Am I asking too much from a nurse? - page 2

My dad had surgery Tuesday to remove pituitary adenoma. This is his second surgery in 5 years for this issue. Both last time and this time, he developed diabetes insipidus, which I understand is... Read More

  1. Visit  MECO28 profile page
    3
    You'll find your own ways of dealing with those questions when you start getting confronted with them. There are ways to deflect giving out information that the MD should be going over while giving a somewhat satisfactory answer:

    For instance- "It is standard to check calcium levels after a thyroid surgery. Your doctor will let you know the results after she interprets them."

    I try to be as honest as possible about why we draw certain labs without giving out too much info and overstepping my bounds. It can be difficult sometimes, and I may sometimes be guilty of appearing to brush off questions. Also, as other posters have said, med-surg nurses often have many patients and we don't always have the time to look at every patient's individual labs. (And unless it's critical, I don't have anyone's lab values memorized)

    Short answer, your dad's nurse probably #1. didn't know your dad's sodium level off the top of her head and #2. felt uncomfortable discussing lab values when that is really the job of the MD. and #3.probably hadn't eaten/peed/sat down in 10 hours and was too physically exhausted to think of a good reply. Med-surg is fun!

    Welcome to nursing! Glad your dad is doing well!
    GrnTea, Fiona59, and Meriwhen like this.
  2. Visit  tmartin83 profile page
    0
    I don't think you asked too much... Very touchy subject indeed. Although I've only been working for a little less than 2 years now, I can definitely say to stay clear from giving out or hinting at diagnostic results for things like CTs, XRs, and all that good stuff...

    The only time I'll bring up a lab value is if I go in the room to give blood, hang a K-phos drip or give insulin, or a corrective med, and the family's around. I explain why I'm giving the medication then (usually family will ask what and why I'm giving something anyway...). By that time, the doc has already made rounds and talked to the family in regards to his plan.
    Last edit by tmartin83 on Jan 31, '13
  3. Visit  Meriwhen profile page
    2
    Keep in mind three things:

    1. Facility policy can prohibit nurses from disclosing lab results to patients as well as families--they want the PCP to be the one explain them. In my facility, I can't even tell patients their test results were normal/negative without the MD's blessing first. So while it may seem like I'm brushing you off, it's because they will not let me tell you this info.

    2. The fact that you are a daughter present at the bedside doesn't mean it's a given that you are on the patient's release of information form. You probably are...or you may not be. Rather than risk a potential HIPAA violation, healthcare staff are going to err on the side of not discussing patient care with you until they are sure.

    3. The fact that you are a nurse doesn't mean that rules #1 and #2 don't apply to you. I'm not saying this to be mean, but sometimes it's easy to forget that in this instance you are not a nurse but a family member who happens to be a nurse. The problem is that you are not his nurse...

    I've experienced myself when it comes to sick family members. The reality is that we can't expect facilities to bend/break the rules for us because we're also licensed. And that's not always easy to remember because as you yourself said, when it comes to sick family members, we're too close to the situation.

    While the nurse technically did answer your question, I do think she could have explained it a bit better, like a poster above me suggested.

    Hope your father has a speedy recovery!
    jadelpn and Fiona59 like this.
  4. Visit  TheCommuter profile page
    10
    Quote from monkey2008
    The nurse came in and said he needed to draw blood to test his sodium, she drew one vial. I asked if his levels were high. She responded "oh we just test it".
    Another thought came to mind. . .are you sure the person drawing the blood was your father's nurse? At the facility where I'm employed, phlebotomy techs perform the vast majority of the venipunctures and blood draws.

    If the woman who drew your father's blood was a phlebotomist with a very narrow scope of practice, I can see why she would say, "We just test it." After all, they just collect samples and test them.
    KelRN215, TopazLover, nrsang97, and 7 others like this.
  5. Visit  monkey2008 profile page
    0
    Quote from Meriwhen

    3. The fact that you are a nurse doesn't mean that rules #1 and #2 don't apply to you. I'm not saying this to be mean, but sometimes it's easy to forget that in this instance you are not a nurse but a family member who happens to be a nurse. The problem is that you are not his nurse...
    Not mean at all, very truthful and 1000000% accurate. Sometimes I just need to hear another point of view for the lightbulb to go off.
  6. Visit  loriangel14 profile page
    2
    Quote from TheCommuter
    Another thought came to mind. . .are you sure the person drawing the blood was your father's nurse? At the facility where I'm employed, phlebotomy techs perform the vast majority of the venipunctures and blood draws.

    If the woman who drew your father's blood was a phlebotomist with a very narrow scope of practice, I can see why she would say, "We just test it." After all, they just collect samples and test them.
    That's exactly what I thought when I read the OPs post.Where I work it would have been a lab tech not a nurse.Also we aren't allowed to discuss lab results with patients or family members. We have to direct questions to the MD.
    NurseKatie08 and anotherone like this.
  7. Visit  monkey2008 profile page
    0
    Quote from loriangel14
    That's exactly what I thought when I read the OPs post.Where I work it would have been a lab tech not a nurse.Also we aren't allowed to discuss lab results with patients or family members. We have to direct questions to the MD.
    She was the nurse-her badge said RN and she introduced herself as the nurse
  8. Visit  NicuGal profile page
    3
    This is when knowing the difference between nursing diagnosis and medical diagnosis comes into play. You can say, We are looking at his electrolytes to make sure they are okay. You can't say you are looking for a specific diagnosis. This is really important to know if you ever go to court, you can NOT tell a lawyer a medical diagnosis. We also are not supposed to tell patients or visitors or interpretation of results.
    NurseKatie08, Meriwhen, and loriangel14 like this.
  9. Visit  GrnTea profile page
    6
    Quote from MECO28
    You'll find your own ways of dealing with those questions when you start getting confronted with them. There are ways to deflect giving out information that the MD should be going over while giving a somewhat satisfactory answer:

    For instance- "It is standard to check calcium levels after a thyroid surgery. Your doctor will let you know the results after she interprets them."
    ........
    Short answer, your dad's nurse probably #1. didn't know your dad's sodium level off the top of her head and #2. felt uncomfortable discussing lab values when that is really the job of the MD. and #3.probably hadn't eaten/peed/sat down in 10 hours and was too physically exhausted to think of a good reply. Med-surg is fun!

    I vote for door numbah three-- she didn't have the damnedest idea what it was for or about so she gave that ridiculous answer. "Oh, we just check it" tells me this is a nurse who does tasks but not a lot of thinking. If, OTOH, she does know but is under some foolish facility constraint because they think it's OK to let their patients believe their nurses are uneducated ninnies, that's something else, and not an improvement either way. I'd take a long hard look at that and se what I could do to fix it.

    There is absolutely nothing wrong with saying something like, "Mr. Jones, is it OK if we discuss this now? Yes? OK, then. The surgery you had, as you know, affects the organ that has a lot to do with water balance, and the way we look at how that's going is by checking serum sodium. Dr. Smith will let us all know what he thinks about the result. Please be sure to ask him about this when he comes in if I can't be here when he comes to see you, or your daughter can." (because if I am there I will say, "Mr. Jones wanted to know what his labs showed." )

    There is also nothing wrong with saying, "The radiology report says your x-ray shows you're not doing enough good deep breathing (you know this because there is bibasilar atelectasis postop), so we're going to be working on that today. I'm going to help you to ..."

    "Your blood glucose is much better than when you came in last night. Do you want to talk about how you can keep a better eye on that when you go home?"

    "The radiology reading of your new hardware says it's in perfect position. I'm sure that's a relief after you went for that first tough walk with the physical terrorist, uh, therapist yesterday. You did really well."

    Seriously? Do nurses actually consent to being muzzled like that? Why do you think that is? If it's because the physicians don't think we know what a serum sodium or blood glucose or atelectasis means and how it applies to patient teaching, then we need to make sure they get disabused of that old-fashioned notion. I mean...you DO know what it's all about, right?
    KelRN215, JillyRN, acerbia, and 3 others like this.
  10. Visit  morte profile page
    0
    I'm.thinking.HIPAA....
  11. Visit  KelRN215 profile page
    0
    I have never heard of nurses not being allowed to interpret/share lab values with patients/family members. This is something I've done every day of my career since day #1. Working in peds oncology, labs are drawn on the night shift so results are ready for rounds. Often things would happen like transfusions would be ordered, electrolyte boluses would be ordered, etc. long before the medical team would ever set foot on the floor. People generally want to know why their child needs RBCs or Magnesium and Oncology parents are obsessed with the numbers. EVERYONE wants to know their kid's ANC the minute they wake up as it needs to be a certain number before discharge is even discussed. The only results that I'd be able to see but wouldn't share with parents would be Radiology reports. That was always awful... the MRI comes back showing the cancer is rapidly progressing and the parent calls you into the room for a beeping IV... "any word on the MRI?" "I haven't heard" you lie as you wait for the Attending Oncologist to arrive with the Social Worker and to be called into a team meeting where you will listen to them tell devastated parents that their child whose been fighting for so long will soon lose his fight.

    To the OP- I also have Diabetes Insipidus and worked in neurosurgery for the first 5 years of my career. DI was something we dealt with frequently and it was almost always in Neurosurgery patients. (Occasionally we had Neuro-Onc patients who had it, but it was something they developed after surgery and/or because of their tumor's location and their parents were usually well-versed in DI terminology by the time they got admitted for chemo.) Neurosurgery was on the floor for a grand total of about 26 minutes at 6am every day. These patients were on Na checks anywhere from once/day to q 6hrs. I cannot for the life of me imagine not sharing the results with the patient/family because I- as a nurse- am not allowed to interpret the results. A new DI diagnosis requires a LOT of teaching- how do you teach about it without bringing the labs into play? Doesn't the patient want to know why you're holding his ddAVP or giving him an extra dose?
  12. Visit  jadelpn profile page
    0
    Quote from monkey2008
    Thank you all for your responses.

    I did look up why NA levels would be elevated, ad I think I understand. Maybe I'm more confused about my role as a nurse, and how I would handle the question. I start work as a gn next month, so I think I'm also using this as a learning experience on how to handle different situations when they arise.

    Would it have been allowable and reasonable for my dad's nurse to explain why they are drawing it, instead of just saying "oh we just check it"??? Or is that not really an expectation/role of the nurse? I always thought it was, but I also know school is very different from real world, so I'm just trying to connect the dots.

    Your responses brought on something I really hadn't considered (the grey area). It's hard to not think like a nurse when you're playing the daughter role. This is my first experience with it, and I'm trying to learn from it.
    When you are a nursing student, you are taught to interpret things (to assess your knowledge) that you would not have to assess in the "real world" of nursing, including lab values. Additionally, one needs to be mindful that a family member doesn't always have a "need to know" (as nutty as that may sound) therefore, you may find that nurses do not and can not discuss specifics of your family member's care with you. In practice, I would encourage you to defer to the MD to discuss findings. It was obvious that the nurse was drawing labs. As far as asking specifics, I would have answered "Be sure to have your Dad discuss with the MD when he rounds regarding his lab values and what they mean" Nurses are bound by privacy policies. So no matter how well intended a family member is, unless the patient is incompetent (a story for another thread) we are not at liberty to discuss specifics with family.
  13. Visit  dudette10 profile page
    1
    Quote from jadelpn
    Nurses are bound by privacy policies. So no matter how well intended a family member is, unless the patient is incompetent (a story for another thread) we are not at liberty to discuss specifics with family.
    If the patient gives us permission, yes, we can discuss things with family members. Thou shall not fear or misinterpret the HIPPO. The family member who is unable to give permission due to LOC or a/o status is the one that I check and double check who can and cannot be given information. A/O pt with the family member (daughter/wife/son/husband) at bedside? Do we really look at them and say, "I can't give any information to you because of privacy policies." The patient would, 9 times out of 10, look at you like you're crazy.

    There are always exceptions, I know. I've encountered a few of the dysfunctional ones, and I pass it on in report and document in a note. But, we have to think about it, not just proclaim "privacy policies" and leave family members in the dark. "How are you related?" is one of my first questions to visitors. The second cousin twice removed. Nope. No info. The daughter the patient lives with? YES!
    KelRN215 likes this.


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