RNs giving patient lab results.

Nurses General Nursing

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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.

Specializes in Critical Care.
4 hours 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.

That's actually an excellent example of why it's so important for nurses to advocate for their patients by keeping them informed and educated, sometimes their midwife is having a bad day and gets their understanding of the endocrine feedback systems backwards, and hopefully the nurse's explanation will clue the patient into that error and cause the patient to pursue alternative medical assessment and advice to what the midwife provided.

Taking Synthroid unnecessarily does not result in an acutely elevated TSH level, it suppresses the TSH level.

By itself, the severely elevated TSH suggests hypothyroidism, the fact that the patient has already been taking someone else's Synthroid only makes the elevated TSH more concerning.

And as you mentioned, the patient has a history of miscarriages, hypothyroidism is strongly associated with risk for miscarriage. It's far less likely, but it is possible to have an elevated rather than suppressed TSH level while taking Synthroid inappropriately, but only further tests can help differentiate the contradictory findings.

7 Votes
22 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...

I guess I missed this the first time through the thread. Where did you get this idea?

Overall some people on this thread are making it way too complicated and are significantly exaggerating the significance of the situation.

****

Also, the OP hasn’t been back to elaborate but I suspect this phone call was received in an office setting.

2 Votes
Specializes in Psychiatry, Community, Nurse Manager, hospice.
6 hours 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.

This situation was not caused by the nurse informing her patient about lab results, or by the nurse at all, in any way.

A very common culture is for the nurse to be the one who gets blamed for every thing that goes on in the workplace. If you are in such an environment, you aren't going to fix it with your own behavior. You just need to get out.

4 Votes
Specializes in Critical care.

Sooo not to add to this can of worms, but HIPAA requires us to share this information with patients. I agree with the posters who tell patients, I wonder at the advocacy ability of nurses who don't. If your facility has a policy that states nurses may not release labs to patients when asked I would seriously ask a legal team to review the policy.

The specific situation is an exception though, patient has already been discharged, I would explain to them that I am not allowed into their chart after they have left the hospital (to protect their privacy ie HIPAA) and that the Dr.s office will have those results available for them.

Cheers

6 Votes

Outpatient setting... we only defer to the provider if test is abnormal and a treatment is still needed. Otherwise, we give all results.

3 Votes
Specializes in Dialysis.

I work with a group of 5 nephrologist, 4 don't care if we give results and other info, the 5th, we are not to utter a word but are to refer to him. Then he gets pi$$ed with the amount of phone calls he gets. He has even went to the extreme of having the standing order on his pts to call regarding any questions or results...to me, this is just control freak behavior...and no, this isn't even an older neph, he's our youngest! Our older nephs are pretty laid back, but want to give life altering or negative news themselves

1 Votes
14 hours ago, MunoRN said:

That's actually an excellent example of why it's so important for nurses to advocate for their patients by keeping them informed and educated, sometimes their midwife is having a bad day and gets their understanding of the endocrine feedback systems backwards, and hopefully the nurse's explanation will clue the patient into that error and cause the patient to pursue alternative medical assessment and advice to what the midwife provided.

Taking Synthroid unnecessarily does not result in an acutely elevated TSH level, it suppresses the TSH level.

By itself, the severely elevated TSH suggests hypothyroidism, the fact that the patient has already been taking someone else's Synthroid only makes the elevated TSH more concerning.

And as you mentioned, the patient has a history of miscarriages, hypothyroidism is strongly associated with risk for miscarriage. It's far less likely, but it is possible to have an elevated rather than suppressed TSH level while taking Synthroid inappropriately, but only further tests can help differentiate the contradictory findings.

It did in this patient. She stopped the Synthroid and her TSH level was textbook normal when rechecked at 90 days and her final trimesters, and postpartum. This ended up being the first baby she carried to term.

So yes, this midwife absolutely understands the endocrine system very well. When you take Synthroid in the absence of hypothyroidism, in high enough does, it can absolutely drive the TSH level up.

My explanation wasn't backwards dear....you apparently have very limited practice in those with endocrine disorders.

By the way....if you contradict me to a patient without going through management or another provider, that is a write-up in my facility. Giving a diagnosis is out of your scope of practice. If you want to play APRN or an MD/DO...go back to school.

0 Votes
10 hours ago, hawaiicarl said:

Sooo not to add to this can of worms, but HIPAA requires us to share this information with patients. I agree with the posters who tell patients, I wonder at the advocacy ability of nurses who don't. If your facility has a policy that states nurses may not release labs to patients when asked I would seriously ask a legal team to review the policy.

The specific situation is an exception though, patient has already been discharged, I would explain to them that I am not allowed into their chart after they have left the hospital (to protect their privacy ie HIPAA) and that the Dr.s office will have those results available for them.

Cheers

Actually, them having access to their lab results doesn't mean the facility cannot control HOW they have access to lab results. A facility may allow a nurse to give you the result, but you cannot provide an explanation as to why. That is a diagnosis. That is up to the provider to interpret unless they have already provided documentation in the progress note. I have never minded nurses further elaborating on notes I have already made so the patient can understand what is going on. There is more than one way to explain things.

1 Votes

Too many huge can of worms situations here. Sure, it's so nice to tell someone their HgA1C has improved. Gives you a really good feeling. The patient should keep doing the same thing they have been doing. Everybody can smile.

How about a BUN of 95? Same good feeling? I thought not.

How about HIV positive results?

Grossly elevated PSA?

What if the news is sort of good, but not really, and requires a ton of explanation, most of which the patient will not hear or absorb?

2 Votes
19 minutes ago, Oldmahubbard said:

Too many huge can of worms situations here. Sure, it's so nice to tell someone their HgA1C has improved. Gives you a really good feeling. The patient should keep doing the same thing they have been doing. Everybody can smile.

How about a BUN of 95? Same good feeling? I thought not.

How about HIV positive results?

Grossly elevated PSA?

What if the news is sort of good, but not really, and requires a ton of explanation, most of which the patient will not hear or absorb?

You must work with a bunch of idiot nurses if they don’t know when it is and is not appropriate to discuss lab results with a patient. Fortunately my peers and I are smarter than that. I wouldn’t touch that creat level with a ten foot pole but you can bet that since many times our nurses are the first to actually see the results we would be getting on the horn to notify the provider so there is no delay in intervening. Maybe you should come work with us.

10 Votes
1 hour ago, Wuzzie said:

You must work with a bunch of idiot nurses if they don’t know when it is and is not appropriate to discuss lab results with a patient. Fortunately my peers and I are smarter than that. I wouldn’t touch that creat level with a ten foot pole but you can bet that since many times our nurses are the first to actually see the results we would be getting on the horn to notify the provider so there is no delay in intervening. Maybe you should come work with us.

Thanks . I did work with a bunch of absolute idiots, and left 20 years ago to become an NP. No regrets

0 Votes
42 minutes ago, Oldmahubbard said:

Thanks . I did work with a bunch of absolute idiots, and left 20 years ago to become an NP. No regrets

That’s great but please don’t paint all nurses with the same brush based on your experience. We certainly aren’t perfect but many of us are pretty smart.

4 Votes
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