What are we allowed to share?

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Specializes in critical care.

Patient is admitted with pneumothorax. Gets chest tube, drains a ridiculous amount of fluid. Several days later, pneumothorax resolved on X-ray. Chest tube gets pulled. Immediate chest X-ray. This one shows a pneumothorax, 5%, same lung. Pulmonologist calls to tell me this, gives orders for timed imaging through night, in addition to very specific instructions if the patient crashes.

We also decided to move the patient to a room closer to the nurses' station. Knowing the patient might want to talk about this, and with it being shift change, I was looking forward to bedside report. So night nurse and I walk in, and I start talking about the night's plan of care (calmly - no sense in scaring anyone, but honestly, I was and am afraid for the guy).

Early on, I realized that the pulmonologist left without telling the patient what was seen on X-ray. She didn't stop by his room at all. Surely he realized not everything was okay, if I was talking about imaging through the night.

I read the radiologist's summary. It was obvious to him, I'm sure, that I was aware of WHY all of this was happening. Honestly, I was a bit shocked and disappointed by the doctor.

Anyway, I think I messed up. As an RN, am I allowed to disclose abnormal results before the MD discusses them, as long as I don't do anything but read it exactly, word for word? There was no interpretation, diagnosing, advice or treatment options stated/offered by me, except to discuss plan of care put in place by the MD.

I'm also afraid that it may make the MD look bad for not discussing this with the patient herself first. I may be bothered by her doing that, but it benefits the patient in no way to have him possibly be bothered she didn't pop in either. (Yes, I may be way over thinking that.)

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Specializes in General Surgery.

I personally don't think you did anything wrong. If it wasn't you it was gonna be the scary xray people waking up the patient with their machines.

I always prepare patients for upcoming diagnostics. I always explain that [xrays; CT; MRI] are tools to assist physicians in diagnosis and in turn treatment if indicated.

I especially have to since I work at a university hospital where residents forget a lot of basics... like talking to the patient. LOL

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Specializes in Medical-Surgial, Cardiac, Pediatrics.
I personally don't think you did anything wrong. If it wasn't you it was gonna be the scary xray people waking up the patient with their machines.

I always prepare patients for upcoming diagnostics. I always explain that [xrays; CT; MRI] are tools to assist physicians in diagnosis and in turn treatment if indicated.

I especially have to since I work at a university hospital where residents forget a lot of basics... like talking to the patient. LOL

I agree with this.

I think it's a nursing judgment call. I don't always discuss non-emergent or secondary priority findings, i.e., a possibly cancerous mass that doesn't require immediate intervention to assure safety, before the MD. But a pnueumothorax that requires very close and accurate monitoring to maintain safety is a priority, and I would discuss that with the patient even without the MD doing so beforehand, since their input and awareness is part of the plan of care that would assure the best outcome, because they need to be prepared to make fast decisions in an emergent situation.

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Specializes in SICU, trauma, neuro.

I don't see anything wrong w/ how you handled it, and that's pretty much what I do if someone asks me for an imaging or lab result when MDs are not around. I'll tell them what the radiologist's note says, etc. and defer follow-up questions to the MD (unless it's something I know for a fact--such as we will repeat the HCT in 6 hrs, or the QBAL is still pending.)

That stinks that the pulmonologist didn't talk to the pt herself, though. And as far as I'm concerned, if she's upset that you spoke at all...well she could have avoided the need, if she'd done it herself. I mean these people have the right not to be clueless all night.

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No two situations are exactly the same. In this instance, I think it would be fine to tell the patient that there was just a teensy little bit of pneumo, that the pulmonologist expected it to resolve on its own, but that you would be keeping a close eye on her overnight. That's a lot more comforting than trying not to overstep and coming off as evasive. I think you did just fine.

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Specializes in critical care.

I am so thankful to read these responses! Thank you!

That stinks that the pulmonologist didn't talk to the pt herself, though. And as far as I'm concerned, if she's upset that you spoke at all...well she could have avoided the need, if she'd done it herself. I mean these people have the right not to be clueless all night.

About this..... The thing that upset me most of all about her not talking to him is how serious she made it sound to me. Essentially what she said was that she'd check in on the x-Ray results as they come in. If he becomes symptomatic with unstable hemodynamics, she doesn't have much confidence he'll survive it. (He has significant comorbidities.) Surely there is a good reason why a new tube wouldn't be placed tonight???

This got under my skin. On my way out, I reported off to the hospitalist so that he could be up to speed on the patient in case anything does happen. Any little bit of time saved at that moment could be a really big deal!

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Observation is a reasonable medical decision in someone who is asymptomatic with a 5% pneumo. The chest films will show whether it is expanding, and he will either become symptomatic or not, and then clinical decisions will need to be made at that point.

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Specializes in Critical Care.
I am so thankful to read these responses! Thank you!

About this..... The thing that upset me most of all about her not talking to him is how serious she made it sound to me. Essentially what she said was that she'd check in on the x-Ray results as they come in. If he becomes symptomatic with unstable hemodynamics, she doesn't have much confidence he'll survive it. (He has significant comorbidities.) Surely there is a good reason why a new tube wouldn't be placed tonight???

This got under my skin. On my way out, I reported off to the hospitalist so that he could be up to speed on the patient in case anything does happen. Any little bit of time saved at that moment could be a really big deal!

A very small pneumo, often an apical pneumo, does not justify chest tube placement.

As with anything you're not sure of, you should always check with MD about the plan of care, but in general it's not only allowed, but expected that the nurse keeps the patient informed about their care in a timely manner. In a teaching hospital there is some pressure to let the residents give patients these types of updates since they need the practice, but even then if they weren't reasonably quick in keeping patient up to date then we did ourselves, since that is after a big part of the nurses' job.

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