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

[Kooky Korky, BSN, RN]

blondy2061h said:

When you check someone's glucose, don't you tell them the result?

Sometimes this depends on policy, but in general, you can give lab results to patients. Now all of our patients can see their results on our patient portal online pretty much as soon as they're available. The other two big hospital networks in this area have the same set up. Before that, it was a bit murkier, but the service I work with has always had a standing policy that patients can get lab results printed off for them in the AM.

The key here is that your Service had a policy.

OP: You need to get this clarified. Dig through the mess of a policy manual, don't go by this one says it's ok, this one says it's not.

Ask your boss what she does (did) in the scenarios you have mentioned, like bedside Report.

[sailornurse]

MunoRN said:

Radiologists are physicians.

DUH!!!!!

Just trying to clarify that there is a difference in referring to the radiologist vs. the physician or provider who ordered the study.

[MunoRN, RN]

sailornurse said:

DUH!!!!!

Just trying to clarify that there is a difference in referring to the radiologist vs. the physician or provider who ordered the study.

There is and the patient is entitled to the interpretations of both if they differ, so there should be no reason for the nurse to hide the radiologists interpretation from the patient.

[nursej22, MSN, RN]

MunoRN said:

There is and the patient is entitled to the interpretations of both if they differ, so there should be no reason for the nurse to hide the radiologists interpretation from the patient.

Sorry, if a routine chest X-ray shows nodules consistent with a neoplasm, that news is not coming from me, the bedside nurse. I am not hiding an interpretation, I am letting someone who has had a chance to get a consult and draw up a preliminary plan of action relay that information.

I think it would be cruel to tell a patient they may have cancer without knowing what the plan is.

What does waiting a few hours change?

[MunoRN, RN]

nursej22 said:

Sorry, if a routine chest X-ray shows nodules consistent with a neoplasm, that news is not coming from me, the bedside nurse. I am not hiding an interpretation, I am letting someone who has had a chance to get a consult and draw up a preliminary plan of action relay that information.

I think it would be cruel to tell a patient they may have cancer without knowing what the plan is.

What does waiting a few hours change?

If there is truly something that you can't explain sufficiently to a patient, such as the pathology based type and staging results that will come further down the line then that's absolutely appropriate to defer to an oncologist.

A possible nodule on a CXR is not a cancer diagnosis, an appropriate radiologist's interpretation will contain what the next step is based on standardized recommendations, usually a CT, which will itself usually have a standardized interval surveillance recommendation ("follow up CT recommended in 6 months".) A physician can read that part of the radiology report just as well as a nurse.

Whether or not hospital staff does a good job of telling patients about their test results is now something that is tracked, the disturbing number of people who years down the road had no idea that a CT recommended repeat imaging is often given as an example of why this is a problem as it can mean the difference between successful treatment and a condition that is now too late to be treated. A few hours doesn't change much, a few years certainly does.

[Anna Flaxis, BSN, RN]

Under my state's Nurse Practice Act, I am not authorized to diagnose medical conditions.

The radiologist's impression and the assigned provider's diagnosis may differ because the radiologist simply gives their impression of what they're seeing without very much context, but the assigned provider does the clinical correlation, which is a synthesis of the "big picture"- i.e. the patient's age, past medical history, familial history, signs and symptoms, etc., and actually makes the diagnosis.

If it is a new diagnosis, then I defer to the licensed independent practitioner who is authorized to diagnose and treat medical conditions, stating something like "I'm not qualified to interpret (blank), and I don't want to misinform you, so I'm going to let the doctor come and talk to you about that." But, if it's part of a continuum, where the patient already has been given a diagnosis and we're monitoring progression of illness or response to treatment, then it is within my scope to discuss radiology reports in more detail- again, with the caveat that I'm only repeating what the radiologist said, but that the person's doctor needs to put it all together.

If it's a new diagnosis of heart failure, I defer it to the doctor. But if it's an existing diagnosis, and the patient wants to know their EF, I'll tell them.

It's really important not to be evasive, because people pick up on that, and it increases their anxiety as they imagine all the worst case scenarios. Avoiding disclosing results can easily come off as evasive, but when you verbalize a concern for not wanting to misinform, people tend to understand and appreciate that, at least in my experience.

Clear as mud?

[Dranger]

It's common sense.

I will tell patients basic lab values or what I see in a simple chest x-ray i.e. if known edema or pneumonia/consolidation is improving (with a simple disclaimer that a doc needs to look it for a official report). Techs gives preliminary reports all of the time.

If I read a CT report that says Stag IV Pancreatic cancer with mets to the liver and lungs, then I am going to hold off on that one...

Most of what I do is clarifying or simplifying what a doctor said or forgot to say.

[VANurse2010]

MunoRN said:

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

sometimes the primary team has a different take on the imaging and/or have a different idea of the plan of care going forward than what we may assume. Thus, I am cautious with radiology reports unless it's a simple study that's a clear-cut negative.

[brownbook]

Anna Flaxis said:

Under my state's Nurse Practice Act, I am not authorized to diagnose medical conditions.

The radiologist's impression and the assigned provider's diagnosis may differ because the radiologist simply gives their impression of what they're seeing without very much context, but the assigned provider does the clinical correlation, which is a synthesis of the "big picture"- i.e. the patient's age, past medical history, familial history, signs and symptoms, etc., and actually makes the diagnosis.

If it is a new diagnosis, then I defer to the licensed independent practitioner who is authorized to diagnose and treat medical conditions, stating something like "I'm not qualified to interpret (blank), and I don't want to misinform you, so I'm going to let the doctor come and talk to you about that." But, if it's part of a continuum, where the patient already has been given a diagnosis and we're monitoring progression of illness or response to treatment, then it is within my scope to discuss radiology reports in more detail- again, with the caveat that I'm only repeating what the radiologist said, but that the person's doctor needs to put it all together.

If it's a new diagnosis of heart failure, I defer it to the doctor. But if it's an existing diagnosis, and the patient wants to know their EF, I'll tell them.

It's really important not to be evasive, because people pick up on that, and it increases their anxiety as they imagine all the worst case scenarios. Avoiding disclosing results can easily come off as evasive, but when you verbalize a concern for not wanting to misinform, people tend to understand and appreciate that, at least in my experience.

Clear as mud?

I cannot like this post enough. It is crystal clear. I am so glad my lame attempt to put in my two cents worth on my i-pad kept crashing. This says it all.

[nynursey_]

brownbook said:

I cannot like this post enough. It is crystal clear. I am so glad my lame attempt to put in my two cents worth on my i-pad kept crashing. This says it all.

Also, people usually respond well when you say this:

"As a Registered Nurse, per my NPA, I am not authorized to diagnose a medical condition or interpret diagnostic testing. That is something the physician will have to discuss with you. What I can do, however, is notify him that the results are available and that you'd like to discuss those with him when he's available."

[MunoRN, RN]

VANurse2010 said:

sometimes the primary team has a different take on the imaging and/or have a different idea of the plan of care going forward than what we may assume. Thus, I am cautious with radiology reports unless it's a simple study that's a clear-cut negative.

While the primary physician might have a different take than the radiologist, the patient has a right to hear both views, both on the basis of having access to all available information determining their care and decision making, but also because they are going to get a few-hundred-dollar bill for the radiologists interpretation, at that price they certainly have a right to know what it was.

[MunoRN, RN]

nynursey_ said:

Also, people usually respond well when you say this:

"As a Registered Nurse, per my NPA, I am not authorized to diagnose a medical condition or interpret diagnostic testing. That is something the physician will have to discuss with you. What I can do, however, is notify him that the results are available and that you'd like to discuss those with him when he's available."

Educating a patient about a diagnosis already made by a physician is not "diagnosing", and every NPA in the country requires the nurse to ensure the patient is informed and educated about their plan of care.