RNs giving patient lab results.

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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.

On 6/26/2019 at 1:01 PM, MunoRN said:

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.

Sounds like an innocent enough of an explanation? You review the chart and find out the patient reported they took Synthroid 125 mcg for several months at home...sounds legit?

In this particular patient, patient never had a diagnosis for hypothyroidism...of any kind. Patient was taking their neighbor's Synthroid (because she didn't think she needed it) because she wanted to see if it would help her lose weight and feel better.

She also had a history of recurrent miscarriage and I was consulted because she came into the ER with something else and it was an incidental finding.

So this is how it usually goes down after the nurse gives an explanation:

Pt: The nurse said my TSH level was high. Sounds really high.

Me: Yes, it is very high. I'm going to have you stop taking the Synthroid and we are not going to do anymore labs. I want you to come by the office in three months for a thyroid panel so we can see if it is back to normal.

Pt: But the nurse said I needed additional tests.

Me: Well you do...just not right now. We are going to do labs in three months.

Pt: But she also said that my body was producing too much TSH, why is that?

Me: Because you are taking a thyroid medication that I suspect you don't need. But we need to know how your thyroid is functioning without medication. Do I remember correct? A physician has never diagnosed you with hypothyroidism?

Pt: That's right....so what are you going to do about my TSH levels being high right now.

Me: Nothing...your thyroid is part of your endocrine system and it cycles...it takes a long time to correct itself, naturally or with medication. It's really important not to take medications that isn't prescribed for you. We will see you in our clinic in the next couple of weeks for prenatal labs, but we are going to skip the thyroid panel for now, OK?

Pt: Sure. Thank you! I really appreciate it!

<a week later on Facebook>'

"Horrible experience at General Hospital. My thyroid is not functioning well and I have been on Synthroid for months. Nurse and midwife are clearly not on the same page. Nurse said I needed more testing and midwife doesn't want to do anything for three months! I'm pregnant now! I have had miscarriages in the past and now I'm worried I'm going to lose this baby."

Remember..people only "hear" a portion of what you say.

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Specializes in Adult and pediatric emergency and critical care.
23 minutes ago, Jory said:

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

You posed the question for the lowly nurses to answer.

There is a difference between telling a patient that they have a specific diagnosis and telling them something like 'when thyroid stimulating hormone is high for some reason your body is signaling your body to produce more of the hormones in your thyroid. This could be for a couple of reasons for this but when we have rounds this morning the team probably be able to give you a more specific answer.'

A TSH isn't even really a good lab to use as an example, it isn't something that we are very likely to act upon or tell a family with a large degree of urgency.

A better example would probably be something that patients know we are trending or that are being followed for anyway. The renal disease patient that wants to know their creatinine, diabetics that want to know their blood sugar, dialysis patients that want to know their potassium, oncology patients that want to know their ANC, and so on.

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Specializes in Adult and pediatric emergency and critical care.
2 minutes ago, Jory said:

Sounds like an innocent enough of an explanation? You review the chart and find out the patient reported they took Synthroid 125 mcg for several months at home...sounds legit?

In this particular patient, patient never had a diagnosis for hypothyroidism...of any kind. Patient was taking their neighbor's Synthroid (because she didn't think she needed it) because she wanted to see if it would help her lose weight and feel better.

She also had a history of recurrent miscarriage and I was consulted because she came into the ER with something else and it was an incidental finding.

So this is how it usually goes down after the nurse gives an explanation:

Pt: The nurse said my TSH level was high. Sounds really high.

Me: Yes, it is very high. I'm going to have you stop taking the Synthroid and we are not going to do anymore labs. I want you to come by the office in three months for a thyroid panel so we can see if it is back to normal.

Pt: But the nurse said I needed additional tests.

Me: Well you do...just not right now. We are going to do labs in three months.

Pt: But she also said that my body was producing too much TSH, why is that?

Me: Because you are taking a thyroid medication that I suspect you don't need. But we need to know how your thyroid is functioning without medication. Do I remember correct? A physician has never diagnosed you with hypothyroidism?

Pt: That's right....so what are you going to do about my TSH levels being high right now.

Me: Nothing...your thyroid is part of your endocrine system and it cycles...it takes a long time to correct itself, naturally or with medication. It's really important not to take medications that isn't prescribed for you. We will see you in our clinic in the next couple of weeks for prenatal labs, but we are going to skip the thyroid panel for now, OK?

Pt: Sure. Thank you! I really appreciate it!

<a week later on Facebook>'

"Horrible experience at General Hospital. My thyroid is not functioning well and I have been on Synthroid for months. Nurse and midwife are clearly not on the same page. Nurse said I needed more testing and midwife doesn't want to do anything for three months! I'm pregnant now! I have had miscarriages in the past and now I'm worried I'm going to lose this baby."

Remember..people only "hear" a portion of what you say.

You really think taking extra synthroid would cause you to have an elevated TSH, do you actually understand the meaning of an elevated TSH? You know that untreated elevated TSH in pregnancy is associated with increased risk of losing the pregnancy?

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Specializes in Nurse Leader specializing in Labor & Delivery.

OFFS.

We stupid. We just dum nurses. We no understand labs.

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30 minutes ago, Jory said:

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

Come on Jory, I have a lot of respect for you but we aren’t idiots. Your follow up post wasn’t much better. I’m not advocating for nurses going rogue and we do need to know our limitations but it is not an absolute that releasing to and even reviewing lab results with patients is out of our scope or beyond our education. In fact, it’s part of my job and the providers are grateful for it because it reduces their work load significantly allowing them to handle the things that really are not within the purview of the nursing staff.

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Specializes in NICU/Neonatal transport.
9 hours 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?

That's a whole different situation. I would not give info like that on a patient I was no longer caring for, as an NP or RN.

And patients can misunderstand and misconstrue what we say no matter what. Patients have a right to their health information. When I was hospitalized, I would see my liver panel every morning, because I was in for liver failure. A nurse telling me she couldn't tell me the result would have sent me into a panic most likely, because that's totally within their scope, and if they wouldn't tell me, perhaps something else was wrong.

another possible review:

"Bad nurses at city hospital, wouldn't even give me the results of basic tests because they are too dumb to understand them, was forced to wait unreasonable time to find out about my own health!"

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Specializes in Nurse Leader specializing in Labor & Delivery.

This whole “gatekeeper” attitude regarding patients’ own health information is infuriating to me.

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Specializes in ICU, trauma, neuro.

In my 11 years as an RN I have probably relayed lab results several thousand times not only have I never gotten in trouble for this I have never seen anyone get in trouble for this. I just reviewed the Florida Nursing Practice Act and can find nothing that prohibits relaying labs, however heath teaching is specifically referenced as a Nursing act. It would be fascinating and perhaps educational to review the “case law” of the collective nursing boards around the nation to see how this action has been evaluated in the past.

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Specializes in CVICU, MICU, Burn ICU.

I'm confused. Are nurses not supposed to understand lab results? And who does the patient education? Nurses do it. It is our job to do it. I don't deliver devastating news (if at all possible) without a plan and support to do so. Most times that includes the provider doing the delivering and me doing the damage control.

The providers I work with would sigh and roll their eyes if we acted like pansies about stuff like labs and the plan of care, etc. We are a team and operate as such.

The "gatekeeper" business is disrespectful to both nursing AND patients.

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Unless it's something detrimental or requires relaying a diagnosis or a myriad of follow up questions, I'm giving the results. I've never gotten in trouble about results. Let's also be sure to note most patients ask nurses questions and won't/don't ask doctors questions.

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I haven’t encountered any pitfalls as a result of using common sense to give appropriate information.

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If they've been discharged then they should be calling medical records not the floor.

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