How extensive can RN discuss with patient

emtb2rn, BSN, RN, EMT-B · Jul 18, 2012

A new question just dawn on me today and I have struggling with it for better answer for awhile. Floor nurses and charge nurses cant even answer that. They just brushed it off. I know we RNs only allow to discuss with patient of their health care need to certain extend. How extend is another ball game. What kind of information can you discuss freely? The major one would be lab results. RN normally knows it first hand before the attending seeing the patient. I often time withhold that information wait until attending show up. Often time patients ask me so how is my C-X-ray look or if my UA positive...when that arise I just told them the attending will making round shortly and will let you know the result. My question is what type of information can you or can't you not withhold?

I will not inform pts of lab, scan or dx results. If asked, I tell then that I can't as an RN and the doc will be in shortly. You do not want to be the one informing the pt that something came back out of normal levels. After the doc talks to the pt/family, I go in and ask what they were told and if they have any questions. Then I answer what I can and find out the answers to what I can't.

I will tell the pt what tests and/or procedures are ordered and ask if they have any questions.

HouTx, BSN, MSN, EdD · Jul 18, 2012

I will not inform pts of lab, scan or dx results. If asked, I tell then that I can't as an RN and the doc will be in shortly. You do not want to be the one informing the pt that something came back out of normal levels. After the doc talks to the pt/family, I go in and ask what they were told and if they have any questions. Then I answer what I can and find out the answers to what I can't.
questions.

This seems to be uncomfortably close to the old "handmaid" role of nursing - when nurses couldn't even divulge vital signs to the patient. Is this your employer's policy? Why wouldn't you want to help educate the patient and help them become more knowledgeable so they can actively participate in their own care? Remember that patient communication is a vital part of the new HCAHPS measurement.

The patient's information belongs to them. Patients who understand their lab results will have a better understanding of the rationale for medical interventions & be much more likely to adhere to post-discharge care plans.

emtb2rn, BSN, RN, EMT-B · Jul 18, 2012

I should have been clearer. I will not deliver abnormal results to the pt, especially the dx. That IS the docs job. I'll let pts know everything has come back wnl, if that's the case.

Aeterna, BSN, RN · Jul 18, 2012

If it's blood test results that I'm doing something about, I will tell the patient. For example, if their potassium level is a bit low and I have to go in and give them some potassium elixir, more often than not, the patient will be like, "What's this for?" I'm not going to brush it off and tell them to just drink it, the doctor will be in soon to discuss it with you. I just tell them, "You're blood work showed your potassium was on the low side. I talked about it with the doctor and he ordered this for you, which will help bring your potassium up."

Also, working in oncology, there are several patients that like to keep up with their CBC results, so they know what the status of their immune system is and/or if they will need blood or platelet transfusions. It also helps track their progress and recovery. I have no issue giving them these results if they ask.

However, I will not cover any diagnostic imaging results (because I have never been trained to interpret them or draw conclusions from them; I can only read the end report, which is just a small piece of the big picture, anyway) nor will I cover anything regarding the patient's diagnosis or prognosis. That is up to the doctor and I will be very clear with my patients on that. Same goes for anything else I have not been trained or educated on (i.e. bone marrow aspiration results).

Susie2310 · Jul 18, 2012

I will not inform pts of lab, scan or dx results. If asked, I tell then that I can't as an RN and the doc will be in shortly. You do not want to be the one informing the pt that something came back out of normal levels. After the doc talks to the pt/family, I go in and ask what they were told and if they have any questions. Then I answer what I can and find out the answers to what I can't.
I will tell the pt what tests and/or procedures are ordered and ask if they have any questions.

I think that this is a good response, especially for abnormal data. I also agree with Aeterna.

While I have some training as a nurse in interpreting lab results, I cannot interpret them in the context of everything that is going on medically with the patient, as the doctor can.

To use a personal example: My husband was recently hospitalized with acute renal failure and sepsis. The hospitalist discussed the labs with us in the hospital, and then my husband's internist and oncologist discussed the labs with us after discharge on follow up appointments. All I could have said about his labs was that they were very abnormal, but I couldn't say which ones were expected to normalize and which ones would likely not show great improvement. Even the lab values that appeared to be coming back to baseline received a different interpretation from the doctor than I expected. So I couldn't say what it all meant (at all) in terms of my husband's medical problems and his prognosis. My training as a nurse did not teach me this level of interpretation.

StayLost, BSN, RN · Jul 18, 2012

Patients have a right to review any part of their chart at any time, including labs and progress notes...

With that said, I use caution to not step on the doctors toes or diagnose. For instance, if I review a radiologist X-Ray report for a CHF patient and it says their lungs appear less congested today, I pass it along the report's findings along with my assessment findings (i.e. improved lung sounds, incr urine on diuretics, decreased BNP...).

If a patient has an MI & we are collecting Cardiac Enzymes, I'll let the pt/family know that these enzymes are now trending down and what that means.

If a CT was ordered for change in LOC, and a radiology report came back negative and the family was anxious, I would tell them the initial report came back negative but the radiologist, but it still must be reviewed by the ordering physician.

Things I would zip my lip about: If I get an pathology report with malignancy, (+) Drug Screen, (+) blood cx's, or anything that may drastically change the medical plan.

dudette10, MSN, RN · Jul 18, 2012

This is such a difficult question to answer because so much comes into play.

It's not a simple, "Yes, I tell them," or "No, I don't." It's a whole heckuva lot of things that need to be considered.

I was in a very uncomfortable situation recently. A patient came in with a HUGE malignant melanoma on the chest. I called the path results into the onc consult, and he came to see the patient immediately. (Oncology is NOT my specialty, but the surgical beds were all taken up, so to the patient came to our floor.) The doc wrote orders for a CT of chest, abdomen, pelvis, and MRI of brain. Looking for mets.

When I went to prep the patient for the MRI, she said, "Why is he looking at my brain? There's nothing wrong with it!" I asked her if she knew what the growth on her chest was. She said, "Yes, it was cancer. What has that to do with my brain?"

Why was I the one to have to tell her that the doc was looking for mets? The doc had been in there less than a half hour previously!!!

**canoehead, BSN, RN** · Jul 19, 2012

When tests have come back I usually say, "they look normal to me but the doc will be in to talk to you with the final word." Or on the other hand "There are some abnormalities, and the doc will discuss them with you." If the patient insists I might give information like rising or falling levels, or more often I explain that it's above my pay grade, and I don't know all the nuances the doctors do so I could easily tell them the wrong thing. If they need to prep for another test I don't hesitate to tell them why, and then say "do you need to talk to the doctor again before we do this?"