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.

8 hours ago, NurseBlaq said:

This whole post is an example of what I'm talking about. You are arguing several things that weren't said, including the assumption my thyroid wasn't palpated and still missed. Also, my thyroid disorder predated having children. It wasn't caught until pregnancy until the third child and after umpteen doctors. Were they all incompetent and you're superb?

Talk about stating things that were not said. YOU are the one that stated you had a HUGE goiter...if it was that big...even an inexperienced provider should have been able to pick that up. So were you exaggerating on how big it was? I wasn't questioning your account...if you said it was HUGE, then it was HUGE...so it is very reasonable to not understand how something SO HUGE could be missed on palpation.

Once you have palpated a HUGE goiter or nodules, they are not hard to find.

Also, I didn't state YOU prescribed anything, I said I was given Synthroid and it didn't do anything and I still felt bad until Armour Thyroid, so yes, it does matter because there are several instances of people saying they noticed a difference in the two meds. Again, you're presuming people are so incompetent they can't tell a difference, even when it's their health. Not what I was stating at all but here you are arguing what wasn't the point.

I didn't prescribe anything to the patient because I had her discontinue to the Synthroid. There are two different medications that do different things. I never stated anyone was incompetent (there you are...stating things I never said), I just said, "Depends". I didn't see your labs. I never stated you shouldn't have been placed on Armour. I don't know what your provider's treatment goals were. I don't know where your labs started...I ONLY STATED..."Depends" and if you read more into that than what I wrote...that is on you.

Yes, you are being elitist, evidenced by this entire post. I shared my experience and you took the time to write a whole narrative arguing what wasn't the point at all, not to mention, being condescending throughout. Maybe take your own advice about being snide. No one is arguing giving lab results and undermining providers, you just seem to have the opinion of everyone being too simple minded to give out basic lab results. No one said they'd interpret or give medical diagnoses, you took it there with this high horse you're sitting atop.

I think you need to go back and read your post. Your entire post's purpose was to "school" me on labs as if I had never had a thyroid patient in my entire career. Your ENTIRE remark was snide, you absolutely read my RESPONSE correctly...it was meant to be condescending..I was just following the tone you set for how you wanted to communicate.

Nurses giving lab values does NOT equate explanation. If your patients "don't have confidence in the level of care they're receiving" maybe it's something you're doing and not the RNs. For example, when the patient is explaining their health to you, don't assume they're only a patient and don't know better and that you know more than they do because you've interpreted some labs, reviewed some tests, or work with endo or whomever, which was the point of my story in case you missed it. Patients know their body better than anyone else despite the lab values you're looking at, or whomever you work with. Based upon your perceived slight in this thread, I'm sure you're guilty of this because you refuse to take anyone's POV into account except your own. NONE of us are above being wrong at any time, including you.

I never stated that giving out lab values equates explanation (again, you can't read), I said when you give lab values patients GENERALLY WANT AN EXPLANATION. There is a REASON why providers have to sign off on labs..the lab result may be so far off I may ask for a verification, it may be abnormal, but an improvement for that particular patient...you only have your portal...I have access to both the hospital and our clinic's lab results for established patients. I also never stated patient's didn't know their bodies or any of that other nonsense you are claiming...I have just been on the receiving end of what happens when a nurse (or two) tells a patient one thing and my treatment goal is different and then they go through 20 questions wanting to know which is the "real story". I never did this as a floor RN b/c it was against our policies. So yes, it is possible.

Having said that, I'm not going back and forth with you. All of my providers are NPs but if they were dismissive and elitist like you I'd definitely get a new provider, especially if they didn't listen to me as a patient because what I said didn't match their lab values. And FYI, undiagnosed patient here again, working closely with endo doesn't equate a missed diagnosis or assumption of unprescribed Synthroid causing miscarriages.

You are taking your misdiagnosis out on me...I can't help you were mismanaged. YOU ARE THE ONE that said, "everyone missed it". I didn't...YOU DID. I never stated I didn't listen to my patients...THAT WAS YOUR ASSUMPTION AND BASED ON WHAT???? Oh that's right...NOTHING. The endocrine system is a delicate balance of the TPO axis...I would suggest you do some research on that...she was taking a WHOPPING dose of Synthroid that I'm shocked didn't land her in the hospital...but as a CNM,I think I am very qualified to equate her stopping her Synthroid, the normalcy of her labs later, and the fact she had an uneventful pregnancy and a normal birth along with MANY other labs that returned to normal, as VERY instrumental in her not miscarrying this pregnancy as well. If your TPO axis is dysfunctional it will also lead to ovulation disorders...disorders of ovulation result in a poor quality egg that may fertilize, but will not go on to a viable pregnancy. If you want more information, I suggest you consult one of your textbooks from school.

Also. I'm lost here:

You state she was seeing another provider and you saw her via ER then go on to say she had multiple pregnancies which all had to rely on ultrasound to date them. What does that mean? Did you see her each pregnancy? Did you not know about the Synthroid with the previous pregnancies? Since there were more, and you knew her periodss were irregular, were you seeing her on an outpatient basis too? I have many questions based upon this paragraph so I separated it.

When someone is admitted to the ER the ER docs take a full health history. When consulted, we review that health history and also interview the patient in a focused assessment. You can date a pregnancy within a few days of accuracy with a first-trimester ultrasound, assuming the embryo is large enough to obtain measurements. This is very common when an LMP is unknown or in question. She told me this in the interview and when she had her US she was told by her other provider how many weeks she was...that is how we know she lost all of her pregnancies in the first trimester. This particular patient's Beta HCG level was only around 1,000 or just under, I can't remember exactly, but it wasn't high enough to where I would see anything on US. Needs to be between 2-3,000. I ended up managing the patient outpatient because her previous provider, refused to evaluate her thyroid....there is some controversy in whether or not this is necessary...some providers do...some don't...I do....and because nothing changed with her previous losses, she didn't want to go back.

I don't steal patients from other providers. But when they say they are not going back and ask where they should go. As a professional courtesy to other groups, we give them a list and allow the patient to choose. She elected to stick with our group.

See comments above.

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12 hours ago, canadianedmurse said:

I understand where you are coming from, however I think it is the elitist "Provider" role who insists on being the sole provider of information that is often the issue. We are in an age of technology and freedom of information. People are likely to google their symptoms and abnormal lab values to self diagnose themselves.

I hope the RNs you work with don't interprete lab values matter of factly and state their findings to the patient, unless the cause is obvious. I don't think anyone here is saying that RNs can and should state what is causing the abmormal value. I think providing simple explanations for results is completely fine. Especially when you discuss things in a manner using terms such as "It often indicates" "it can indicate" "it could be from" and end your discussion with the caveat that "Your provider will be back in to discuss the findings and their cause in greater detail" ect.

I never stated what other hospitals should do...I stated what mine did and gave a scenario of issues it can cause. When patients are in an acute care setting, their labs are not in a portal. They have to go through a staff member to get them.

We have had issues in the past of RNs at our facility providing an interpretation and yes, several were providing what they felt was causing the abnormal value and have had families blow up when the two explanations were not congruent.

I think that every nurse should temper giving out lab results with a bit of common sense. "Did my blood culture come back?" Nurse: "Yes, your 24 hour results came back negative, but our policy is to run them for 72 hours...so we are still waiting on a final result. Some bugs like to show up late to the party"...nobody cares about a clear drug screen, clear x-ray, etc. The problem...is when the labs are not normal.

I obviously don't admit babies after I attend the deliveries...but the pediatricians have made an exception on reporting of bilirubin levels and blood cultures, if negative. I don't have an issue with them releasing negative drug screens to moms, but I prefer positives to be explained by either myself or the hospital social worker...it can prevent a horrible scene. Nurses don't give out results for Hep C, HIV, or any STD...this requires immediate counseling, some of these labs are screenings and require confirmation...that needs to be all explained to the patient in one shot. They don't need to be told, "Oh, your HIV test is positive, doc will be back this afternoon to go over that further with you".

My comment on "If you contradicted me at my hospital, that would result in a write-up", was in direct response to a poster that felt she should give out results and her explanation regardless of the policies of the hospital or the provider's wishes. To me...that is a pretty arrogant statement in my book.

I have never worked in a floor nurse in an ICU or an ER....so I will absolutely default to those nurses that do if I am way off base in terms of how those departments operate..but if they do give them out...they shouldn't assume that is appropriate in every department....I merely sought to demonstrate WHY some hospitals have that policy to not give out lab results.

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Specializes in ICU, trauma, neuro.

There are several points that should be understood at a minimum.

a. It is simply not possible to function in the modern hospital environment without sharing lab and diagnostic values with patients. It may be something as small as a blood glucose requiring juice or as significant as a very elevated creatinine/potassium requiring emergent dialysis or the patient going into sustained V-tach and explaining to family members that the patient will need ACLS protocols.. Thus, nurses would either be placed in a position of "not doing their jobs" or giving lab values and having to deny it or some quasi state in between were they to attempt to avoid communicating such information entirely.

b. Many research organizations, but especially the Robert Wood Johnson Foundation and the IOM have for more than a decade called upon nurses to take an increasing role in the reform of health care especially as it relates to health promotion, and prevention https://www.ncbi.nlm.nih.gov/books/NBK209872/ . A key, part of this is being empowered to share basic health information with patients in the appropriate setting and circumstances. Of course the definition of appropriate will differ with the nurse, patient and institution.

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41 minutes ago, MunoRN said:

Not to keep sticking my head in the Lion's mouth here as I'm really not trying to be snarky, but clearly our understandings of the relationship between thyroid levels and TSH diverges at some point, so here's a simplistic description of the thyroid level / TSH relationship, maybe we can pinpoint where that divergence occurs.

According to every available source, including AACE, when thyroid levels decrease the body responds by increasing TSH levels, and vice versa. It's a well understood relationship as it's the basis for thyroid replacement dosage adjustments; High TSH level = needs more thyroid replacement, low TSH level = needs less thyroid replacement. So I'm not clear how it seemed apparent to you that an extremely elevated TSH level was explained by the patient taking their neighbor's Synthroid, that would be a paradoxical response to exogenous hyperthyroidism, not the expected response.

I agree with you completely...that is usually how it works. This is why it's a bit of a zebra. Patient started taking her neighbor's Synthroid because she couldn't lose weight and was feeling tired. A later investigation showed her ferritin levels were in the single-digits and her H&H was borderline low.

As you can imagine, this is a rare scenario...my OB/GYN will allow me to treat cases where the TSH levels are under 15 (shortage of endos in my area)...we start everyone out on 50 mcg of Synthroid and monitor response and adjust accordingly...if it's refractory, then we refer. Anything over 15, we refer. If nodules are felt or enlargement, we order an US and refer.

When I was about a year in practice, I had a patient that had an TSH level of I think around 20 or so (from routine annual labs, new patient, she had moved to the area). So I referred to get her re-established with an endo. This patient had previously had been diagnosed with hypothyroidism, was trying to conceive, but was just over 4...treatment goal was to get it under 2. Now her HUSBAND had previously had part of his thyroid removed, so he was on a huge dose of Synthroid (maybe 200 mcg..something like that).

When she got her prescription filled, they used a mail order with their insurance and received a 90-day supply. The label, on the bottles, was marked correctly, however, the pills in both ended up being the SAME dose. Wife was only supposed to be on 25 mcg. She was nearing the end of her 90-day supply when we referred her because her TSH levels were sharply elevated. She had labs drawn only a few months before that showed 2.1 or around here...right where she was supposed to be.

I called the endo personally to see if I could get her in sooner than later because I was really worried about this dramatic change. He saw her the following week. She brought in her bottle....I NEVER would have thought to have checked the pills...but this endo did...and realized she was taking 200 mcg tablets...they were slightly different than the 25 mcg tabs. Again, bottle labeled correctly. He had her discontinue them for about a week and then restart with her regular dose he wrote for. Her labs slowly returned to normal.

I asked the same questions you did...apparently this only happens with really large doses. The endo stated he had seen it only a couple of times before himself...one patient had recently got her 90-day Synthroid filled and they forgot to tell her to stop her Synthroid and gave her Armour when they changed her, she got confused and took both.

41 minutes ago, MunoRN said:

If her BP was 180/100 despite taking her neighbor's labetolol, and the provider said "that's because you're taking someone else's labetolol, labetolol increases blood pressure" and just sent them on their way then yes, I would voice concern, that's my professional responsibility and my job.

If you read above, I stated "If your patient's blood pressure was bottoming out, would you still have them take the labetolol?". So by bottoming out...I am referring to TOO LOW.

If you read my response, she said, "You shouldn't have had her stop taking her Synthroid". Thyroid panels is not as black and white as blood pressure. See my explanation above.

And I'm still not clear why you think explaining to a patient the basic physiologic mechanisms that a test is assessing is out of a nurse's scope.

Oh I agree completely. But...I never stated explaining a test was out of nurse's scope of practice...I said, interpreting the test was. Someone else wrongfully posted that I felt that way and I never made any such statement.

See statements above.

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Specializes in NICU/Neonatal transport.

@Jory Stop. You've acted poorly. You aren't representing NPs well.

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Specializes in ICU.

In my humble experience, releasing lab results varies. For example, staff was not allowed to release HIV status or other STDs. The physicians did those. Once had a patient who had a lab result come back that required new consults and yielded a life altering diagnosis. Left that for the physicians to discuss. I said that the doctor would be in to discuss results. As for post-discharge labs, I've never encountered that. I would guess that we deferred those to the provider. However, I have no idea. I would consult the facility policy or ask a supervisor.

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Specializes in NICU/Neonatal transport.

And patients who are getting serious or life altering lab results should not have to wait once those results are back. The provider should be there promptly to give them. The a reasonable delay would be to notify the patient that the provider is making a care conference for discussion of the results - if that is what needs to happen before sharing.

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Specializes in ICU.
Just now, LilPeanut said:

And patients who are getting serious or life altering lab results should not have to wait once those results are back. The provider should be there promptly to give them. The a reasonable delay would be to notify the patient that the provider is making a care conference for discussion of the results - if that is what needs to happen before sharing.

The intensivist came in and went over everything. And the consult showed up ~2 hours later. By the time the shift ended, a game plan was laid out. We were fortunate that day.

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Specializes in Critical care.

Honestly in my experience providers (MDs and NPs included) are the worst at delivering lab results often related to their work load. First, they are usually unaware of the result when asked, whereas I can recite them from memory. Second, they say the number and rush off to their next pt leaving me to explain to the pt and family what that number means in the first place. Third, I spend twelve hours a shift with that pt and their family they spend maybe 5 minutes, so my rapport with said pt is wayyy better.

Cheers

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2 hours ago, Jory said:

See comments above.

I stopped after the large goiter BS because you don't seem to understand it's possible to have a large goiter and it not be obvious due to being overweight, short neck, etc. Instead you just want to rant and appear to be superior and be loudly wrong! Because of your superiority complex that's quite evident with each post, I'm not reading further and will not reply to your winded, condescending rant and elitism. Just say you think you're superior to RNs and call it a day.

You DON'T know everything and seem to forget we learned this in nursing school and that NP was an extension of that knowledge. We are not blithering idiots.

If you look down from your high horse you'd realize it may just be a mule!

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2 hours ago, hawaiicarl said:

Honestly in my experience providers (MDs and NPs included) are the worst at delivering lab results often related to their work load. First, they are usually unaware of the result when asked, whereas I can recite them from memory. Second, they say the number and rush off to their next pt leaving me to explain to the pt and family what that number means in the first place. Third, I spend twelve hours a shift with that pt and their family they spend maybe 5 minutes, so my rapport with said pt is wayyy better.

Cheers

I can assure you that they are billing both for the lab evaluation. and the "fact" that they discussed it with the pt or family.

Fraud

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Specializes in Adult and pediatric emergency and critical care.

From time to time I wonder if some of the posters on here really have the experience they claim, or are even nurses at all.

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