What you can say to patients as a NP.

Editorial Team / Admin · Aug 18, 2008

Very good question, GoLytely,

The APN provides care just like the physician; diagnoses, treatment, prognosis, etc. You speak to them as the physician would.

Trauma Columnist · Aug 18, 2008

Totally agree with Siri. One of my roles is to provide education too to the pt/family regarding dx and tx plan. That part of my job is very rewarding.

jlcole45 · Aug 18, 2008

I know as a nurse, I'm limited in what I can tell patiernts and family about diagnoses and prognoses. Do you have any limitations in what you can discuss as a NP? Or, do you speak with them as a doctor would?

To be honest I have never felt restricted about openly speaking to my patients about their conditions, diagnosis, and prognosis especially after the physician has spoken with them. I really try to be in the room when the docs round, so I know what they've been told. And on a regular basis I am the one who gives results of a recent lab or x ray to a patient as I am preparing them for a procedure i.e., a pleuracentitis or getting ready to administer a medication such as amiodarone or potassium.

Often I have find that I am the one who translates what the doctor just said into common language so they have a better understanding.

It is very, very rare that I have been instructed not to discuss a patient's condition with them or their family (in fact I can't remember the last time). So I guess I am wondering what your concern is Golytely.

Editorial Team / Admin · Aug 18, 2008

I have never felt restricted about openly speaking to my patients about their conditions, diagnosis, and prognosis especially after the physician has spoken with them.

This is what the OP's concerns are. You would not "openly" speak to your patients about these issues before the physician (or, in this instance, the APN) advised them.

Often I have find that I am the one who translates what the doctor just said into common language so they have a better understanding.

This is something all nurses should be able to do. Translate what the physician or APN has already stated. Again, you do not initiate this type of communication until the physician or APN has had the opportunity to advise the patient.

I am the one who gives results of a recent lab or x ray to a patient as I am preparing them for a procedure i.e., a pleuracentitis or getting ready to administer a medication such as amiodarone or potassium.

Yes, but only after the physician or APN has advised the patient on having a procedure or has prescribed a medication.

jlcole45 · Aug 18, 2008

QUOTE "This is what the OP's concerns are. You would not "openly" speak to your patients about these issues before the physician (or, in this instance, the APN) advised them. "

Do you really believe that every time that one of our fresh heart surgery pts goes into A Fib that our CV docs run up to the floor and talk to the pt/family first before care is started?

It falls to the primary nurse to call the Md/pa and notify them of the pt's condition and then start the protocol. 99 times out of 100, we are the ones who goes into the room and explains to the pt/family what is going on and what we are going to do about it. Unless the MD just happens to be on the floor when the A Fib starts - which of course doesn't happen very often.

Do you see what I am getting at? The primary care nurse is in the unique position as the patient advocate and communication is one of our most important tools.

Open communication alleviates stress and anxiety for the patient and family. Power is knowledge. Don't you remember the old "fear of the unknown" being one of the largest stressers??? I try my best to answer their questions and I have enough experience and education to do so most of the time and when I don't I say that I don't know. Now, don't get me wrong, I am not diagnosing or prescribing treatment, and I am still practicing within my bounds.

I've been doing this a long time and I have NEVER a doctor give me a hard time about explaining things to the pt.

indecisiveRN · Aug 18, 2008

I think what sirI was referring to is more along the lines of a chest x-ray or CT result that suggests cancer (just for example), not a post-CABG with new a-fib. Patients and families are often really anxious to know diagnostic results, but I never tell them unless it is normal or unchanged. It is not my job, nor is it appropriate, to give that kind of diagnosis or information.

Trauma Columnist · Aug 19, 2008

This actually is a good question. I was a staff nurse for many years and would not have discussed prognosis with a pt as I am not privy to their entire hx, lifestyle, other comorbidities, etc.. Plus, and I'll be brutally honest here, I didn't have time to discuss much past basics of their current care due to time constraints.

Jo Dirt · Aug 19, 2008

QUOTE "This is what the OP's concerns are. You would not "openly" speak to your patients about these issues before the physician (or, in this instance, the APN) advised them. "
Do you really believe that every time that one of our fresh heart surgery pts goes into A Fib that our CV docs run up to the floor and talk to the pt/family first before care is started?

Nurses do not have the authority to make a diagnosis on a patient, or even be the first one to bring it up. A nurse cannot (and rightly so) be the one to go in to see a patient and their family and tell them they have cancer or ALS or some other disease.

I had a patient in the nursing home ask me if the growth they removed on her arm was cancer. It was, but it was not my place to be the first one to bring her the news. I told her that we were waiting to hear back from the doctor and he would be the one who should discuss that with her.

I think most any doctor would be very upset if a nurse went over his/her head with something like this.

That could be called practicing medicine without a license.

It would make sense to me, that as PCP's a NP would have the authority to discuss these types of things in place of the doctor, but I wasn't sure.

Thank you for the clarification.

Editorial Team / Admin · Aug 19, 2008

It would make sense to me, that as PCP's a NP would have the authority to discuss these types of things in place of the doctor, but I wasn't sure.
Thank you for the clarification.

You are very welcome, GoLytely

Good luck with your plans to become APN!!

Advanced Practice Columnist / Guide · Aug 19, 2008

Nurses do not have the authority to make a diagnosis on a patient, or even be the first one to bring it up. A nurse cannot (and rightly so) be the one to go in to see a patient and their family and tell them they have cancer or ALS or some other disease.
I had a patient in the nursing home ask me if the growth they removed on her arm was cancer. It was, but it was not my place to be the first one to bring her the news. I told her that we were waiting to hear back from the doctor and he would be the one who should discuss that with her.
I think most any doctor would be very upset if a nurse went over his/her head with something like this.
That could be called practicing medicine without a license.
It would make sense to me, that as PCP's a NP would have the authority to discuss these types of things in place of the doctor, but I wasn't sure.
Thank you for the clarification.

As a NP, there are still certain information that I'd rather wait for the physician to discuss with the patient. Once I know the physician have discussed these, then I am very comfortable answering questions from patients and families. Most have already been discussed above...such as the pathology result from a lung biopsy for instance, details of findings during surgery (did the tumor look like cancer?), decisions made during tumor board meetings, decisions made during heart/lung transplant meetings...

Editorial Team / Admin · Aug 19, 2008

True, pinoyNP. Especially if the issues at hand are out of our SOP or I need a referral/consult. Something where I am having to consult with the physician-colleague in regards to differentials and/or plan of care. I agree with you.