Am I asking too much from a nurse?

TheCommuter, BSN, RN · Jan 31, 2013

No, you were not asking too much of your father's nurse.

However, I cam sympathize with the nurse in many ways. A med/surg floor can be hell on earth with the hundred different things happening at the same time. The ICU nurse typically has no more than one or two extremely sick patients and knows every little detail about the patient from top to bottom.

On the other hand, the med/surg nurse might have five, six, seven, eight, or perhaps nine to ten patients under her charge. With those types of ratios, it is not as if the nurse is going to memorize every patient's lab values or trends. However, the nurse could have made more of an effort to seek an answer to your question. "I don't know, but I will find out" would have sufficed much better than "We just test it."

In addition, my facility's policy forbids me from interpreting lab values. Unless the attending physician or one of the consulting doctors explicitly says, "Go ahead and tell the family what these lab values mean," I am not allowed to say that any patient has hypernatremia or discuss what the trending suggests.

I hope your father recovers well. Good luck to the both of you!

RNperdiem, RN · Jan 31, 2013

Labs and test results are sort of a gray area in nursing.

It is more the doctors' responsibility(diagnosis and treatment) to deal with the interpretation and follow up for labs and test results. I recommend families direct questions about biopsy results, lab results, CT scan to the doctors when they come on rounds. They will get a more complete answer they seek.

Unless the lab results are critical high or low, the nurse has a different focus in the work performed.

netglow, ASN, RN · Jan 31, 2013

I think the nurse answered your question, but maybe not clearly. The test was not done because of any specific worry. It's a check among many, many checks. Now, since you are a student you can go look that dx up and learn for yourself why certain labs might be checked. Go back to your anatomy and physiology first, then the pathophysiology....

Sun0408, ASN, RN · Jan 31, 2013

Yep, tests and results are a grey area and as nurses we can get into hot water if we say too much... As a family member, of course you want more info but the "nurse" might not be able to give you the info even though she/he knows.. More detailed questions should be directed to the MD, depending on the facility of course.

monkey2008 · Jan 31, 2013

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.

netglow, ASN, RN · Jan 31, 2013

Well, think of the test, and what all you'd have to say to a patient or family member to thoroughly explain? You'd have to teach them anatomy, physiology, pathophysiology.... so basically you'd better be good and fast and accurate, right? Do you have time for that? Are you absolutely sure what the MD is looking for specifically? Can you explain all of this without causing a layperson to freak out and worry? Thing is, it's all scary to them. Let the MD tell them why, let him do all interpretation in regards to family discussion.

HouTx, BSN, MSN, EdD · Jan 31, 2013

I'm glad you're able to be there for your dad. It is a great learning experience for you also - more insight into what the patient's family goes through. It will definitely make you a better nurse.

If you want 'higher level' information from nursing staff, you need to disclose yourself as a nurse. Based on my own experience (on both sides) this opens up a whole different channel of communication. We are more open with other members of our (nursing) tribe.

TopazLover, BSN, RN · Jan 31, 2013

I am also glad you could be there for your dad. Some grown children, even if not health care professionals, learn about the diseases of family members. As a new nurse you might not wish to be in that nursing tribe, as some members then might spout off numbers and expect you to interpret.

Many nurses prefer to keep the status as nurse private. In the case of my DH sick, dying and in ICU, I did disclose. It helped because staff stopped talking in platitudes and were free to be honest. That is not always the case. On a M-S floor it probably would not have worked. Keep learning about the disease processes your dad is going through. He knows you are a nurse and wil expect discussion, if not answers, at times.

RNperdiem, RN · Jan 31, 2013

It varies depending on the hospital and the doctors involved, but often the nurses are not told directly about the medical plan of care for the day.

Some doctors have rounded, written orders and left without ever speaking to a nurse about what is planned or why.

Sometimes you need to figure things out by what orders are written. If you are lucky you will be a part of rounds( the gathering of attending, residents, med students and hopefully the primary nurse, charge nurse and RT) and will have a better understanding.

dudette10, MSN, RN · Jan 31, 2013

As others have said, you have to be careful when answering questions. I feel comfortable giving info such as "Your father is more alert today, has been up to the chair, and appetite is improving," all of which are squarely in the nursing scope. Often, answering these types of questions lead to medical questions that I will not answer. It really all depends on the situation, what I know the patient or family member has been told, what I know they understand, etc. Sometimes they'll ask why a test was being ordered. A RUQ u/s when the pt has been complaining of abdominal pain? "The docs just want to take a look at some organs in the abdomen to see what may be causing the pain." Other times, I won't answer why things are being ordered. It really all depends on context; every situation is different. Most family members and patients are very understanding when I say, "It is best that you talk to the doctors about the test results and the medical plan. They can give you a more complete answer and address any additional questions you may have."For the nurse you encountered, she could have been brushing you off, she could have been replying within her personal comfort zone of providing medical info, any number of things. The problem is that we are so accessible as nurses being there 24/7, but the docs are ghosts that materialize in human form for 10 minutes a day. That's why we get all the questions!

Fiona59 · Jan 31, 2013

My unit got slammed recently for disclosing information to family members. Your Dad is a not under a guardianship order so we cannot give you information unless he authorized us to prior to his surgery.

Who knows what's been happening on that unit lately?