A health services coordinator submitted a question about the use of surveillance cameras in school-based clinics.
She was concerned about surveillance cameras privacy issues on students and staff who seek medical care there.
In addition, the nurse was concerned that RNs working in the clinics were being constantly watched.
One ethical and legal obligation of RNs and school nurses who work with students is protecting their rights of privacy. I wrote about this topic in my blog, “When School Nursing and Student Privacy Laws Clash.”
Which laws apply to student privacy protection?
The 4th Amendment to the United States Constitution prohibits an “unreasonable search or seizure.” If either occurs, a warrant is necessary and based on “probable cause” when a student attends a public school.
State and federal laws also protect student privacy, whether or not the student attends a public or private academic entity. State school codes and the Family Education Rights and Privacy Act (FERPA) are two that are well-known.
The Health Insurance Portability and Privacy Act (HIPAA) and its Privacy Rule does not, in most cases, apply to a school setting — whether elementary or secondary school — because it is not a covered entity.
If it is a covered entity, the records kept about a student’s health information are an “education record” under FERPA and therefore not subject to the HIPAA Privacy Rule.
This is so because in most instances, the school-based health staff do not transmit health information “in connection with certain administrative and financial transactions” covered in the rule.
If a staff member bills Medicaid services for a student under the Individuals With Disabilities in Education Act, for example, that transaction must comply with HIPAA’s rule.
But if the records are kept as education records under FERPA, as above, then FERPA’s privacy rules apply, as discussed in “Does the HIPAA Privacy Rule Apply to an Elementary or Secondary School?”
Surveillance cameras privacy issues in schools
According to the National Center for Education Statistics, more than 80% of public schools and more than 94% of high schools in the U.S. used security cameras to monitor students during the 2015-2016 school year.
In an age where school shootings have become almost commonplace, such cameras help provide school safety and security.
Their use for these purposes have been upheld and determined not to be an invasion of privacy in locations such as classrooms, hallways and the perimeter of the building, according to National Center for Education Statistics.
Bathrooms and locker rooms — where an expectation of privacy is greater — create constitutional and general invasion of privacy difficulties.
Does school safety require cameras in clinics?
One answer that would justify their presence is the fact the clinic houses medications, including controlled substances, syringes and other healthcare equipment that could be stolen and sold.
The medications and equipment also could be used in an adverse way against students and school personnel if the school was taken over by an intruder.
Even if this were a strong argument for having cameras in school-based clinics, is it strong enough to override a student’s privacy?
How surveillance cameras co-exist with student privacy
Although FERPA does not directly address surveillance cameras privacy issues in the school setting generally or in a school-based clinic, it provides guidelines that can help use them in a responsible way.
First and foremost, parents must be informed of the use of surveillance cameras throughout the school and specifically in the school-based clinic. The policy developed and adopted by the school for their use must be clear, include the reasons for the cameras, and require the written, informed consent of the parents or legal guardian.
The consent should be kept with the student’s education records, especially if the school system is the keeper and maintainer of the surveillance system.
For staff who seek treatment at the clinic, they need to know the policy and provide written, informed consent.
For both groups, the consent should include information as to who or what entities will have access to:
- Any camera footage.
- The roles and responsibilities of those who have access to the cameras.
- How long any footage will be kept.
- How any footage will be destroyed.
What about nursing staff surveillance?
Employers have been using cameras in the workplace for some time, and the courts have upheld their use there. Employer-based rationales include security and risk management.
Employee anxieties with electronic surveillance include a mistrust of the employer’s motives and a reduction in their privacy.
Although the surveillance in a school-based clinic is not to “watch” the staff, their concerns should not be taken lightly. Initiating surveillance in an ethical and legal manner with clinic staff is equally important as it is with students, parents and others who seek treatment.
You can learn more about the ethics of electronic surveillance of nurses by reading Rodney Wallace’s journal article, “Ethics: Electronic Surveillance of Nurses in the Workplace: Ethical Considerations.”
If you work in a school-based clinic that uses electronic surveillance, what has your experience been?
Take these courses about surveillance cameras privacy issues and school nursing:
HIPAA and Confidentiality
(1 contact hr)
The federal Health Insurance Portability and Accountability Act was implemented in 1996 and has been revised since then. HIPAA can refer to guidelines that protect your ability to maintain your health insurance as you move from job to job or place to place (“portability”). HIPAA can also refer to efforts to simplify the administration of health insurance. These efforts include the creation of national standards for diagnostic terms, insurance forms and provider identification. Perhaps the most common use of the term for healthcare professionals, however, involves protecting the confidentiality and privacy of healthcare information. In this module, you will learn about parts of HIPAA, especially as they concern nursing and other health professionals and the protection of healthcare information. Because you play a key role in the production of healthcare information, you play a key role in its protection.
Forensic Nursing and School Shooters
(1.5 contact hrs)
Many forensic nurses focus on interpersonal violence. At one time, schools — a workplace for students, teachers, and nurses — were considered safe. The reality is that violence on school grounds and inside school buildings is continuing in the aftermath of several high-profile cases of shooting homicides in these settings. Nurses working in the school, community, and emergency and psychiatric mental health settings can play a key role in the prevention of violence by understanding the dynamics and profiles behind these types of homicides.
School RNs Lead Education Efforts for Students with Diabetes
(1 contact hr)
Diabetes is one of the most common chronic diseases in school-age children. In the United States, about 208,000 people under the age of 20 have diabetes (about 0.25% of all people in this age group). Because of this incidence and the federal laws that guarantee students with disabilities access to public education, most school nurses already have students with diabetes on campus — or will in the future. For students with diabetes to have a successful school experience, school nurses must be well informed about the students’ special needs. The school nurse is the most appropriate person to coordinate the care of students with diabetes and to train school staff on diabetes-related tasks and ways to treat any diabetes-related emergency. This module informs nurses about significant factors in planning and initiating care in the school setting for students with diabetes. Overview of diabetes in children and adolescents. National Diabetes Education Program