Inquiry about breaking bad news

ChristineN, BSN, RN · Dec 9, 2013

I assume you mean test results, lab values, etc. If it is something new and bad, I always let the physician tell the pt. The pt may have questions about how this news will affect the plan of care, etc that are outside of your scope to answer. Now if the bad news is say a chronic cancer pt is neutropenic again, then I will sometimes let the pt know, but only if the news is something related a chronic condition and the news was somewhat expected (ie. High Hgba1c in a newly diagnosed diabetic).

Smamaghrabi · Dec 9, 2013

Thanx for your replay. But is there any clear policy in USA nursing practice that prohibit the ICU nurse from breaking bad news to patient and his family .

elkpark · Dec 9, 2013

The policy would be the policy of a particular hospital/facility. Everywhere I've ever worked over the years, it was the responsibility/privilege of the physician (or other independent provider) to review and discuss lab results, diagnoses, prognosis, etc. Nurses could reinforce teaching and information provided by the physician in that regard, but would be significantly out of line to initiate discussions of those types of topics (which could be considered practicing outside of scope). Frankly, I've never wanted to be the one to break bad news to clients and their families. There is no "clear policy in USA nursing practice" on this or anything else, because nursing practice is defined and regulated by the individual states. Your state BON would have info on whether a particular scenario would be considered practicing outside of scope in your state.

Da_Milk_of_Amnesia, MSN · Dec 10, 2013

My rule of thumb is try not to give results about anything.

Kitesurfing bum · Dec 10, 2013

But is there any clear policy in USA nursing practice that prohibit the ICU nurse from breaking bad news to patient and his family .

There is a common sense policy that clearly states that it is not within a nurses scope to tell someone they have cancer, interpret CT/MRI results, etc. I wouldn't want a nurse to tell my family or me big news, I want the doc to do it... because I'll have questions that are directed towards plan of care that the nurse can't answer.

When in doubt, defer.

detroitdano · Dec 10, 2013

If it's life changing news, I let the doc handle it. If it's expected news (low hgb after bleeding, C. diff positive with diarrhea) then I would tell the patient/family.

As was mentioned, if you expect questions and you won't have the answers, let the doctor break the news. If you already talked with the MD and they told if the patient had such and such result that such and such a test would be done next (so you're both on the same page), you could probably say something yourself.

detroitdano · Dec 10, 2013

Also, gotta say I was disappointed. I was expecting this thread to be about Breaking Bad.

cardiacfreak, ADN · Dec 12, 2013

We have a policy that states all results are to be given by the doctor. That being said, if the doctor tells the nurse to give the patient and family the results of said tests the nurse is allowed.

litepath2 · Dec 28, 2013

Depends. Like mentioned mostly it will be the physicians responsibility and purvey to talk with a patient and family about a given outcome or test result.

That said, I have on too many occasions to count, gotten the family to change a status from Full CPR to DNR. And that is well within your scope as long as it doesn't go against Hospital Policy.

So rather than breaking bad news, be an advocate for the patient in other ways.

nightengalegoddess · Jan 3, 2014

I explain clearly to family and patient certain results are legally beyond my scope to discuss before physician discourses with them. I also tell them after physician has diagnosed/analyzed and discussed, any questions may be directed to nursing staff. If nursing is able to legally discourse......we are their resource. I want them to know there are legalities associated with what we can tell. Because as we know....sometimes docs do a poor job of confrontation when failure is imminent.I don't want pt/fam. to think I am withholding what they need to know....I want them to know that I am bound to parameters. Most of them don't have an idea of our job.

Of course, I don't say it like that....say it differently for who I am speaking with! If the patient is from the projects....I use their colloquial ( sp?) terms....if they are college professors....I try my best to sound like an English major. Ya know? Just explain it after it is diagnosed. We can't diagnose. We can educate. That is the scope/parameter.

As said....if pt./fam. is already tracking and understanding of certain flows of results and meanings per previous discourse with physicians....then...yes....honesty.

Bad news.....your face can transfer a lot of info. Your tone can transfer everything they need to know. The physician will say the words. We will deal with the aftermath. That is our job. To tidy up the heart , soul, and mind of the world gone wrong.

Also...for my practice (nights)....always still try to educate from get-go, so bad news will be noticed by family themselves to soften the blow..

EX:..If physician is AWOL for a while and pt/fam. are anxious; and I know in my mind that some result is not positive for analysis of whatever diagnoses/trend they are worried about....I often say something like...."as a nurse I work with signs and symptoms..the physician is the only one educated to give you the full story....but I can tell you that if something were terribly worrisome, the doc would be here right now.......so let's just work on keeping you comfortable and let me explain what I am going to be assessing and monitoring related to the results that I have seen."

And I tell them all about the numbers and colors on the monitor and what parameters we are trying to achieve and why. Most people are really freaked out by the monitors; I have found, and a little education on what the heck we are staring at when we gallop into the room really helps them contribute and feel empowered to help.

Family often become my help mates. They deserve to have some control by learning that every alarm doesn't mean death is at hand. They seem to appreciate what we do more when they know what we are watching and why. And they can tell me...while I am admitting next door...."hey ya know....that number has been going below 90%......do ya think we should try something?"......I actually LOVE when everything comes together like that.

Excuse my excitement. 10 years as RN but 1 year in MICU and STICU......still amazed with the intimacy and collaboration of it all. If family and pt is willing...they are part of my team in any way possible. BUT NEVER shall the RN (well, me) allude to diagnosis before the physician. That is my line. I know I am not educated enough to do that. I don't want that responsibility either.

Also, being pretty aggressive with physicians to "get the heck into the room before the family freaks out"...is something I will do freely....and animatedly...........thanks for letting me get all excited.

tap87 · Jan 5, 2014

Agreed - if it is something related to a chronic illness or a low hgb for example and pt needs blood, etc. I feel comfortable letting the pt know. As far as a change in code status, I will discuss it with family if they bring it up first but only to give basic information on the process and then I tell the family I will have the MD discuss it with them. In my opinion, the MD should have that conversation with family (at my hospital the MD has paperwork to fill out with family anyway regarding a change in code status).