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.

[Wuzzie]

1 hour ago, Hoosier_RN said:

But realistically, most patients, are more savvy and know about test/labs and care, or want to learn.

Heck, most of our lab results are released to the patient portal before we even see them. You can imagine the mess that makes when they freak out over every single "abnormal" result. ?

[klone, MSN, RN]

21 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?

True - I was speaking more to the global issue asked in the OP’s thread title, rather than about the specific situation.

[Forest2]

7 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...

So much grey area here. There should be some kind of policy, but it needs to be rather general. You don't want to box yourself into a corner. I believe that a nurse can give some results in certain situations, such as tests the patient has repeatedly and is knowledgeable of and follows, If the nurse is comfortable with doing that. In addition, I may not give further information as to the "why" of results if I am not sure. I would say that interpretation of results calls for mostly a medical license and is not up to a nurse to do in most cases. And I would explain such to the patient if I wanted to stop there. You should also be aware that patients will pit the nurse against the doctor etc. thinking it will get them leverage.

[canadianedmurse]

I would have to agree that it varies based upon hospital and unit. I work in the ED and often times we get orders due to abnormal labs/diagnostic tests before the MD has time to go back into the room and talk with the patient (which they will always do - eventually). Examples include giving KCl for a low K, starting abx for an infection, putting on a cast/brace for a fracture, starting an NG for a BO, ect. I will explain to the patient why I am doing the intervention, state that the provider gave me these orders, and that they will be back in to chat and talk about results in more depth than me. Depending on the circumstance I will disclose information as well prior to an order. For example we get patients wanting to go home because the wait is too long and they ask me about my opinion. I will often say things like "You're blood work indicates that you likely have an infection - your white blood cell count is elevated so I would reccomend you stay", obviously depending on patient, clinical circumstance, ect.I am also tactful in that I try not to say anything that would allow the pt to say "well the nurse said you would do x,y, and z".

[Forest2]

23 minutes ago, canadianedmurse said:

I would have to agree that it varies based upon hospital and unit. I work in the ED and often times we get orders due to abnormal labs/diagnostic tests before the MD has time to go back into the room and talk with the patient (which they will always do - eventually). Examples include giving KCl for a low K, starting abx for an infection, putting on a cast/brace for a fracture, starting an NG for a BO, ect. I will explain to the patient why I am doing the intervention, state that the provider gave me these orders, and that they will be back in to chat and talk about results in more depth than me. Depending on the circumstance I will disclose information as well prior to an order. For example we get patients wanting to go home because the wait is too long and they ask me about my opinion. I will often say things like "You're blood work indicates that you likely have an infection - your white blood cell count is elevated so I would reccomend you stay", obviously depending on patient, clinical circumstance, ect.I am also tactful in that I try not to say anything that would allow the pt to say "well the nurse said you would do x,y, and z".

Exactly, patients will tell the doctor that the nurse said so and so. I have had them do that even when I did not say anything at all. Because the patient wants something from the doctor they think that throwing the nurse in the mix will help them accomplish their goal. AND a lot of patients only hear part of what you tell them or only what they want to hear. If you say "most of the time" or "often", then a patient interprets that as being "always". You know the alarmist types. You have to be really careful.

[Swellz]

2 hours ago, Wuzzie said:

Heck, most of our lab results are released to the patient portal before we even see them. You can imagine the mess that makes when they freak out over every single "abnormal" result. ?

I had a patient whose mother was a nurse and he gave her access to his online patient record. So I go in to do my thing and she stops me because she already knew what was up lol. Best case scenario.

In general, I give labs results. There's usually something I'm doing related to those labs, so it's part of my teaching about what I'm doing. I don't in general give imaging results, but if it is something straightforward (and good news) I'll tell them. I know where I presently work, most doctors rarely go through imaging results with patients which is pretty disappointing. I'd be so frustrated if I were a patient here.

[Oldmahubbard]

As an RN, I would not, unless your workplace clearly allows it, and has a very specific written protocol about what can be revealed and when.

The number of different problems you can end up having approaches infinity, and for the small amount you are paid, completely not worth trying to be Nancy Nurse.

If you are tempted to do this, you are working way too hard and your provider isn't working hard enough.

[brownbook]

1 hour ago, Oldmahubbard said:

As an RN, I would not, unless your workplace clearly allows it, and has a very specific written protocol about what can be revealed and when.

The number of different problems you can end up having approaches infinity, and for the small amount you are paid, completely not worth trying to be Nancy Nurse.

If you are tempted to do this, you are working way too hard and your provider isn't working hard enough.

You can't be so black and white! You would not tell a patient their blood glucose level prior to giving insulin? Even for a newly diagnosed diabetic this would be part of patient education. And long time IDDM patient's know their glucose levels and insulin needs way better than you do.

You would not tell a patient who's H&H was low, who the doctor had already talked to about the treatment plan...."to get 3 units PRBC then the H&H would be rechecked", what it was? You'd just walk in and hang a 4th unit without any explanation? Or tell the patient you can't tell him what the new H&H was, the doctor has to tell them?

[Oldmahubbard]

5 minutes ago, brownbook said:

You can't be so black and white! You would not tell a patient their blood glucose level prior to giving insulin? Even for a newly diagnosed diabetic this would be part of patient education. And long time IDDM patient's know their glucose levels and insulin needs way better than you do.

You would not tell a patient who's H&H was low, who the doctor had already talked to about the treatment plan...."to get 3 units PRBC then the H&H would be rechecked", what it was? You'd just walk in and hang a 4th unit without any explanation? Or tell the patient you can't tell him what the new H&H was, the doctor has to tell them?

I see where you are coming from, but every workplace is different, and this could very much burn you in the end.

One of many reasons I now have NP after my name, after being chided as an RN for telling pts their labs.

Just realize, if there is ever a question, a concern, or a complaint, as a RN you will be blamed for giving the pt information that exceeds your scope of practice.

Just my negative experience, and one of the many,many reasons I kiss my NP license every day when I get up in the morning.

I kiss it with a passion few people who have not been grossly disrespected in the health care field can understand.

[canadianedmurse]

I can agree that being that black and white is crazy, not telling a diabetic patient's their sugar level before giving insulin is insane. All I can say is I am happy with my workplace, my coworkers, and my doctors. We have a lot of autonomy as RNs in the ED where I work, and I think this is one example.

[klone, MSN, RN]

Giving patients information about their lab results is NOT outside a nurse's scope of practice.

[Jory, MSN, APRN, CNM]

23 hours ago, PeakRN said:

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.

This is exactly the problem in nurses giving lab results. Putting the whole picture together is essentially a diagnosis and explaining why.