes. With consent from the patient, the nurse may advocate for a referral for supportive services. Nurses also participate in the development and maintenance of policies and practices that protect both personal and clinical information within organizational and public domains.

Confidentiality pertains to the nondisclosure of personal information that has been communicated within the nurse-patient relationship. Central to that relationship is an element of trust and an expectation that personal information will not be divulged without consent. The nurse has a duty to maintain confidentiality of all patient information, both personal and clinical, in the work setting and off duty in all venues, including social media or any other means of communication. Because of rapidly evolving communication technology and the porous nature of social media, nurses maintain vigilance regarding all forms of media that intentionally or unintentionally breach their obligation to maintain and protect patients’ rights to privacy and confidentiality.

Personal information relevant to clinical care may need to be disclosed for continuity of care under defined practices, policies, or protocols. Information disclosed for education, peer review, professional practice evaluation, and other quality improvement or risk management mechanisms may be disclosed once anonymized, if anonymization does not hinder required processes. When using electronic communications or working with electronic health records, nurses make every effort to maintain security related to items within their control, including preventing external attempts to breach data security and adhering to best practices by using secure internal portals.

Public health-related mandatory reporting is designed to protect the public from communicable or contagious diseases and a broad range of abuse, neglect, or other safety issues for individuals, families, and communities. Prior to reporting safety concerns, nurses carefully consider potential ramifications and the context and impact of social determinants of health when assessing criteria and consequences of reporting.

Nurses increasingly encounter legislation regarding mandatory reporting, unrelated to public health, that may conflict with a patient’s best interest. While the law in some states mandates the nurse report, it is ethically justified for the nurse to protect the privacy and confidentiality of the patient seeking care. Nurses may find themselves in situations in which they face conflicting interests between ethical constructs of the profession and state and/or institution's reporting mandates. In these situations, the nurse understands either decision holds consequences for the patient and the nurse. Nurses ought to be compassionate, truthful, forthcoming, and transparent when communicating their mandatory reporting obligations with recipients of nursing care.