Am I asking too much from a nurse? - pg.3 | allnurses

Am I asking too much from a nurse? - page 3

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  KelRN215 profile page
    0
    Quote from jadelpn
    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.
    Nurses DO have to assess and interpret lab values in practice. I do this every working day of my career and have since day #1. If I notice my patient's ANC is zero, I know that I have to educate the parents about neutropenic precautions and reinforce fever guidelines. I don't need the MD to tell me "your patient's ANC is zero, that means he is neutropenic" because I know how to assess lab values for neutropenia. If I am reviewing lab values and see that my patient's K+ is 2.4 and don't do anything about it because nurses don't "assess and interpret lab values", am I blameless if my patient develops an arrhythmia that could have been prevented if I had notified the MD and sought an appropriate order for a K+ bolus? I have had patients in the hospital who were ordered for PRN Mag boluses for Mag levels less than 1.2. If a patient's Mag level came back at 1.0 and the nurse didn't administer the bolus because she, as a nurse, doesn't "assess or interpret lab values" and the patient's level continues to drop, whose fault is it?

    As far as privacy goes- there's nothing in the OP's post that suggests that her father didn't want her to know his lab values. If I am sitting at my mother's bedside and ask the nurse a question, he/she can ask my mother if it is ok to discuss this with me. My mom would most definitely want me to know because I have medical knowledge that she does not have and I have more time to explain it to her than a nurse with 5 patients would. When my grandfather was dying, I was only a junior in nursing school but I was still the one who had to interpret all the info for my mother and uncle. Dad very well could have told the nurse that he wanted his daughter to have this information because she is a nurse and can help him understand it.
  2. Visit  jadelpn profile page
    1
    Quote from dudette10
    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!
    Yes, even with family members at bedside, the rights of the patient come first. Period. And the patient is free to discuss what they want to with family. You can not assume anything other than that. We can lose our jobs for that stuff. One nurse had a patient who was on Viagra. That the wife had not a clue about. Stated to patient something regarding the medication, and lo and behold, opened a huge can of worms. You can not and should not get into the practice of discussing anything regarding the patient because family members are present. They do not have a need to know, unless the patient wants them to know.
    Meriwhen likes this.
  3. Visit  jadelpn profile page
    3
    Quote from KelRN215
    Nurses DO have to assess and interpret lab values in practice. I do this every working day of my career and have since day #1. If I notice my patient's ANC is zero, I know that I have to educate the parents about neutropenic precautions and reinforce fever guidelines. I don't need the MD to tell me "your patient's ANC is zero, that means he is neutropenic" because I know how to assess lab values for neutropenia. If I am reviewing lab values and see that my patient's K+ is 2.4 and don't do anything about it because nurses don't "assess and interpret lab values", am I blameless if my patient develops an arrhythmia that could have been prevented if I had notified the MD and sought an appropriate order for a K+ bolus? I have had patients in the hospital who were ordered for PRN Mag boluses for Mag levels less than 1.2. If a patient's Mag level came back at 1.0 and the nurse didn't administer the bolus because she, as a nurse, doesn't "assess or interpret lab values" and the patient's level continues to drop, whose fault is it?

    As far as privacy goes- there's nothing in the OP's post that suggests that her father didn't want her to know his lab values. If I am sitting at my mother's bedside and ask the nurse a question, he/she can ask my mother if it is ok to discuss this with me. My mom would most definitely want me to know because I have medical knowledge that she does not have and I have more time to explain it to her than a nurse with 5 patients would. When my grandfather was dying, I was only a junior in nursing school but I was still the one who had to interpret all the info for my mother and uncle. Dad very well could have told the nurse that he wanted his daughter to have this information because she is a nurse and can help him understand it.
    I said nothing about not notifying the MD. I am saying that as nurse, we do not (at least in my neck of the woods) take it upon ourselves to discuss lab values with a patient. We certainly should bring it to the attention of the MD, but as far as getting into values with a family,or with a patient until the MD has reviewed and decided what to do to treat-- this is different.
    And one should not get into the habit of asking the patient in front of the family member if it is "ok" to discuss anything with said family member. And in fact, maybe Dad did say "tell my daughter and not me" or something of that nature, but we all have to be mindful that no matter how well intended, some patients just don't want family members in their business. Period. And if they are alert and oriented, THEY can share what they want to.

    Another scenario is a triage situation when a family member wants to come in and be part of the medical decisions....no can do, sorry, but until we have the opportunity to ask what is needed, and ask the PATIENT in private who should know what, then I can only say "I will have the MD speak with your Dad about this"......

    The patient has a right to privacy. The nurse gets into hot water when discussing medical diagnosis with family.
    Meriwhen, TheCommuter, and loriangel14 like this.
  4. Visit  heron profile page
    2
    Besides, unless you're the designated POA, he can't discuss labs or much of anything else with you without Dad's permission.
    jadelpn and loriangel14 like this.


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