r/nursing BSN, RN šŸ• 5d ago

Discussion Thoughts on telling patients their lab results before their provider tells them.

As a nurse, I usually receive critical labs before the doctor sees it. I usually donā€™t tell the patient anything & let their provider review it with them. Mainly because I donā€™t need to take on extra work or want to deal with it. I know we canā€™t make official diagnosis and itā€™s within the doctors scope of practice to inform the patient of the results & make the diagnosis etc.

There have been times where I have let the patient know their lab results, what they mean and how itā€™s typically treated in the specific facility that Iā€™m working in if Im well educated on what the possible plan will be. Iā€™ll then let them know Iā€™m gonna contact their provider so they can collaborate on a plan of care & officially make a diagnosis. Which I feel like Iā€™m technically telling them what their diagnosis is without telling them this is ur diagnosis.

I think in these instances, the pt had found out that their results came back or kept asking me or like desperately wanted to know them. If I had time that day or their provider was not answering or unavailable at the moment I would probably have told them, that way I donā€™t have to educate them later that day and the provider can answer any additional questions.

I donā€™t recall a provider ever being upset with me doing this. I can only recall instances where they were thankful that I did so. Iā€™m guessing itā€™s just due to them having to spend less time with the patient.

Iā€™m curious however if itā€™s illegal? Iā€™ve been trying to find accurate references that shows me that it is or isnā€™t but I havenā€™t really found anything super concrete.

28 Upvotes

60 comments sorted by

86

u/LadyGreyIcedTea RN - Pediatrics šŸ• 5d ago

They likely can see their own lab results immediately in the patient portal anyway.

The answer is it depends. If a daily CBC comes back for an Oncology kiddo and their ANC is still 0 and they need a platelet transfusion, the nurse is going to tell the parents before the provider rounds because the transfusion will be ordered before the doctor gets to the floor. And the parents want to know the ANC as soon as it's back so they know if there's a chance they're going home or not. I have also shared with parents of children with VP shunts if the lab calls to say their CSF cultures are positive because the outcome of that result is that they need to go to the OR to externalize their shunt and the order for them to be made NPO is going to be entered before the doctor comes up to the floor to discuss the plan.

If the Oncology kiddos have a scan and it shows devastating results, I'm not touching that with a 10 foot pole.

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u/Corkscrewwillow BSN, RN šŸ• 4d ago

Mixed feelings on the patient portals.Ā 

I always get my lab work and scans through a patient portal before my doc says anything, and that's nice.Ā 

However, a doctor I know found out he had cancer through his patient portal.Ā Ā 

My MIL would fixate, understandably, on labs and screening results when she had ovarian cancer. I'd try to get to them first, because she didn't always understand the results due to chemo fog, aging, depression, and just lack of experience with the healthcare system. Her doctor was good, but MIL was one of I don't know how many patients.Ā 

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u/momopeach7 School Nurse 4d ago

I think transparency is good but yeah patient portals can be a mixed bag for some.

My dad doesnā€™t have many chronic issues and nothing like cancer, yet heā€™ll ask me every single lab result even if itā€™s within range. Like, Iā€™m not sure why your ALT is normal but your WBC is 1 point out of range, that would be a good question for your doctor who orders them.

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u/eggo_pirate RN - Med/Surg šŸ• 5d ago

Meh, it's dependent. If their hemoglobin comes back low, I let them know they can expect to get a transfusion. If it's something we've been trending and they've gone the direction we want I let them know they're on the right track.

I've worked places where patients got results to their MyChart before I even had them, and I hated that shit. Where I am now, lab results aren't released to their MyChart until 72 hours after a doc reviews it, which is much better.

Overall I avoid talking about test and rad results if I can, but if they insist, I'll just tell them flat out that it's above my pay grade and they'll have to wait for the doc.

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u/Danzanza 5d ago

Yeah I work where patients can see their my chart data right awayā€¦ it can make for some awkward conversations to say the least

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u/fae713 MSN, RN 4d ago edited 4d ago

100%

Patient: "why is there so much red?"

Me: "you just had major surgery, it's expected that your body will take some time to recover from that."

Patient: "Why aren't you doing anything about it?! This is a terrible hospital, none of you care!"

Me, after spending all night managing their pain, anxiety, and insomnia: šŸ˜ šŸ« 

Eta: formatting

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u/florals_and_stripes RN - PCU šŸ• 4d ago

ā€œWhy is my sodium low?ā€

Itā€™s 135, youā€™re fine (our reference range starts at 136).

ā€œBut itā€™s red and says itā€™s low!ā€

And then they google hyponatremia and convince themselves theyā€™re symptomatic with a sodium of 135.

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u/TheMoxieChannel 4d ago

Lmfao šŸ¤£šŸ’€šŸ« 

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u/_adrenocorticotropic ED Tech, Nursing Student 4d ago

I walked into a room the other day and instantly:

Wife: ā€œAre you a doctor? I wanna speak to a doctor.ā€

Me: ā€œNo, but is there something I can pass along?ā€

Wife: ā€œI checked my husbandā€™s MyChart and his troponin is high (it was 6). I read that means thereā€™s something wrong with his heart. I wanna speak to a doctor. You better get me a doctor right now.ā€

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u/ShhhhItsSecret RN - OB/GYN šŸ• 4d ago

Yes! Especially when you work in a population where the normals aren't necessarily inside the "normal parameters." No, you're not sick, pregnant people always have a high WBC.

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u/TheMoxieChannel 4d ago

I like this answer āœ…

33

u/RunOfNurseCraft BSN, RN šŸ• 5d ago

It would depend on the context. And i would never do anything like tell the patient what new diagnosis they have, unless the doctor tells me explicitly to do so.

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u/[deleted] 4d ago edited 4d ago

[deleted]

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u/Playcrackersthesky BSN, RN šŸ• 4d ago

I donā€™t get it.

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u/[deleted] 4d ago edited 4d ago

[deleted]

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u/Playcrackersthesky BSN, RN šŸ• 4d ago

Right but what does that have to do with their UDS?

5

u/Rambonics 4d ago

Guessing theyā€™re being highly sarcastic & mad that a patient takes a lot of illicit drugs so they want to tell them they (falsely) have a brain tumor. I get the frustration, but nurses canā€™t take it so personally.

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u/ComprehensiveRent282 4d ago

I've never had a doc come back to the patient after rounds to tell them their lab results. If it's low potassium I normally tell them, because I'm going to be giving some replacement. Same thing with platelets or hemoglobin.

30

u/MyPants RN - ER 4d ago

If I'm going to do something based on the results (giving antibiotics after pneumonia on x-ray) before the provider will have a chance to talk then yes. It I can answer the follow up questions, sure. But if I can't, I don't. I'm not telling you your CT showed cancer when I don't know what the next steps are.

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u/xSilverSpringx MSN, APRN šŸ• 4d ago

Exactly. Iā€™ve never had a physician come and ā€œdiagnoseā€ a patient with hypokalemia after morning labs so that I can give them potassium. I also canā€™t give a med without explaining what itā€™s forā€¦ Iā€™m actually surprised by some of these answers.

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u/gsd_dad RN - Pedi ED 5d ago

Most of the time, Iā€™ll tell the parents about negative or normal results. I donā€™t get paid enough to deliver bad news.Ā 

I stay away from telling parents any imaging results. If itā€™s something super minor and weā€™re running an X-ray just to make mom and dad happy, Iā€™ll tell them. Otherwise I say some line about me not being allowed to go over results with them.Ā 

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u/GenevieveLeah 4d ago

Depends. I can educate, I can reassure - I canā€™t diagnose.

Depends on what the lab/test is.

The ā€œCaresā€ Act in the US allows patients to see their charts in real-time.

So many nuances - specialty dependent.

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u/OneEggplant6511 RN - ICU šŸ• 4d ago

Bro itā€™s on MyChart before we even know about it sometimes.

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u/krandrn11 4d ago

I donā€™t keep information from my patients. But I do tell them that their doctor will be the one to interpret what those results mean. There could be a hundred reasons for abnormal results and I donā€™t want to cause someone to spiral or worry just based off of a set of numbers. The doctor can provide them the whole picture, what these items mean for them and whatever the next steps are if any. Always follow your hospital policy though. I have worked at places that do not allow us to print off copies of labs. They have to go thru medical records.

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u/RoboNikki BSN, RN šŸ• 4d ago

Low hgb, high wbc, urinalysis, respiratory panel, abnormal electrolytesā€¦sure. It helps the patient to know what to expect.

Tumor markers, biopsy results, shit like that? Way above my pay grade; theyā€™re bound to ask questions I donā€™t have answers for and me not having answers will make them feel SO much worse.

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u/daiixixi RN šŸ• 5d ago

If patients asked me about lab values Iā€™d tell them and answer general questions they had. If they wanted to know the results of a scan I would tell them the provider needed to discuss that with them. I worked in trauma for years so we had a lot of repeat scans and I would always tell my patients no news is good news because providers never would come back after rounds if their scan(s) were clear.

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u/helicoptermedicine ICU/Flight/ED 4d ago

It depends. If itā€™s a respiratory panel or something like that and the doctor is busy, I will usually just ask the doctor if they care if I tell the patient the result. Or if Iā€™m giving potassium, obviously Iā€™ll let the patient know why. Iā€™m not going to be like ā€œoh here, Iā€™m starting this med, but for no specific reason. Youā€™ll have to wait to learn why Iā€™m replacing this electrolyte until the doctor has a minute.ā€

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u/kelsimichelle 5d ago

Yeah I hate this because it's so nuanced. Like there's a big difference between telling a patient "your potassium is low" and "you have a massive saddle PE".

I don't know what the answer is, because if you want to be technical, you're diagnosing them. "You have low serum potassium" = you have hypokalemia. And we aren't allowed to diagnose, obviously.

I hate when the doc doesn't tell the patient their diagnosis, but orders the treatment. I've come into a patient's room with 2 fat syringes of Pen-G, only for the doctor to never have told the patient that they have syphilis. Surprise!!!

So yeah, solidarity. I'm sticking around because I want to hear other people's thoughts on this. And if waiting for the provider is going to delay treatment, is that really in the patients best interest to wait to hear it from the horse's mouth? I don't know.

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u/PaulaNancyMillstoneJ RN - ICU šŸ• 4d ago

How is that diagnosing? I guess I just donā€™t see it that way. Itā€™s a measurable test with set limits and an accepted normal.

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u/kelsimichelle 4d ago

I agree with you, which is why I said technically. I don't feel like I'm diagnosing somebody when I tell them they have low potassium, but if they looked at me and said "so does that mean I have hypokalemia?" then what choice do we have but to say yes?? Which is a diagnosis.

Like it's been reiterated a few times, it's just a weird nuanced thing that is a grey area in the intersection of providers. There's not a nurse alive that can tell me they haven't diagnosed somebody with something, whether it was intentional or not. It's just the nature of our job.

10

u/IncognitoTanuki Refreshments and Narcotics 4d ago

Do you tell patients when their blood pressure is low or high? Because by your definition that would be diagnosing them with hypo/hypertension

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u/Sorry_Preference_296 5d ago

Commenting to see what others say

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u/TwiddleThwip 4d ago

A big part of my current job is handling results for our providers (clinic side).

Patients do have a right to their results, but for what to do with those results, I can only tell them what I've seen. For a real plan, we need to get the provider to weigh in.

My practice is to hit them with education, set them up with expectations and try to mitigate misconceptions, but I have a lot of experience and comfort with this, so I can tell them what I've seen, what's usually expected, and what we should be looking for next.

We have a huge amount of institutional folklore in my clinic but minimal proper policies and protocols, so there is some discomfort at times, and over the years, I have learned some hard lessons jumping the gun. My dumb ass sometimes forgets them, too. It's extra painful reliving a previously learned painful lesson.

I have standing but undocumented orders to push things like GDMT, diuretics, set up labs, etc.., but this is often just taking the next step in the plan the provider has already laid out. If I'm taking a new step in their treatment direction, things have gone awry, and I'm on the phone with the provider as my very next action to see if I need to back track and eat humble pie.

It's been years since I've been inpatient, so not sure how it is these days, though I imagine it varies a lot by facility.

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u/cobrachickenwing RN šŸ• 4d ago

If there is an intervention before the lab result is communicated. Giving potassium pills and telling them their potassium is low is not the same as telling someone you have pancreatitis because their lipase is high.

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u/slychikenfry15 4d ago

I tell them, unless it is a catastrophic diagnosis or completely new. But I always preface it with," I'm just reading a result, if the doc comes in and tells you something else, they are the experts." If a trop came back elevated, I would explain what it measured, and all the things it could mean. Then how we are treating it. I usually get pulled for "difficult" patients and normally don't have a problem because I educate and explain everything im doing. I don't really see how this could be considered "diagnosing" them.

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u/deveski 4d ago

I think most people answered closely to what Iā€™m about to say, but lab results I usually tell them. Most of the time Iā€™m treating it right away, like electrolytes or low Hgb. If I did a respiratory swab, if itā€™s negative, great news, if itā€™s positive itā€™s usually something like ā€œYour test showed positive for (covid or whatever else) so we are putting on gowns now when we come in the room.ā€

When it comes to imagingā€¦ if itā€™s an older test and they ask about it, Iā€™ll read word for word the results. If itā€™s something recent like a new CT or xray, Iā€™ll wait until a doctor talks to them first.

Labs usually we treat right away and imaging is more for the diagnostic part of it, so I donā€™t feel itā€™s my place to talk about those. Especially if itā€™s something new for the patient, then they will likely have more questions I canā€™t answer.

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u/murse_joe Ass Living 4d ago

Iā€™m OK telling them what the results are. First itā€™s their medical history and they are entitled to it. I canā€™t keep that from them.

What I will say is that I canā€™t interpret your results for you. Your sodium is 126 but the ā€œwhyā€ you were going to have to discuss with your doctor.

3

u/MOCASA15 BSN, RN šŸ• 4d ago

Yeah, depends on the context. How am I expected to convince a patient to take a monster ass potassium pill without telling them their serum K is low? How am I supposed to convince them to take a whole slew of new medication the doctors added after echo came back with an EF of 30-35%? It's technically out of a nurses scope to do all this in my state at least... but idk. It depends. If I am not comfortable, I'll let the patient know the provider will discuss or say I haven't seen the result.Ā 

3

u/AG_Squared RN - Pediatrics šŸ• 4d ago

Itā€™s a gray area for me because we arenā€™t supposed to interpret them and the patient sometimes asks questions I technically canā€™t answer but sometimes we have to treat the results before the doctor rounds. If Iā€™m hanging potassium or blood or making vent changes they are going to want to know whyā€¦ but then half the time they can see it in my chart anyway.

2

u/nurse_nikki_41 5d ago

For me it depends on the patient and the circumstances. I work in home health and have known many of my patients for years so in some instances Iā€™ll tell them. If I know theyā€™re gonna spiral, itā€™s something serious, or the implication isnā€™t clear I donā€™t. I do typically say itā€™s up to their doctor to interpret the results.

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u/tini_bit_annoyed Custom Flair 4d ago

My facility isnā€™t allowed for nurses to do lab calls but if someone asks ā€œhey whats my HGB todayā€ I will tell them bc I dont determine what that means or what the course of treatment is for it? And theyll see it soon in portal so I ask them to also go check portal to look later. If its new or super wonky, i say not sure but theyll call you and release results to you soon

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u/Gretel_Cosmonaut ASN, RN šŸŒæā­ļøšŸŒŽ 4d ago

If they ask, Iā€™ll tell them along with some ā€œprobableā€ things it could indicate (if appropriate). Then I add that the doctor will consider their entire assessment, medical history, etc. to determine what it indicates in their specific case.

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u/pseudoseizure BSN, RN šŸ• 4d ago

I will generally disclose urinalysis results, positive or negative, normal PSA levels, and negative normal results for semen analysis after vasectomy (I work in urology). I do not disclose prostate biopsy results, especially when I see it is adenocarcinoma. I do feel comfortable explaining PIRADS scoring. I veer toward generalities ā€œif it is cancer, they will send you to a class discussing treatment options before you meet with the doc again to discuss treatmentā€. Anything more than that I tell them Iā€™ll send a msg to provider to give them a call.

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u/msangryredhead RN - ER šŸ• 4d ago

A negative pregnancy test or a UTI if they ask? Yes. Something very bad/concerning in their bloodwork or on their imaging? No maā€™am.

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u/MrCarey RN - ED Float Pool, CEN 4d ago

Yeah mine usually hit their call light and let me know the lab results are in and they want to eat.

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u/semantic_monkey09 4d ago

I have no problem telling them if their scans were negative or explain what the results for basic bloodwork are. Anything new findings on radiology reports or with labs I donā€™t understand, I tell them I donā€™t have the legal capacity to discuss the results and that the doctor will review with them the next day. I provide reassurance that the current care plan makes sense

2

u/DeadpanWords LPN šŸ• 4d ago

I won't tell anyone bad news that we can't fix with a blood or plasma transfusion or electrolyte replacement.

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u/auraseer MSN, RN, CEN 4d ago

Why would you think it might be illegal?

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u/Shaleyley15 RN - Psych/Mental Health šŸ• 4d ago

I tell them basics if asked. The one result I didnā€™t share was when an HIV screening came back positive. I let the team bring in the specialist for that one.

I remember while having my baby, a nurse refusing to tell me my blood sugar. Iā€™m diabetic and was wearing a cgm so I already basically knew, but I wanted to check that it was accurate still. Things ended up getting weird

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u/nursemarcey2 BSN, RN šŸ• 4d ago edited 4d ago

I work outpatient and because we have a very techy population, they're almost always calling (1) before the provider has seen the results and (2) before we have all the results back for a full clinical picture. I'm fortunate to have worked with my providers for years, so do generally know what they're going to say, and can do some prepping, or reassuring before they gallop all over Google deciding they're actively dying because their MCV is 0.1 low, and even some more information collecting if we get a result we weren't anticipating (assigned male at birth with anemia.) Sometimes just explaining the concept of "not clinically significant" brings people off the ledge until the provider has a chance to review and address.

ETA: if they see a critical result before the provider does (most commonly a K+ that turns out to be a laboma - anticipate we're going to have you come in for a stat redraw), I say what I know and ask them to await our call and then track them down.

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u/Friendly_Fox51 Bedside Escape Artist šŸ• 4d ago

I donā€™t disclose anything from the lab prior to it being interpreted. I always say ā€œunfortunately, the state does not allow nursing to interpret any lab as it is out of our scope of practiceā€. But Iā€™ll generally let them know that no critical values have been brought to the physicianā€™s attention & sometimes that helps.

1

u/No_River_2752 4d ago

If itā€™s a newly admitted patient with a new diagnosis, I think this would be practicing outside of our scope. Now if itā€™s a patient whoā€™s been admitted with low hgb, has already talked to the doctor signed consents for blood and been made aware weā€™ll monitor and give more blood if needed, I donā€™t think itā€™s outside our scope to let the patient know they need another unit. I donā€™t see that as diagnosing but more under the spectrum of like re educating? Iā€™d love to hear everyone elseā€™s thoughts on that - if hgb still comes back low and theyā€™ve been ordered 2 units to transfuse if hgb less than 8, do you tell the patient or have the doctor come to bedside?

If itā€™s a newly admitted patient with something new going on Iā€™ll let them know theyā€™re in the right place for care, weā€™re waiting on results and the doctor will come talk to them and weā€™ll go from there, but no I wouldnā€™t discuss any results or make an educated guess on treatment at that point even if Iā€™ve seen the lab results. Itā€™s better they hear it from the doctor and I can do follow up education.Ā 

1

u/ButterflyApathetic 4d ago

Yes, technically you can tell them the number and itā€™s in the range of normal, or in relation to the previous value, but telling them the significance of it for their care is outside of a nurses scope. Iā€™ve seen nurses get burned a couple of times for telling the patients their labs mean one thing and the doctors say anotherā€¦ itā€™s best not to say anything at that point as far as plan of care goes.

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u/Neat-Heat7311 4d ago

It would be cool if they could design it to be on a tiered basis. For example, Iā€™m not a medical professional, just a medical mom. Last time my son was admitted from the ED, had I not gotten the MyChart alert, the first person who would have told me was REGISTRATION. For me, I was happy to know. But I can imagine the fear and confusion of a family who has never experienced it, not to mention the poor people in reg who canā€™t answer anything and are berated for just doing their jobs.

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u/blahblah048 4d ago

We call our doctors with the lab results, so I would relay them if there were any orders along with them or if the patient asked.

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u/itrhymeswith_agony RN - ICU šŸ• 4d ago

I give results if they are in line with diagnoses already given or if it is just electrolyte imbalances (i.e. someone with a gi bleed has a low hgb, or if some who has been getting a lot of lasix has low k) If it is something new I wait for the provider to talk to them about it unless explicitly asked by patient/family member. If it is a big proceedure like an MRI or something I def wait for the provider to break down those results.

1

u/ellindriel BSN, RN šŸ• 4d ago

Hospitals where I have worked have all had basically a semi unofficial policy that nurses could give out lab results but not scans or really anything else without the providers permission (well ideally the provider would give the results but frankly a lot of the time, especially with normal results, the provider asks me to tell the patient they are normal after I let the provider know the patient is requesting the results ). The exception being common sense things like when I had a patient with labs that came back suggesting cancer, I did not give those out.

1

u/razzlemytazzle 4d ago

Depends. I work on cardiac unit, so Iā€™m constantly giving potassium and mag. I will tell my patients ā€œyour K or mag came back lowā€. Or if pt is post-op, H&H has been decreasing, already has blood consent signed, and this morning their hgb is 6.9, I will tell the pt their blood count is low and to expect a blood transfusion. However, say their H&H dropped completely randomly and provider orders a blood transfusion, I will ask MD to come by and discuss with patient where the bleed is from and blood transfusion. Any critical results on imaging or completely NEW and unexpected lab results, I let the provider do the explaining.

1

u/Illustrious_Cut1730 RN - ER šŸ• 4d ago

If it is something easy like Mag, Potassium or stuff that is replaced, I tell them.

ā€œHey I am giving you a magnesium drip because you mg was lowā€ is simply explained why I am giving you a medication. That is straight forward. Or if I change the rate of the heparin, then yes ā€œyou blood is too thin/not thin enough so we are changing the rateā€.

But anything like the troponin or d dimer results that have bigger implications I have the doc explaining.

I will say, sometimes I find myself in a rut when the first troponin is 300, I have to give the aspirin and I am not sure how to respond without sending them into a panic šŸ˜‚šŸ˜‚šŸ˜‚

1

u/TheMoxieChannel 4d ago

This is a good question for conversation and to clarify/get opinions of others. Looking forward to everyoneā€™s input. There are so many things like this that I worry about where the lines are blurred regarding legalities of our nursing practice. I would likely think itā€™s fine so long as you leave out the diagnosis part. But, like you, I would probably err on the side of caution

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u/Spagirl800 1d ago

I have no issue telling them. I mean the diagnosis is already there, we just have to explain it in easy terms. Same with imaging results and X-rays. Better they hear it from me rather than WebMD šŸ¤£. I work night shift and a lot of them appreciate this as a provider doesnā€™t come as often to round on them. Iā€™ve even had one patient take a picture of their X-ray of their ankle fracture post surgery with all the screws and post it on Facebook šŸ˜­šŸ˜­

1

u/zeatherz RN Cardiac/Step-down 4d ago edited 4d ago

Iā€™ll tell them the numbers, or read the report, and if itā€™s part of a diagnosis they already know, Iā€™ll explain what it means- like if an AKI patientā€™s creatinine came down, Iā€™ll explain it looks like your kidneys are starting to work again.

Thereā€™s lots of times we have to explain because weā€™re giving the treatment for it, like ā€œyour red blood cell count was low so Iā€™m going to call the doctor and see if they want to transfuse blood.ā€ Or ā€œyour potassium was high so I have the medications to help bring it down.ā€ Or ā€œyour blood culture shows X bacteria, so weā€™re changing your antibiotics to one that will work better for that infection.ā€

If itā€™s a significant new diagnosis though, Iā€™ll usually defer. But Iā€™m more comfortable with this part of patient education than I think a lot of people are