RNs giving patient lab results.

[Dperez201]

Patient discharged after being hospitalized in ICU for sepsis. Patient calls RN to find out results of urine and blood cultures. RN sends the physician an email requesting the he contact the patient to provide the results. The physician said that I should have given the patient the results myself. Has anything changed? I thought RNs can only give results after the doctor has reviewed them? Please help.

[MunoRN, RN]

5 hours ago, Jory said:

I have a real-life example for you:

Patient admitted to the hospital and has a TSH level of 31. They ask for results and you give it to them. They ask why is it so high? What is your answer.

I'd explain to them that TSH levels are typically adjusted by the body based on your thyroid hormone levels, if your body senses low thyroid levels then it triggers increased TSH production to then increase thyroid hormone levels, although less commonly the body might produce too much TSH despite sufficient thyroid hormone levels. An elevated TSH might indicate the need for additional tests, we'll see what the physician's plan is.

[PeakRN]

12 hours ago, Jory said:

I have a real-life example for you:

Patient admitted to the hospital and has a TSH level of 31. They ask for results and you give it to them. They ask why is it so high? What is your answer.

Would you like to give a better case presentation than just a lab result? Patients are more complex than one lab. An elevated TSH could present with a myriad of conditions including endocrine, autoimmune, oncologic, and others.

[PeakRN]

12 hours ago, Jory said:

We have a very strict policy on this at our hospital.

Nurses don't give out lab results, period. Just because a physician has reviewed them doesn't mean the RN should interpret them.

We do have two exceptions: Bilirubin results (normal only) and blood culture results, but only if clear.

It just opens up a can of worms. Something as simple as bilirubin levels coming down/up leads to, "Is my baby going home? Are they going to start/top the bili lights? It's going up is my baby going to have brain damage?" Goes on and on.

Clinics can sometimes work a little differently. Our nurses can only repeat the labs result (some patients don't have access to their patient portal and will be told to come in if there is going to be an intervention. But they can't state what is causing an abnormal lab result, etc.

So when a family has a question about their plan do you come to the bed side every time?

I assume you worked at the bedside at one point. Did you tell diabetic moms what their blood sugar was before giving them insulin? Or did you make the medical team come down and do that?

[klone, MSN, RN]

I think it’s a ridiculous and paternalistic throwback to the “old days” of medicine to state that a nurse cannot give a lab result to a patient.

[Redhead,RN, BSN]

5 hours ago, klone said:

I think it’s a ridiculous and paternalistic throwback to the “old days” of medicine to state that a nurse cannot give a lab result to a patient.

If you are going to give the lab results then you have to be able to act on it, i.e. adjust meds, reorder tests, etc. I've never worked at a place that allowed nurses to give out labs that weren't resulted by Doctors, NPs or PAs first. I'm clinical, perhaps bedside has different rules...

[K+MgSO4, BSN]

I think there are 2 issues at play here.

The whole giving lab results to a patient and also a pt who has been discharged calling the ICU to ask about his lab results.

If a discharged patient called and asked about lab results I am directing them to the FoI team. I have no reason to go into this pt files as he is not under my care currently and it is a breach of privacy (not in US so using different terminology), or he can contact his GP who can contact med records who can give the GP the results and explain them to him (questions popping into my head about why he wants this specific result). It is really strange that a pt who has been discharged is contacting the unit like this.

[LilPeanut, MSN, RN, NP]

Wow, I'm glad some of you weren't my nurses when I was in the hospital. My nurses would print out my labs in the morning for me to look at.

3 hours ago, Redhead,RN said:

If you are going to give the lab results then you have to be able to act on it, i.e. adjust meds, reorder tests, etc. I've never worked at a place that allowed nurses to give out labs that weren't resulted by Doctors, NPs or PAs first. I'm clinical, perhaps bedside has different rules...

That is absolutely not true. You do not have to act on it to be able to tell a patient about it.

Some of it is culture dependent, but in general, if the result is normal (and you should know this as a nurse) it's fine to share with the patient/family. If it is "abnormal" but not life-changing, still fine. In general, everywhere I've worked, if it is going to lead to a devastating diagnosis, wait on that until more people can be involved (MRI results, biopsy results that are not normal).

I'm a provider now, but I still won't tell devastating news to a family on my own, I get the whole team involved, including social work. And I would expect any nurse to be able to give routine lab results, even if it needs intervention. "The TSH was elevated, I've let the doctor/NP know, nothing needs to be done at this moment, but they'll look at your overall plan in the coming days to evaluate for any changes to therapy."

Because if a change needs to be made right away, then the provider should be ordering that change right away. Otherwise, you can give the result and tell them to discuss with the provider about changes to the plan.

[FolksBtrippin, BSN, RN]

In general, I will talk to my patients about their labs when they ask me.

I wouldn't talk to my patients about labs I didn't understand, but I would also be on the doc to do it and also to teach me.

I can understand RNs choosing not to discuss labs unless you are doing an intervention based on a lab value. Then it is an essential part of your practice and neglectful to skip it.

If I was written up for educating my patient about labs related to my intervention, I would quit.

[klone, MSN, RN]

5 hours ago, Redhead,RN said:

If you are going to give the lab results then you have to be able to act on it, i.e. adjust meds, reorder tests, etc. .

So not true. It is totally okay to say “these are your results, this is what it means, your provider will be in later today to discuss what the next step is”.

With the exception of results that the nurse doesn’t understand, or grave or life-altering results, it’s totally acceptable for a nurse to discuss test results with their patients (unless it goes against your hospital policy, which I personally think is ***, but whatever).

[Hoosier_RN, MSN]

It may also be facility policy dependent. Just a thought...

But realistically, most patients, are more savvy and know about test/labs and care, or want to learn. They hear so much on tv and look at things online, or have family members or caregivers who do

[RNperdiem, RN]

But this is a patient who has been discharged some time ago phoning and asking about labs. The nurse might not even know who this person is. In this specific case, I would ask the patient about scheduled follow up appointments, and direct the patient to ask their provider about labs. If a lab is very abnormal for a discharged patient, won't the doctors call them at home?

[Wuzzie]

5 minutes ago, RNperdiem said:

But this is a patient who has been discharged some time ago phoning and asking about labs. The nurse might not even know who this person is. In this specific case, I would ask the patient about scheduled follow up appointments, and direct the patient to ask their provider about labs. If a lab is very abnormal for a discharged patient, won't the doctors call them at home?

A very salient point. I would, however, call the provider myself rather than directing the patient to do so.