What are we allowed to tell patients?

MikeyJ, RN · Nov 15, 2007

I think it may vary by institution and perhaps state, however, I always tell my patients about the condition they have. If I am unsure of something, then I tell them I can either go look it up or they can talk to their doctor when they round on them.

The things the nurses at my hospital are not allowed to talk to their patients about: any type of procedure that will be performed by a physician -- we can talk to them generally about it but any type of specifics must be described by the physician performing the procedure, and any lab, procedure, or imaging results that haven't first been discussed by the physician.

So in regards to your questions: #1) Yes I would talk to your patient about their condition, given that you know what their condition is... however, I would only speak generally about the condition and wouldn't make specifics. #2.) I would definitely not look at the lab results and devulge whether her husband still has sepsis before the physician has spoken to them about it. If you misinterpret the lab results and tell them the wrong thing, you could potentially be in some hot water.

Snow1278, RN · Nov 15, 2007

when i talk to patients about things like lab values, i make sure not to diagnose them. for instance i had a patient with a positive troponin level and it was around 10 at night. i called the doctor the results and received new orders for her. i had to tell the patient why she was getting a new medication, but i just explained that her troponin was high and this is what the doctor had ordered. she wanted to know a little more about an elevated troponin so i printed her the patient education papers on troponin levels and what they mean. the next morning the doctor rounded around 7 am and she received his diagnosis. when it comes to patients that are unable to respond, i always double check to see who is the power of attorney or listed on the list of who i can give information to. i have had a few occasions where the person asking isn't allowed to know anything. i am sure you will do a great job as a nurse. good luck.

EDNewbie · Nov 15, 2007

I always ask patients, "What has the docotor told you?" to gauge what their concern may be. If I can answer their questions I usually try to do it in a general way; then I let the doc know - "Hey, Mr. Smith is confused/concerned about whatever, could you please talk to him when you get a chance." Seems to work pretty well.

EmmaG, RN · Nov 15, 2007

Most of my patients are extremely knowledgeable about their disease process, treatments, labs, etc. I provide them with lab results if they ask.

danissa, LPN, LVN · Nov 15, 2007

Heather, as a student, its wise to get a qualified member of staff to tell the patients anything regarding their treatment/diagnosis, whether it be a nurse or a doctor. I have seen cases in the past of students taking it on their shoulders, trying to tell patients stuff, and it's all gone so wrong! When you are still a student, the nurses in that place are responsible for you, and any mis-information given by one who is still training falls back on them. NOT that I am saying you personally would give the wrong information, please understand! Just that, until you hold responsibility for your own practice, always refer the patients to someone who is experienced. It protects you, the nursing staff and the patient. The patients in your care, in the meantime, should ALWAYS be aware that you are a student, not a qualified nurse.

One day, I'm sure you will be great at taking on that role....good luck to you !

pagandeva2000, LPN · Nov 15, 2007

I also ask what the doctor told them first. I was taught that we can't initially tell them their diagnosis before the physician has. Also, telling the family member without consent of the patient can violate the HIPPA law.

I have been caught in situations because of lazy, stupid doctors. Once, I had a patient who had enormous cold sores surrounding her mouth, and she came in with 2 year old child. The chart stated that the woman had oral herpes, and prescribed acyclovir ointment. Immediately, I started thinking about the child and told her not to kiss the kid until the lesions healed and to avoid oral sex as well. I assumed the doctor told her what he diagnosed, and of course, I am obligated to explain the reason for getting a medication, side effects, etc. The woman said "I HAVE HERPES??? The doctor told me that I had an allergic reaction!!" I looked into my drug book to make sure that this med was not given for another reason, and it wasn't. I sent her back to her doctor, because I felt he should have told her.

Another worse case scenerio (happened the same day as the herpes disaster). Woman comes into my office as a new patient, crying. She told me she went to the ER for chest pains, no one tells her what it is, and she was referred to my clinic for follow up. She said that the doctor told her that she is a psycho (because she came to my hospital a few years ago for psychiatry), and that she has some nasty disease that she would not seek treatment for. He says to her that if she doesn't want treatment, that he will not waste his time prescribing anything. I looked in the chart (electronic charting) and the only thing I see is general health maintainence, return as needed. I see no labs, nothing! She was so upset, asking "What nasty disease do I have??". I went to my manager and asked her if this patient can see another physician, because she wants an explanation; and also, this doctor is known to be rude and arrogant. The manager takes her to see the physician in charge of the clinic. 45 minutes later, the physician in charge gives me prescriptions and I see that it is for INH and vitamin B-6, and I believe rifampin. I asked the woman what the new doctor told her, and she says "Oh, she just told me to take these medications for about 9 months...what are they for?" I was horrified! I did tell her, and she walked out smiling and told me thanks for helping her.

Yeah, she may have been a psych case, but, she had a right to know. And, because of her mental illness, if it does exist, she may not have been able to process what happened. And, I see nothing in the chart from the chief, either. Spoke to my nursing supervisor, she tells me that this doctor has been doing this for some time. Every time I think about this, I have a headache. And, now, each time an incident happens with this doctor and I go to his boss, she says to me that he makes appropriate orders and she is not going to get between our differences.

Daytonite, BSN, RN · Nov 15, 2007

I am surprised that you haven't had any lectures or education regarding HIPAA laws and patient confidentiality. A patient is entitled to know their medical information, but as a nurse you do have to use discretion when it comes to disclosing information. Not that the patient isn't entitled to know it, but you also have to be prepared to answer questions the patient may have. It is traditional that the patient's doctor provide them with test results and their diagnosis. However, there are often instances when I've told patients the results of their lab tests. Family are not entitled to know any information, technically, unless they have power of attorney.

Dolce, RN · Nov 15, 2007

I am very general about questions when patients ask me, "How am I doing?" I tell them their vital signs and their labs if they ask. But, I try to be cautious about explaining all the possible diagnosis of each lab value. Patients get confused enough without adding the added stress of speculating about possible diagnoses! When a patient asks about a specific condition/disease they have been diagnosed with I am free with information and education. But, I try not to be involved in the "what do you think the doctor is going to do" routine. I provide basic answers but I am not a prescribing clinician and I won't speculate too much about what the doctor thinks. I always just page the doc and tell them that the patient has some specific questions for him. Thankfully most of the docs I work with are excellent and will call the patients on their phone if they can't speak with them in person.

heather318 · Nov 15, 2007

I am surprised that you haven't had any lectures or education regarding HIPAA laws and patient confidentiality.

We have had lectures about HIPAA. But it didn't address exactly what we as nurses are allowed to tell the patients as opposed to what the doctor should tell them.

Tweety, BSN, RN · Nov 15, 2007

We have had lectures about HIPAA. But it didn't address exactly what we as nurses are allowed to tell the patients as opposed to what the doctor should tell them.

Doctors need to results and treatment plans. It's kind of grey what nurses can and can not tell patients.

Like a poster above, I'm reasonably comfortable test results, but careful not to diagnose or give a treatment plan. For example, if a paitent with next pain has a broken neck. I might tell them that there's a fracture if they are worried about the results and are asking me, just so they stay flat and still. I might say "there could be several things to MD does like a collar, a halo or even surgery, I can't tell you, but the doc will be in to discuss the treatment plan."

I would never give results that are grave or serious, such cancer tests, or even HIV results, etc. I leave that for the MD. But if someone's potassium is low, I don't mind tellling them that.

I am also mindful of family members. When my dad was in the hospital with a heart attack, my then RN sister was instrumental in gathering infomration and helping my dad understand things since the doc was in and out so fast.

Naturally we have to be mindful of HIPPA. That's a given.

I did some research and lack of infomration and communication with staff was a #1 source of anxiety reported by patients and families, and we can help.