A Plan to Increase A Plan to Increase Confidentiality in the Confidentiality in the Health OfficeHealth Office

Shelly McEvilly, RN, BSNShelly McEvilly, RN, BSN

Current problemsCurrent problems

Too much access for outside personnel to Too much access for outside personnel to nurse’s office and computernurse’s office and computer

Outside personnel congregating in health office Outside personnel congregating in health office to talk and gossipto talk and gossip

Students congregating in health office when Students congregating in health office when not needing to be treated or working as health not needing to be treated or working as health aidesaides

Environment does not project a safe place for Environment does not project a safe place for students to discuss personal health issuesstudents to discuss personal health issues

Old records stored in area accessible to Old records stored in area accessible to outside personneloutside personnel

First Steps First Steps

Discussion with principal outlining problems Discussion with principal outlining problems and request for collaboration in correcting and request for collaboration in correcting situation.situation.

Request to have lock changed on nurse’s Request to have lock changed on nurse’s office to prevent access to outside personnel.office to prevent access to outside personnel.

Request for blinds on window of nurse’s office Request for blinds on window of nurse’s office to provide increased privacy for physical to provide increased privacy for physical assessments and personal discussions.assessments and personal discussions.

Training Training

Training for FASA, health office backups, Training for FASA, health office backups, student aides, and monitorsstudent aides, and monitors Discuss privacy and confidentiality, including laws Discuss privacy and confidentiality, including laws

about HIPPA and FERPAabout HIPPA and FERPA Stress need for safe and welcoming environment to Stress need for safe and welcoming environment to

invite openness by students on personal issuesinvite openness by students on personal issues Discuss need to curtail congregating in health office Discuss need to curtail congregating in health office

of unnecessary personnel and studentsof unnecessary personnel and students Eliminate gossiping (even if not about health office Eliminate gossiping (even if not about health office

issues)issues) PROMOTE PROFESSIONAL ENVIRONMENT!PROMOTE PROFESSIONAL ENVIRONMENT!

Creating a Creating a Safe ZoneSafe Zone

Display posters and educational material on Display posters and educational material on confidentiality and a range of subjects pertinent confidentiality and a range of subjects pertinent to student healthto student health

Maintain an open, professional environment Maintain an open, professional environment that promotes confidentialitythat promotes confidentiality

Take care not to discuss student issues in Take care not to discuss student issues in open environments and in front of othersopen environments and in front of others

Invite students to share concerns in a private Invite students to share concerns in a private setting where they can’t be overheardsetting where they can’t be overheard

Provide privacy for students who are Provide privacy for students who are performing procedures in the health officeperforming procedures in the health office

Promoting the Safe ZonePromoting the Safe Zone Discuss Safe Zone concept with principal, Discuss Safe Zone concept with principal,

assistant principals, counselors, and other assistant principals, counselors, and other pertinent staff.pertinent staff.

Send letter to teachers and staff regarding Send letter to teachers and staff regarding need for confidentiality and sensitivity in the need for confidentiality and sensitivity in the classroom and other public settings for classroom and other public settings for students with health issues. students with health issues.

Monitor health office regularly to maintain Monitor health office regularly to maintain appropriate environment and reinforce training appropriate environment and reinforce training to appropriate personnel.to appropriate personnel.

Additional EffortsAdditional Efforts

Discuss alternate storage locations for long term Discuss alternate storage locations for long term maintenance of past years’ sensitive health recordsmaintenance of past years’ sensitive health records

Visit pregnancy class and health classes to introduce Visit pregnancy class and health classes to introduce myself as school nurse and inform students of myself as school nurse and inform students of availability to discuss personal health issues in privacy availability to discuss personal health issues in privacy of health officeof health office

Research school district regulations and nurse practice Research school district regulations and nurse practice act regarding minor consent and required parent act regarding minor consent and required parent notification for pregnancy, mental health, substance notification for pregnancy, mental health, substance abuse, and sex related issuesabuse, and sex related issues

Adapt Adapt Understanding Confidentiality and Minor Consent in CaUnderstanding Confidentiality and Minor Consent in California: An Adolescent Provider Toolkit lifornia: An Adolescent Provider Toolkit to reflect Nevada laws and school district regulationsto reflect Nevada laws and school district regulations

References References Benton, Jeremy (2003). Making Schools Safer and Healthier for Benton, Jeremy (2003). Making Schools Safer and Healthier for

Lesbian, Gay, Bisexual, and Questioning Students. Lesbian, Gay, Bisexual, and Questioning Students. Journal Journal of School Nursing, 19of School Nursing, 19(5), 251-259.(5), 251-259.

Bergren, Martha Dewey (2004). HIPAA-FERPA Revisited. Bergren, Martha Dewey (2004). HIPAA-FERPA Revisited. Journal Journal of School Nursingof School Nursing, , 2020(2), 107-112.(2), 107-112.

Schwab, Nadine C. & Gelfman, Mary H. B. (2005) Confidentiality: Schwab, Nadine C. & Gelfman, Mary H. B. (2005) Confidentiality: Principles and Practice Issues. In Schwab, Nadine C. & Principles and Practice Issues. In Schwab, Nadine C. &

Gelfman, Mary H. B. (Eds.) Gelfman, Mary H. B. (Eds.) Legal Issues In School Health Legal Issues In School Health Services Services (pp. 261-295). New York: Authors Choice Press.(pp. 261-295). New York: Authors Choice Press.

Schwab, Nadine C. & Pohlman, Katherine J. (2004). Records-The Schwab, Nadine C. & Pohlman, Katherine J. (2004). Records-The Achilles’ Heel of School Nursing: Answers to Bothersome Achilles’ Heel of School Nursing: Answers to Bothersome Questions. Questions. Journal of School Nursing, 20Journal of School Nursing, 20(4), 236-241.(4), 236-241.

Simmons, M., Shalwitz, J., & Pollack, S. (2002). Simmons, M., Shalwitz, J., & Pollack, S. (2002). Understanding Understanding Confidentiality and Minor Consent in California: An Confidentiality and Minor Consent in California: An Adolescent Provider ToolkitAdolescent Provider Toolkit. San Francisco, CA: Adolescent . San Francisco, CA: Adolescent Health Working Group, San Francisco Health Plan.Health Working Group, San Francisco Health Plan.