Scope of Nursing Practice

Are you sure the physician did not tell the nurse to tell your friend the physician's diagnosis? I've seen that happen. I've had the nurse from an office calling me with what the doctor wrote on my chart. Not all doctor's make phone calls with lab results.

I work in an ER and sometimes the docs will tell the nurse the results of tests, usually when they're negative, then the nurse tells the patient at discharge. Depends on how busy we are.

If she did come up with the diagnosis herself, then she should be reported to the BON.

Yes sure of it,

The patient was in the office and they were attempting to draw the lab work and this was when said nurse told him this when he asked what the labs being drawn were for. Her exact words were to see if he needed dialysis no explanation of what that meant or anything he called me to ask about what could be going on. The doctor was not present and he was just asked to come in to repeat labs by office. He has never been told at a prior time of any abnormal labs and his last cardiology doc's labs were good. he saw said doctor a week ago for insect bites.

I myself would have said personally to test your kidney function, until something was known for sure. I just thought what a crappy unethical way to tell someone, if so. Then he said he heard them( said nurse and coworkers talking outside the room about him. I know thats a HIAPPA violation for sure,I will make absolute sure of this before I go to Board of Nursing.

Thanks for your input. :)

Are you sure the physician did not tell the nurse to tell your friend the physician's diagnosis? I've seen that happen. I've had the nurse from an office calling me with what the doctor wrote on my chart. Not all doctor's make phone calls with lab results.

I work in an ER and sometimes the docs will tell the nurse the results of tests, usually when they're negative, then the nurse tells the patient at discharge. Depends on how busy we are.

If she did come up with the diagnosis herself, then she should be reported to the BON.

I'm a bit confused here... just what was the "diagnosis" given to this patient by the RN ?

"might be needing dialysis" is not a diagnosis the last I heard. Nor is "dialysis" a diagnosis.

While I agree that the nurse should have chosen her words more wisely and professionally, and included some explanation of why the labs were being drawn (without making the patient fearful, or giving away any indication of possible tx. down the road), what you described above was IMO not "diagnosing".

I would be careful to have all the facts beore going to the BON with anything.

Personally, I would address this with the RN first (make a call to the office)and share with her about the patient calling you and how this affected him.

It might be enough to make this nurse think in the future and behave omre professionally.

As for discussing patient labs, etc. amongst colleagues, I don't see how this will change anytime soon and is often neccessary, to boot.

It's not like they were out in public, or even in the facility lunch room or cafeteria.

Depending on what the labs were previously (do you KNOW?) it is well possible that this patient might be looking at dialysis in the near future.

I would assume that the nurse understood this as well.. or was GIVEN to understand this as the reason for drawing the labs.

Adequate urination is not all that's looked at.. the labs will show just how well his kidneys are filtering.. toxins, electrolytes, etc. These labs can tell a LOT about renal function, or dysfunction. My own dialysis patients often ask me the same thing... "but I still pee a LOT and OFTEN... why do I have to be on dialysis?"

But, I agree with you that it was not the nurse's place to just bluntly throw it out there... she certainly could have/should have eased her way around his question and offered a more generic answer, allowing the physician to give him the full story.

I am still amazed at how many times I have read on this site about nurses so ready to call the BON to report another nurse...and many times, with half-baked information and nothing of any harm done. This story has WAY TOO MANY holes in it....or at least the way you have described it to us. It doesn't really sound like the nurse diagnosed him...and certainly didn't prescribed any care....and it doesn't sound like he is not still receiving medical attention from attending physicians. And as far as the HIPPA thing, it is not necessarily a HIPPA violation if the nurse talks to co-workers re: the patient if it's appropriate and pertinent....you didn't quite elaborate on that either.

My suggestion would be to put the phone down.....I'm sure you would probably be devastated if someone called the BON on you for some third party, through the grape-vine info that was riddled with inaccuracies.

Kathryn

I am still amazed at how many times I have read on this site about nurses so ready to call the BON to report another nurse...and many times, with half-baked information and nothing of any harm done. This story has WAY TOO MANY holes in it....or at least the way you have described it to us.

Kathryn

I second this notion. I find Nursing's greatest threat is nursing.

Yes sure of it,

The patient was in the office and they were attempting to draw the lab work and this was when said nurse told him this when he asked what the labs being drawn were for. Her exact words were to see if he needed dialysis no explanation of what that meant or anything he called me to ask about what could be going on. The doctor was not present and he was just asked to come in to repeat labs by office. He has never been told at a prior time of any abnormal labs and his last cardiology doc's labs were good. he saw said doctor a week ago for insect bites.

I myself would have said personally to test your kidney function, until something was known for sure. I just thought what a crappy unethical way to tell someone, if so. Then he said he heard them( said nurse and coworkers talking outside the room about him. I know thats a HIAPPA violation for sure,I will make absolute sure of this before I go to Board of Nursing.

Thanks for your input. :)

He asked WHY the labs were being drawn. She told him in layman's terms why. She may have felt that his level of understanding was such that he needed to hear a possible outcome. That does NOT mean she interpreted his results? Nowhere in this post do you say that she gave him results. That's totally different.

Personally, I think maybe you should stay out of it.

i just don't see the dx in the information you provided. if you are concerned that the nurse acted improperly, call them on it directly.

In the real world, nurses diagnose, prognose, prepare for inevitable possibilities all the time.

I work in critical care and many doctors just don't like to deal with death and avoid the issue at all costs. If I'M not preparing families for real possible outcomes, then nobody is doing so.

The concept that nurses aren't smart and/or educated/experienced enough to interact with patients is the garbage that has held us back, mired in care plans and nursing diagnosis that make absolutely no sense. We speak in a child's language, trying to say what we mean without saying what we know because we dare not step on anybody's toes.

And if you are a nurse, you've done this countless times. But you're ready to run to the board because you/your friend didn't get a response that you wanted.

You are entitled to be angry: it's a stage of grief. But. Are you really angry at the nurse, or the situation? Are you angry because you really believe that nurses should know their place and dare not share what we know, or is it because you don't want to hear what we know?

I can't speak to this particular nurse and her accuracy and/or tact. And I'm sure you, in fact, can make a 'federal' case out of it. But it's not going to change your friend's medical situation one bit. And if He does need dialysis in the next month or two, bad news or not, shouldn't he have had an opportunity to prepare for it, mentally? You already said the doc was completely disengaged. If the doc isn't doing his job, who the heck is going to?

If nurses weren't 'practicing medicine' on a daily basis, in many times and situations, it wouldn't get practiced.

Nurses push the boundaries of 'scope of practice' every day. They are my heroes. First, because we are the primary patient advocates, putting our patient's best interests first. Second, because this is how, day by day, patient by patient, our 'scope of practice' is being redefined. Someday, that scope will truly represent the expertise and experience that nurses actually bring to the table.

I'm sorry about your friend's situation. But really, how is it this nurse's fault? What has she done that is so bad that you are ready to yank her livelihood? I think your anger is misdirected, but that's my opinion.

~faith,

Timothy.