Breaking bad news to patients

LongislandRN23 · Sep 12, 2014

It depends upon what the news is? If the patient is in the hospital and tests are conducted that reveal that the patient is positive for cancer (as an example) as the nurse I would not disclose that. It's not that I would not but at my facility and in most nursing areas nurses are not allowed/unable to confirm medical diagnosis. The doctor must see the patient and explain to the patient the diagnosis and the test results. For instance in my practice if a patient has an MRI done I can li in and view the results however I cannot explain to the patient what the results mean. After the doctor has seen the patient I can educate them on the results and what not. For patients with diagnosis already established like an admitting diagnosis as CHF I can explain the disease process, home care, meds and all that good stuff.

jadelpn, LPN, EMT-B · Sep 12, 2014

Most "bad news" is due to a medical diagnosis. And medical diagnosis under the realm of the MD. Which is up to the MD to explain and the nurse to then educate based on the diagnosis.

If it is other general bad news, it is not something that as a nurse, I would do alone. There is no need to. There is a team, use your resources, there are other people involved in the care of patients.

And finally, what is one to do with the information "hey, pt abc, your tests have come back and you have cancer"--then what? Nurses can not order further testing, can not do referrals to specialists, and in some facilities need an MD order to refer to hospice, home health, or any number of other disciplines that could help the patient.

If a nurse is in a place where wanting to be "in the know" to the point of oversharing with a patient without direction, wanting to be the one who is sharing and then the "shoulder to cry on" "rock" or any other motivation to break bad news, then said nurse really needs to look within themselves as to what their motivation is, and how to shift the focus back on the patient and not on them.

I believe that this could fall under a professional boundry issue as well.

Let us know how the debate goes!

Esme12, ASN, BSN, RN · Sep 12, 2014

There are times that a nurse has no choice but to break ht bad news. This will vary greatly facility to facility. Lets say in a community hospital with no hospitalist the patient doesn't survive the resuscitative effort it is the nurse who goes out to the family and say I am very sorry....your family member did not survive the code.

I don't think it is the nurses place to give "bad news" in general. This should come from the MD. The MD is the one who can explain treatment plan and options for a cancer diagnosis. The nurse can follow up longer term with the patient once the initial diagnosis has been given. Nurses do not diagnose medical problems...the MD is the one responsible for that.

KelRN215, BSN, RN · Sep 13, 2014

What is the bad news that the nurse is breaking? If the bad news is "sorry, your surgery was bumped till later because there was an Emergency that came in", yeah the nurse would be the one to tell the patient that. The surgeon operating on the emergent case certainly isn't coming up to explain to Mr. Smith why his add on case has been delayed. If it's lab results- like your kid's ANC is still 0 and therefore you're not going home today- I'd have no problem sharing those results either. I've had to tell parents that their kid's shunt tap was growing out bacteria and therefore, we would be making the child NPO in anticipation that he would be going to the OR for shunt removal/externalization later today or that the stat CT we just did showed worsening hydrocephalus so the child would be going to the OR for a shunt revision. When a patient is made NPO, they want to know WHY. If it's something like "the results of the EEG we just did are back and are abnormal" or "your child's MRI revealed a large brain tumor", I leave those discussions to the MD.

Here.I.Stand, BSN, RN · Sep 13, 2014

I agree with the others, that "bad news" r/t medical diagnoses should be broken by the provider. Which is what most "bad news" is, at least when I think about bad news that a pt could receive in the hospital. Just some examples that come to mind from my own experience--the MRI that the pt was finally able to lie flat to have showed a brain stem infarct...the pt is acutely rejecting her new heart...apnea, cold caloric, etc. tests reveal brain death...

(Well the brain death example might not be a good one b/c it's more straightforward--it's a matter of helping someone understand that brain death=death, not coma or vegetative state...)

But say the MRI showed a brain stem infarct. The RN happens to open up the MRI report seconds after the radiologist enters it, and says "I'm so sorry, but your mother has had a stroke in her brain stem." What then? I know that the prognosis is not good, and I know that an option *could* be to trach her and find a LTC who will take vents. But I can't say what options the neuro/neurosurg teams *will* offer--sometimes if it's bad enough, our staff will only offer palliative care. I can't get informed consent for follow-up. What *exactly* is the prognosis, and what are the odds of a procedure helping or hurting?

That's outside the scope of an RN.