I was asked an interesting question on the site recently. A reader wanted to know if delivering lab results was appropriate for RNs. There seemed to be some disagreement within the reader’s program about whether the results from any labs drawn during a medical-forensic exam could be delivered to the patient by the forensic nurse who obtained them. The answer is yes–I’m racking my brain trying to think of an instance where it wouldn’t be kosher, assuming there’s no hospital/agency policy that states otherwise. Not only is it appropriate for nurses to do so (and we do it all the time in other types of practice), but recent federal rules dictate that patients can bypass healthcare providers altogether for lab results and obtain them directly from the lab running the tests. In fact, patients can go into electronic portals and look them up on their own in many practices (both my primary care doc and my neurologist allow me to). I am unaware of any state that prohibits RNs from giving patients test results. However, you should refer back to your state Nurse Practice Act to assess your scope of practice, and engage your hospital/agency’s risk management professionals if need be.
That said, my hunch is here the issue is that someone has attached the word forensic to the results. And this is where I need to encourage everyone to slow their roll. Because we sometimes lose sight of the fundamental nursing aspects of our job when that word comes into play. Labs/tests/imaging happening in your own institution are being done for the treatment of that patient. While they may at some point be used in a legal setting, there’s no way for the clinician to know that at the time. Sure, these tests are forensic in nature—everything during the encounter that happens after the patient says they’ve been assaulted is forensic in nature. And everything is medical, because they’ve come in for care, and potentially sample collection for an evidence collection kit (if that’s something available and of interest to them). The two cannot be separated out, and trying to do so is a waste of time. When I get involved in a case going to trial, I will review the forensic nurse’s paperwork—and then I’ll ask for all of the other records generated at the point that patient presented. Triage notes, ED doc’s medical screening exam, any labs drawn prior to the forensic nurse getting involved—all of it. Because it’s all forensic at the point we’re going to trial, just like it was all medical when the patient came in asking for care.
We treat these patients, and our role in working with these patients, differently much of the time because we are so caught up in the legal implications of the work. I would encourage people to stop getting so wrapped around the axel on this, because two points are critical to remember:
1.) A small percentage of our patients will ever see the inside of a courtroom, but 100% of them have the potential to develop healthcare sequelae from the violence they’ve experienced (research is clear on this, from child abuse to elder abuse; trafficking, sexual violence, domestic violence—you name it)*. If you’re only focused on the “forensic” part of the job, you are doing a disservice to the majority of your patients. Take the potential legal implications of the patient encounter seriously, and perform the sample collection meticulously so that patients have all of the criminal justice options available to them if that’s the route they choose. But do not put patients in a position where they are receiving a lesser standard of healthcare than if they just wandered into any ED in the US because the focus is on the kit or the photography. Patients need and deserve the CDC-recommended standards for STI prophylaxis; access to emergency contraceptives; appropriate screening for nPEP; anticipatory guidance upon discharge tailored to their particular issues; and follow-up that’s more comprehensive than “see your primary care provider if you have any problems”. And not for nothing, but these things should be completed by the forensic nurse—the specialist in the agency who understands the interplay between the particular trauma this patient has experienced and the impact it may have on their health. I don’t have hard evidence to back this statement up, but anecdotally based on all the records I review, clinicians who take care of all of these things as a part of the medical-forensic encounter (rather than relying on the ED staff to handle it), simply have more healthcare-focused, complete exams.
2.) There is emerging research that suggests that patients have a better experience at the point of exam and better outcomes, medically and legally, when we are more focused on patient as patient than patient as crime scene (see basically everything R. Campbell and colleagues have authored for support). Focusing on the health and well-being of patients, providing them with choices, treating the whole patient rather than honing in on the body parts of greatest interest in a potential court proceeding, benefits the whole process.
Which brings us back to the original question—can/should RNs be providing our patients lab/test results. Don’t overthink this—be the very best clinician you can be; practice fully within the scope of your licensure and according to your (regularly updated) policies and procedures; attend to the whole patient and document accordingly. And ask yourself—would I provide patient care differently with other populations? If the answer is yes, perhaps it’s time to examine your approach.
*There isn’t a single statement I repeat more often than this one. Not by a long shot.
**Canada, Australia and others: does this differ for you guys? I obviously don’t know the answer to that.
***As always, this site is not intended to provide legal advice. We’re discussing the larger practice implications here. I am not the authority on your scope of practice, so again, refer back to your state nurse practice act and agency risk management for legal advice on this topic.
