Client advocacy and confidentiality in nursing: five duties in one shift
Speak up for the client, make room for Indigenous practices, give equal care, share only through care, consent or law, and report a privacy breach.
- A report that changed nothing is not finished.
- Ask what matters, and use the name the client gives you.
- Share only through care, consent or law. Report every breach.
Client advocacy and confidentiality in nursing mean that you carry the client's need until someone acts, and that their information leaves your hands only through care, consent or law. This guide follows one shift with a nursing student who learns from what you do, and links to a lesson on each of the five duties.
Five duties a practical nurse meets in one shift
| Duty | The rule |
|---|---|
| Speak up for the client | A report that changed nothing is not finished. Call again with the facts, then go up. |
| Indigenous health knowledge | Ask what the client needs, and listen. Then find a safe way, and write it into the plan. |
| Equal care for every client | Use the client's name and pronouns, heard or not. Speak up when a colleague does not. |
| Who may know | Information leaves your hands through care, consent or law. No door, no information. |
| A privacy breach | Recognize it, stop it and report it. Never hide it, and never join it. |
Do not look, and report the breach
At 07:15, a colleague waves you over to see the chart of a famous actor on another unit. Neither of you gives him care. Looking out of curiosity is a breach, even if nobody is ever told. So you do not look, and you ask her to close the record.
She asks you to tell no one. You cannot promise that. You report it to the nurse in charge, the way your employer's process states, because your report lets your employer tell the people who must be told. Later the same rule covers talk about a client in a crowded elevator and a selfie in front of a whiteboard with client names.
Read the full lesson: recognize, stop and report a privacy breach.
Use the name the client gives you
You admit a transgender woman with pneumonia. She tells you her name is Dana and that she uses she and her. At the desk, a colleague reads her health card and says he will call her he.
Sexual orientation, gender identity and gender expression never change the care a client is owed. You call her Dana and say she, at the bedside and at the desk. You record her name and pronouns, and you say them at handover. Then you tell your colleague plainly what name and pronouns we use here.
Read the full lesson: equal care for every client.
Ask what matters, and make room for it
A First Nations woman asks to smudge before her surgery tomorrow. Her roommate is on oxygen. Her practice is part of her care, and your part is to find a safe way.
You ask what she needs, and you listen. Burning sage is unsafe near oxygen, so you tell her plainly that the bedside will not work. With the charge nurse and the Indigenous health liaison, you find a quiet room. You write it into the plan of care and hand it over.
Read the full lesson: Indigenous health knowledge in care.
Share only through care, consent or law
A caller says she is the client's daughter and asks for test results. Your client is capable, so the daughter needs the consent door, and you ask your client first. A physiotherapist who treats the client uses the care door. A public health nurse who calls about a reportable infection uses the law door.
A nurse from another unit, who is a neighbour of the client, gives no care. So no door opens, and nothing is shared. Being family, or being a nurse, never opens a door by itself.
Read the full lesson: who may know a client's information.
Carry the client's need until someone acts
A client two days after bowel surgery still rates her pain at eight out of ten, an hour after her pain medication. You reported it an hour ago, and nothing changed. A colleague tells you not to call again.
You assess her pain again and call again with the facts. If nothing changes, you go up to your charge nurse and document each step. The same afternoon, you ask for a professional interpreter instead of a child, and you bring in the social worker for a client who cannot pay for his dressings.
Read the full lesson: speak up for the client.
Laws and policies differ between provinces and between employers. Follow your regulator and your agency's policy.