An oncology nurse with over 20 years of experience ponders the necessity of professional privacy in the workplace -particularly in light of COVID-19 vaccinations.
Last week, a patient asked me to be removed from their care team for not disclosing my COVID-19 vaccination status and shocked does not begin to accurately describe my reaction. As an expert oncology nurse with more than 2 decades of service under my belt (or scrubs), I have never had a patient ask me about my medical history. I was so taken aback that I found myself stumbling over my words. After finally spitting out an awful, unrehearsed retort about policies and personal rights, she informed me that she was not comfortable under my care. I gasped in disbelief. “I am a great nurse, and my patients love me!”, I wanted to reply, but I simply apologized and honored her wishes. Then, I began to ponder the need for professional privacy.
Despite where someone stands on the COVID-19 vaccine debate, it is hard to deny that it is awkward when a patient asks, "are you vaccinated?". Of course, as vaccine mandates nip at the heels of every healthcare provider, answering "yes" to this seemingly intrusive question may be the only acceptable answer. In the meantime, however, it is crucial for nurses to keep their medical choices private and to politely tell patients to mind their own business.
What HIPAA Says
Although I understand their reasoning, I cringe every time I hear a nurse use HIPAA to protest being asked about their vaccination record. It is not a HIPAA violation for patients to ask their healthcare provider if they have been vaccinated against COVID-19.1 This federal law protects privacy by defining how health information is protected, but it does not restrict patients from asking their nurse (doctor, medical assistant, phlebotomist, etc.) about their medical history.
However, health care providers are not required to answer any questions about our health choices, nor should we. It's that simple.
Not so straightforward, admittedly, is whether organizations can legally adorn their employees with badges and stickers that exploit their vaccination choice. The answer should be a solid no, but it's more like "no-ish". According to the Equal Employment Opportunity Commission (EEOC), vaccination status is considered confidential.2 So, although being forced to bear the scarlet letters “vaccinated” or “unvaccinated” on your scrub top is unlawful, we may be required to have an indiscreet sticker placed on our badge or wear a wristband that affirms our compliance with hospital policy.Why do we need visible evidence of our conformity? Hospital administrators explain that it allows for quick and clear assurance that staff is following safety rules. For example, if an associate is not wearing a mask, a nonchalant glance at the required "accessory" confirms their immunization status, and the proper steps can ensue.
Although there is value in this approach, I wonder about the ramifications for staff who do not yield the sign of obedience. Will judgement occur once patients catch on to the purpose of a covertly placed sticker? Backlash by coworkers has already been reported by nurses who do not want the vaccine. Even more troublesome could be the voluntary bearing of pins that exclaim in all capitals “I’M VACCINATED!”. As if healthcare workers weren’t under enough pressure, we now must compete with one another in garnishments that seem to establish two separate sides, the uncompliant anti-vaxxers versus the selfless vaccinated conformers. Why can’t simply being employed provide enough proof that we are following our institution’s policies, therefore, providing safe medical care?
Respect My Boundaries
Although it is uncomfortable to have our personal medical decisions scrutinized by patients, we must remind ourselves to understand their intentions. Patients are not asking these questions to be nosy or rude but rather to feel safe under our care. Yet, now, more than ever, political views are influencing people’s medical decision making - creating a slippery slope for nurses to navigate.
Therefore, after much rehearsal, here is my new spiel if asked about my vaccine status (you’re welcome to use it as well) - "Mr. Smith, although my medical history is between my care provider and me, I understand that you want to feel safe today (tonight), so I assure you that I follow my organization's policies for COVID-19 safety and that you are in trusted hands.", then I will quickly place my stethoscope in my ears!
Final Thoughts - A Plea for Privacy
Even if you are proud of being vaccinated, I urge you to set clear precedence for privacy with patients, and here's why.
We already share so much with those we serve: our time, energy, healing, and devotion. So, whether you are in line to get the vaccine or in a rally to protest it, nurses should stand together to protect our privacy by maintaining professional boundaries with patients. An unknown author wrote, "I set boundaries not to offend you but to respect myself." Today's inquiry may be about our vaccination status, but tomorrow’s question could involve our mental health history, finances, or social status. The list goes on.
Therefore, in addition to politely telling our patients to mind their own business, it is crucial to strip ourselves of the decorative adornments that give clues to our personal health choices. By drawing a clear line now, maybe we can prevent crossing it in the future.