What are the rules of what we can tell patients?

[NursingInChaos]

As a new nurse I am a little confused about what results we are allowed to tell patients. All the nurses at my job have given me very different answers lol

Some say it is their right to know it all as it is their info (ehhhh I thing that is extreme) and some won't even tell them a basic lab value ... I heard a fellow nurse telling a patient the results of his X-ray an hour earlier before the doctor even saw it - giving the patient the radiology impression info. Am I right in assuming that was not right to do?

Then what about my patient that knows they are watching her BUN levels daily and just wants to know if this mornings bun level is better than yesterday? Can I tell her yes or no - or what about the actual number of the lab value?

How does this transfer to bedside shift report- telling the oncoming nurse abnormal lab or test results in front of the patient- if we can't tell the patient that info until after the doctor has then how can we at bedside shift report?

If the small town hospital I worked at had an easier way to access policies I would look there but they are a mess right now lol

[klone, MSN, RN]

I tell the patient anything they ask that I have the knowledge to explain in further detail if they have questions about it. If I don't have the depth of knowledge, I defer to someone who does.

Yes, a patient has a right to know everything about their care, including test results. To think otherwise is patriarchal and unethical. Not extreme in the slightest. If they ask, I will tell them. If I don't have a good enough understanding, I tell them that and let them know I will have someone else discuss it with them who can better answer their questions.

[RNperdiem, RN]

If it relates to the medical plan of care, I will have the doctors come and update the family. The docs can tell them what the CT scan found since they are the ones who will be writing orders and making plans for what comes next and can explain this to the family since they will have follow up questions that are beyond the scope of nursing.

Simple lab results when requested is fine, even if some families get a little hyperfocused on a number or two.

I will freely explain my nursing plan for the day: "We will get you out of bed to a chair, remove your arterial line, continue to wean your oxygen, send you to dialysis in the afternoon and transfer you to the floor once a bed is available."

[AJJKRN]

MunoRN said:

The radiology report are the results that have already been interpreted by the Physician.

In instances where the radiology reports reads things such as "probable MS" or "METS", etc...I leave the interpretation to be disclosed and explained to the Pt by the MD. Way above my pay grade I feel like.

[nursej22, MSN, RN]

MunoRN said:

I agree that we should defer those things, which are relatively few, that would require a discussion only an MD can provide, but I don't think that all abnormal results can or should only be explained by the Physician, maybe I'm misinterpreting what you're saying.

Ah, interpretation was probably not the correct term. What I meant was, abnormal imaging usually requires some follow-up, or next step, which is out of my scope to determine. Yes, radiologists interpret the imaging, but they do not determine the next course of action, except to recommend more imaging.

[KatieMI, BSN, MSN, RN]

Patients do have right to know the total 100% of their own health care information. They also have right to designate someone to receive the same information. This is not a problem. The problem is that 98% of them have no idea at all what it might mean and what to do with it, and giving them the knowledge they are not prepared to interpret can lead to disaster. They lost trust, panic and can get out AMA in the middle of life-threatening crisis just because someone told them that mom's BUN "is significantly elevated and going up and she might need dialysis because of her kidneys are dying up because of all that drugs and that they do not let her drink and do not give her enough fluid" (sodium 120 low -something, Bumex drip, taken out AMA and did not make it to the neighborhood ER. Interpretation was given by CNA/nursing student who "just wanted to keep family informed").

In LTACH we do have time to painstakingly, daily, in small increments teach patients and families and we work with them long enough to gain trust and stop their fears. Under these circumstances, they can be given more information sometimes. I even showed families actual X-rays and scans and pointed onto things they needed to understand, like pleural fluid (which is treatable) vs. massive scarring (which is not). Their total, absolute lack of basic knowledge is usually borders with impossible in the beginning of the process, but with time it is can be corrected somewhat. But even with well-informed and knowledgeable families we leave diagnostic breaks to the physician. And yes, this is prefectly ok to tell "I am sorry, but this is something you need to discuss with your doc".

[KelRN215, BSN, RN]

I can think of only one time, in 8 1/2 years of being a nurse, that I knew the results of a test and declined to tell a patient's parents when they asked.

It was an 8 year old who had had a nearly lifetime history of a brain tumor. He was s/p his first resection surgery (tumor previously deemed inoperable) and was having this post-op MRI just to get it done before he transferred to rehab. The MRI revealed that the tumor had grown exponentially and was now completely blocking all CSF pathways. (The child had a shunt which was functioning.) It also revealed clots in every major vessel in his head. When I went in the room after he was back on the floor, his parents asked me if the MRI results were back. I said I didn't know, even though I had seen them. These results needed to be discussed with the parents by the child's Neuro-Oncologist. In fact, they were so bad that the team called over his primary Oncologist from the clinic, the Attending on service deferred to him in disclosing this information to the parents.

There have been other times when I HAVE discussed radiology results with parents. If a head CT shows worsening hydrocephalus and the Neurosurgeon tells me to make the child NPO because they will be going to the OR for emergency surgery, how am I going to tell the parent the child is NPO without telling them why? I tell them what I know, answer questions that I can answer and tell them that the surgeon will be up shortly to speak with them.

If an XR is read and says that an NG tube is in the right or wrong place, why can't I tell a parent that? Same with a PICC line. "The IV RN will be up to pull back your PICC line because it's in the right atrium." I don't really see why it matters if the bedside nurse, the IV nurse or the MD tells a patient something like that.

I know my lab results before my provider 99% of the time. The last time I was in the hospital, I saw them on my online patient portal before any of the nurses or doctors had even looked.

[sailornurse]

MunoRN said:

The radiology report are the results that have already been interpreted by the Physician.

No, the radiology reports are the results as interpreted by the radiologist.

[MunoRN, RN]

sailornurse said:

No, the radiology reports are the results as interpreted by the radiologist.

Radiologists are physicians.

[MunoRN, RN]

nursej22 said:

Ah, interpretation was probably not the correct term. What I meant was, abnormal imaging usually requires some follow-up, or next step, which is out of my scope to determine. Yes, radiologists interpret the imaging, but they do not determine the next course of action, except to recommend more imaging.

It's an expected standard that the radiologist include follow up recommendations in the report (follow-up CT recommended in 6 months) for instance, and it's not only within the nurse's scope to pass that on to the patient, it's the expectation, radiologists don't typically round on patients.

[MunoRN, RN]

RNperdiem said:

If it relates to the medical plan of care, I will have the doctors come and update the family. The docs can tell them what the CT scan found since they are the ones who will be writing orders and making plans for what comes next and can explain this to the family since they will have follow up questions that are beyond the scope of nursing.

Simple lab results when requested is fine, even if some families get a little hyperfocused on a number or two.

I will freely explain my nursing plan for the day: "We will get you out of bed to a chair, remove your arterial line, continue to wean your oxygen, send you to dialysis in the afternoon and transfer you to the floor once a bed is available."

Nurses are responsible for ensuring the patient understands and is kept up to date on all aspects of the patient's care, including the medical plan of care. Do you bring in a patient a medication and when they ask "what's this for?" you say "you'll have to ask the doctor?"

[noyesno, MSN, APRN, NP]

MunoRN said:

The radiology report are the results that have already been interpreted by the Physician.

Sometimes, the ordering MD disagrees with the radiology report.

[MunoRN, RN]

noyesno said:

Sometimes, the ordering MD disagrees with the radiology report.

Absolutely, in which case the patient has the right to hear both interpretations, and it's up the person who's role includes advocating for the patient to make sure they are aware of both those interpretations.