What are the rules of what we can tell patients? - page 4

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... Read More

  1. by   Dranger
    Quote from nynursey_
    I'm not sure what your angle is here. My example, while not blatant, is clearly in reference to a patient asking about the result of a diagnostic test. Confirming or denying opens the door for the patient to ask for a diagnosis, which is definitely not in my scope of practice.
    You aren't diagnosing if you are reading a physician report, plus you can always state clinical correlation with the main provider is still necessary to interpret.
  2. by   VANurse2010
    Quote from MunoRN
    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.
    Their right to know doesn't mean we're the ones who have to deliver the news.
  3. by   sailornurse
    Quote from MunoRN
    A physician can read that part of the radiology report just as well as a nurse.
    But the interpretation of the results is typically for the provider (MD/DO; NP/PA) who ordered the study to discuss with the patient as well as what the next step/plan will be. This is typically not something nurses should do.
  4. by   babyNP.
    Here's an example of why a RN wouldn't be best suited to give out all the results...

    Micropreemies (born <1 kg) are at high risk for intraventricular hemorrhage, which (depending on the severity) may cause life-long morbidity issues and death in some cases. Of course any RN can read off what the radiologist wrote. But if the report is that there is a severe grading of the hemorrhage (Grade III or Grade IV), then the parent would ask what that means. And then as a the RN, you start jumping down into the rabbit hole of telling a parent that their child could have lifelong severe mental/physical effects because of this.

    And the next thing will be that they will want to talk to the doc or provider now. Nothing will be so more important to them than hearing about it right that instant, once they get the information (and we can hardly blame them at all; I would be just as anxious).

    But the doc or provider may not be able to come to them immediately for any number of reasons. It could even be an hour or so or even longer (as the baby's condition isn't actively changing at that moment and even if they have CP, there's not much we can do about it). This is agonizing for them. It's hard for the RN to deal with. And you can be sure that it's hard for the provider who is now dealing with a parent who has sat on this "half" information for awhile.
  5. by   turnforthenurse
    For lab results, I generally disclose unless it's something out of the norm. For certain XRs (ruling out broken bones, etc) I will disclose if the results are negative. Any abnormals on XRs/MRI/US/CT/other tests I tell the patient that the doc will tell them the results as it's not "within my pay grade" to really discuss them, especially since I don't want to misinterpret something. They always understand.
  6. by   MunoRN
    Quote from sailornurse
    But the interpretation of the results is typically for the provider (MD/DO; NP/PA) who ordered the study to discuss with the patient as well as what the next step/plan will be. This is typically not something nurses should do.
    The "result" of a CT is the images, the interpretation is what the patient is paying the radiologist to do, there is no expectation that the nurse is the one to interpret the images.
  7. by   MunoRN
    Quote from VANurse2010
    Their right to know doesn't mean we're the ones who have to deliver the news.
    It actually often does mean that in order not to be negligent in our practice. Lets say you've got a patient who's CT shows a PE (as interpreted by a radiologist) and the Doc puts in an order for heparin gtt, starting the gtt without informing the patient what it's for is negligent. If you're not going to inform the patient of a physicians already stated finding, how does that work? Do you call the Doc and inform them that you can't tell them why you are starting a heparin gtt and they need to do that, at which point you hand the phone to the patient and the Doc says "you have a PE, the treatment for that is a heparin gtt"?
  8. by   MunoRN
    Part of what I do in my job is to be a direct patient care representative in outcomes and compliance projects. I was really skeptical at first when I heard claims about the disturbingly large numbers of patients who are unaware of vital information that should have been provided to them during their hospital stay such as their need for follow up imaging, or even what they were being treated for, after hearing people's views it's not as unbelievable which is pretty depressing. If an RN doesn't want to do the job then please make room for someone else who will.
  9. by   Julius Seizure
    I feel like I am forced to be in the position of "breaking the news" to families all the time. Should I be? No, often the doctor should be the one updating the family. But if they don't, what am I supposed to do? I can't just say nothing.

    Example: Not too long ago, my neonate patient who was in the hospital for unrelated issues starting having frank red blood in their stools. I notified the doctor who ordered xrays and labs. Those were done, and the doctor decided to keep the baby NPO for a while. So here comes the family to visit, and they want to know how the baby is doing. "Well we have stopped feeding her because there was blood in her stool" opens up a lot of questions that I would honestly rather that the doctor addressed. (concern for NEC, what is NEC, what will we do if the baby does have NEC, why are we doing all these tests, how worried should I be, etc) But theres no doctor coming to update them right now, sorry. Its just me. So I have to tread carefully and answer what I can without overstepping my bounds. This happens ALL the time and often the doctors dont see why they should have to come talk to the family outside of their usual rounding time. I can't just be like "Your baby isn't going to be fed for a while, its a secret why."
  10. by   Anna Flaxis
    Quote from MunoRN
    So to use your example of a PE, when the physician puts in an order for a heparin drip, do you just go in and start the drip, what if a patient asks what it's for? Do you tell them you can't reveal that?
    I'm not sure where you get that impression.

    If the patient is being worked up for a PE, they already know that. Of *course* I will explain why I am hanging the heparin gtt. That does NOT excuse the physician of their responsibility to speak to the patient about the diagnosis, treatment plan, and prognosis.
    Last edit by Anna Flaxis on Dec 15, '15
  11. by   Anna Flaxis
    Quote from MunoRN
    Part of what I do in my job is to be a direct patient care representative in outcomes and compliance projects. I was really skeptical at first when I heard claims about the disturbingly large numbers of patients who are unaware of vital information that should have been provided to them during their hospital stay such as their need for follow up imaging, or even what they were being treated for, after hearing people's views it's not as unbelievable which is pretty depressing. If an RN doesn't want to do the job then please make room for someone else who will.
    Do the job of what, specifically?
  12. by   UTVOL3
    This is a really good question. I agree nurses get kind of mixed messages about it. The info belongs to the patient, period. In this day of electronic medical records with online patient portals, we can't keep results from patients anyway.
    I think where your responsibility as a nurse comes in is in how you deliver the information to the patient. Avoid using words like 'good' or 'bad'. If they want to know the exact value of their BUN tell them. If they are asking if it's better, I'd say something like 'the result is lower than yesterday.' Let the doc make the interpretation of whether or not it's 'better' for the patient.
  13. by   Julius Seizure
    Quote from UTVOL3
    This is a really good question. I agree nurses get kind of mixed messages about it. The info belongs to the patient, period. In this day of electronic medical records with online patient portals, we can't keep results from patients anyway.
    I think where your responsibility as a nurse comes in is in how you deliver the information to the patient. Avoid using words like 'good' or 'bad'. If they want to know the exact value of their BUN tell them. If they are asking if it's better, I'd say something like 'the result is lower than yesterday.' Let the doc make the interpretation of whether or not it's 'better' for the patient.
    I will often say, for instance, that the patients potassium level is 2.9 and we like to keep it between 3.5-4.5, so I am going to give you a potassium supplement through your IV.

    The "better" is implied.

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