Recently, I read an article about a nurse who was dismissed after publishing her memoirs. The author detailed her career in nursing, which included alleged verbal abuse from surgeons. In their response, her employers noted that teamwork, trust, and patient confidentiality were important aspects of a critical-care environment, and that breaches in patient and co-worker trust are inappropriate. Their comments led me to wonder what constitutes the realm of coworker confidentiality?
Private communications
Confidentiality is complex and encompasses more than the patient-medical professional relationship. It expands to communication between coworkers and the relationship between the employee and the institution. What's our duty to maintain confidentiality among our peers?
The concept of confidentiality is clear in regard to the provider-patient relationship and is supported by regulatory agencies, legal definitions, nursing organizations, and the American Medical Association Code of Ethics. The concept of confidentiality among coworkers is much less clearly defined or supported.
Confidentiality includes any communication through written, electronic, or verbal modalities. Some aspects of coworker confidentiality are supported by regulatory agencies and legal parameters, such as a coworker accessing another's employee file or health record. When communicating through the internet, sharing information such as policies and procedures or personal challenges might be considered detrimental to the organization and could be interpreted as decreasing the value of the organization. For this reason, organizations may discourage the content of these communications.
Breaching trust
Verbal breaches in coworker confidentiality of a personal nature are largely guided by the organization's code of conduct and institutional guidelines.
Confidentiality among coworkers can be difficult because we sometimes spend more time with them than with our families. In the OR, the team approach and a sense of trust is cultivated and maximized. While the level of commitment and relationship is different than our personal relationships, most of us are still concerned about the health and welfare of our colleagues. We work closely together and in well-defined spaces. Staff is sensitive to each other's moods and deviations in behavior. When absences or extended absences are noted by peers, it can be difficult for leadership to maintain confidentiality.
When confidentiality is breached by a coworker, the result can be anger or embarrassment, which can affect teamwork and productivity, create a hostile work environment for either person concerned, affect retention, and ultimately, decrease the quality of patient care. If an employee's energy is directed toward unhealthy coworker relationships, it's easier to be distracted from our primary focus: the patient.
The issue of confidentiality is continuously evolving as technologic advances provide us with easier means of communication with others. This ease of communication, particularly through publication and the Inter-net, may give us a false sense of security in sharing information. It may seem a paradoxical notion to promote open communication while encouraging the monitoring and censoring of content. As nurses, we must be aware of the domain and constraints of confidentiality among our peers. Let your own ethics guide you and remember the golden rule: Treat others as you would like to be treated.
Elizabeth M. Thompson, RN, CNOR, MSN
Editor-in-Chief, Nursing Education Specialist, Mayo Clinic, Rochester, Minn.
[email protected]