Question from an RN...

[MarkRN]

Hello to everyone --

This is probably a different question than you're used to getting in here.

I'm an RN at a local hospital, and quite often I will come in contact with patients who have questions about risk assessments in regards to transmission on the HIV virus.

At this point, I've based my answers to patients on the most up to date research we have available on our intranet within the hospital, as well as various research articles.
I've most recently come across this website, and this forum (and the HIV Prevention Expert Forum) as a great resource for expanding my knowledge on the subject.

In nursing school, we really didn't delve into the subject of HIV at all and so correct knowledge from most is hard to come by.

In regards to risks, I am hoping I am correct in telling patients that they are only at risk of contracting the HIV virus if:

1) They engaged in unprotected vaginal/anal intercourse.
2) Shared IV needles/partake in IV drug use.
3) Passed from mother to infant.

I get a lot of questions regarding unprotected oral sex (male to male, male to female, female to male) (and it seems like you do too!), and I always tell them (based on my current knowledge) that there was no risk whatsoever, and I do not recommend they pursue testing.


I just want to be clear:  Am I giving the correct information?

One of the standards of being an RN is to "do no harm", so I would feel absolutely terrible if I did not recommend testing, when in fact I was wrong.

The fact is though, I also can't stand fear mongering/incorrect information that just causes needless anxiety in otherwise healthy, sexually active adults.
I also seems to be a waste of time/resources to recommend testing when it is not needed (These tests cost money!)



Anyhow, I've blabbered on, but I just wanted to get an opinion from other educators/health professionals on the matter.

Thanks so much,

Mark RN


PS: We still have Doctors here who recommend testing at 9 months to be conclusive, as well as older emergency nurses who believe 12 months is conclusive! Yikes!

[MarkRN]

Thanks for your reply nursegirl6572!

I totally agree with your statement. I forgot to clarify -- I for sure am staying clear from making any diagnosis/medical recommendations. I do leave that to the Dr.

I think more from my perspective, I am trying to relieve some anxieties towards the condition, and I'm trying to give more up to date information to help relieve some of the stigma that goes along with it.

I feel it is unfair for the Dr's here to give incorrect information…. as you could see… could you imagine being told to wait 12 months for a conclusive result? Eeesh!

I just wanted to make sure that when i'm educating, I'm giving the proper information ex. Sending someone off thinking unprotected oral sex is safe when it fact it wasn't.

Just making sure my facts are correct! :)

But by the sounds of things, it seems like sex just isn't allowed to be fun anymore. So much terror!

Mark RN

[nursegirl6572]

Yes, your assessment of what is and isn't a risk is correct.

Scary that your physicians are still recommending things from the dinosaur era.  We see it all the time here, so it's not real shocking.  I think a lot of docs just are not comfortable committing to the newer window period because they are too "old school" in their thoughts about HIV.  Sadly, medical professionals are horribly trained in the matter of HIV.  

Just a general observation...you have to be very careful, as I'm sure you know in giving advice that may be perceived as a direction to test or not to test.  Specific instructions like that to a patient, really should be coming from an MD.

Just be sure to use the proper verbiage...just present the info factually what is and isn't a risk...and tell the patient that obviously, if they had a risk, testing would be warranted, and if they didn't, no testing would be advised.  If a patient gets into more sepcific questions regarding their desire to test, etc...I would refer them to the doctor.

It's a very thin line we walk as nurses, we really DO need to be careful not to accidentally step into that doctor role.  One of my colleagues actually got fired for acting in the role of a physician because she told the family of a patient what specific medication would be indicated with that patient's diagnosis.  It's a gray area for sure.

The only reason I mentioned that is because, based on your post, it seems as though you are giving very specific testing advice to some of your patients.  Just always be cautious.  I know it's frustrating, especially when the doctor you would go get would be less educated in HIV than YOU.

Start having conversations with the docs and other nurses....educate people, open their eyes.  You will get a LOT of resistance, but there WILL be people who are willing to learn, and know the real truthm instead of the fear-based education model that's been around since the start of the disease.  I've opened a lot of eyes among my colleagues.  Luckily, thank GOD the ID docs always were good resource people, when someone didn't buy what I was saying.

At a former job, I actually organized some training for HIV and Hep B.  It was very informative.  We need to start getting people to bring themselves up to date with the facts.