Occupational and environmental health nurses play an important role in establishing and maintaining employee confidentiality. Preserving confidentiality transcends simple nondisclosure of private information and consists of an agreement between the employee and the health professional regarding the boundaries of shared secrets. Health professionals must be aware of specific limitations to confidentiality and convey these limits to employees. Occupational and environmental health nurses must restrict employer access to employee medical records. Open and honest communication is necessary to establish the appropriate boundaries of confidentiality and strengthen the employee/employer/health professional relationship.