What are the rules of what we can tell patients?

[NursingInChaos]

As a new nurse I am a little confused about what results we are allowed to tell patients. All the nurses at my job have given me very different answers lol

Some say it is their right to know it all as it is their info (ehhhh I thing that is extreme) and some won't even tell them a basic lab value ... I heard a fellow nurse telling a patient the results of his X-ray an hour earlier before the doctor even saw it - giving the patient the radiology impression info. Am I right in assuming that was not right to do?

Then what about my patient that knows they are watching her BUN levels daily and just wants to know if this mornings bun level is better than yesterday? Can I tell her yes or no - or what about the actual number of the lab value?

How does this transfer to bedside shift report- telling the oncoming nurse abnormal lab or test results in front of the patient- if we can't tell the patient that info until after the doctor has then how can we at bedside shift report?

If the small town hospital I worked at had an easier way to access policies I would look there but they are a mess right now lol

[MunoRN, RN]

Anna Flaxis said:

Under my state's Nurse Practice Act, I am not authorized to diagnose medical conditions.

The radiologist's impression and the assigned provider's diagnosis may differ because the radiologist simply gives their impression of what they're seeing without very much context, but the assigned provider does the clinical correlation, which is a synthesis of the "big picture"- i.e. the patient's age, past medical history, familial history, signs and symptoms, etc., and actually makes the diagnosis.

If it is a new diagnosis, then I defer to the licensed independent practitioner who is authorized to diagnose and treat medical conditions, stating something like "I'm not qualified to interpret (blank), and I don't want to misinform you, so I'm going to let the doctor come and talk to you about that." But, if it's part of a continuum, where the patient already has been given a diagnosis and we're monitoring progression of illness or response to treatment, then it is within my scope to discuss radiology reports in more detail- again, with the caveat that I'm only repeating what the radiologist said, but that the person's doctor needs to put it all together.

If it's a new diagnosis of heart failure, I defer it to the doctor. But if it's an existing diagnosis, and the patient wants to know their EF, I'll tell them.

It's really important not to be evasive, because people pick up on that, and it increases their anxiety as they imagine all the worst case scenarios. Avoiding disclosing results can easily come off as evasive, but when you verbalize a concern for not wanting to misinform, people tend to understand and appreciate that, at least in my experience.

Clear as mud?

So to use your example of a PE, when the physician puts in an order for a heparin drip, do you just go in and start the drip, what if a patient asks what it's for? Do you tell them you can't reveal that?

[dudette10, MSN, RN]

MunoRN said:

So to use your example of a PE, when the physician puts in an order for a heparin drip, do you just go in and start the drip, what if a patient asks what it's for? Do you tell them you can't reveal that?

Every situation deserves careful consideration. In this case, I would hope that the physician had discussed a differential prior to ordering the CT, and we can just confirm the diagnosis and explain the reason for the drip. If there had been no discussion, I would be forced to reveal the diagnosis because hanging the drip in a timely manner is very important.

But, I have to throw a question back to you. If a patient knew they were being HIV tested, the results came back, and the patient asked you results, would you be the first person to tell him/her?

[nynursey_]

MunoRN said:

Educating a patient about a diagnosis already made by a physician is not "diagnosing", and every NPA in the country requires the nurse to ensure the patient is informed and educated about their plan of care.

I'm not sure what your angle is here. My example, while not blatant, is clearly in reference to a patient asking about the result of a diagnostic test. Confirming or denying opens the door for the patient to ask for a diagnosis, which is definitely not in my scope of practice.

[Dranger]

nynursey_ said:

I'm not sure what your angle is here. My example, while not blatant, is clearly in reference to a patient asking about the result of a diagnostic test. Confirming or denying opens the door for the patient to ask for a diagnosis, which is definitely not in my scope of practice.

You aren't diagnosing if you are reading a physician report, plus you can always state clinical correlation with the main provider is still necessary to interpret.

[VANurse2010]

MunoRN said:

While the primary physician might have a different take than the radiologist, the patient has a right to hear both views, both on the basis of having access to all available information determining their care and decision making, but also because they are going to get a few-hundred-dollar bill for the radiologists interpretation, at that price they certainly have a right to know what it was.

Their right to know doesn't mean we're the ones who have to deliver the news.

[sailornurse]

MunoRN said:

A physician can read that part of the radiology report just as well as a nurse.

But the interpretation of the results is typically for the provider (MD/DO; NP/PA) who ordered the study to discuss with the patient as well as what the next step/plan will be. This is typically not something nurses should do.

[babyNP., APRN]

Here's an example of why a RN wouldn't be best suited to give out all the results...

Micropreemies (born

And the next thing will be that they will want to talk to the doc or provider now. Nothing will be so more important to them than hearing about it right that instant, once they get the information (and we can hardly blame them at all; I would be just as anxious).

But the doc or provider may not be able to come to them immediately for any number of reasons. It could even be an hour or so or even longer (as the baby's condition isn't actively changing at that moment and even if they have CP, there's not much we can do about it). This is agonizing for them. It's hard for the RN to deal with. And you can be sure that it's hard for the provider who is now dealing with a parent who has sat on this "half" information for awhile.

[turnforthenurse, MSN, NP]

For lab results, I generally disclose unless it's something out of the norm. For certain XRs (ruling out broken bones, etc) I will disclose if the results are negative. Any abnormals on XRs/MRI/US/CT/other tests I tell the patient that the doc will tell them the results as it's not "within my pay grade" to really discuss them, especially since I don't want to misinterpret something. They always understand.

[MunoRN, RN]

sailornurse said:

But the interpretation of the results is typically for the provider (MD/DO; NP/PA) who ordered the study to discuss with the patient as well as what the next step/plan will be. This is typically not something nurses should do.

The "result" of a CT is the images, the interpretation is what the patient is paying the radiologist to do, there is no expectation that the nurse is the one to interpret the images.

[MunoRN, RN]

VANurse2010 said:

Their right to know doesn't mean we're the ones who have to deliver the news.

It actually often does mean that in order not to be negligent in our practice. Lets say you've got a patient who's CT shows a PE (as interpreted by a radiologist) and the Doc puts in an order for heparin gtt, starting the gtt without informing the patient what it's for is negligent. If you're not going to inform the patient of a physicians already stated finding, how does that work? Do you call the Doc and inform them that you can't tell them why you are starting a heparin gtt and they need to do that, at which point you hand the phone to the patient and the Doc says "you have a PE, the treatment for that is a heparin gtt"?

[MunoRN, RN]

Part of what I do in my job is to be a direct patient care representative in outcomes and compliance projects. I was really skeptical at first when I heard claims about the disturbingly large numbers of patients who are unaware of vital information that should have been provided to them during their hospital stay such as their need for follow up imaging, or even what they were being treated for, after hearing people's views it's not as unbelievable which is pretty depressing. If an RN doesn't want to do the job then please make room for someone else who will.

[Julius Seizure]

I feel like I am forced to be in the position of "breaking the news" to families all the time. Should I be? No, often the doctor should be the one updating the family. But if they don't, what am I supposed to do? I can't just say nothing.

Example: Not too long ago, my neonate patient who was in the hospital for unrelated issues starting having frank red blood in their stools. I notified the doctor who ordered xrays and labs. Those were done, and the doctor decided to keep the baby NPO for a while. So here comes the family to visit, and they want to know how the baby is doing. "Well we have stopped feeding her because there was blood in her stool" opens up a lot of questions that I would honestly rather that the doctor addressed. (concern for NEC, what is NEC, what will we do if the baby does have NEC, why are we doing all these tests, how worried should I be, etc) But theres no doctor coming to update them right now, sorry. Its just me. So I have to tread carefully and answer what I can without overstepping my bounds. This happens ALL the time and often the doctors dont see why they should have to come talk to the family outside of their usual rounding time. I can't just be like "Your baby isn't going to be fed for a while, its a secret why."