Shift assessment... really?
- 0Feb 1, '11 by bootheel.bldI was auscultating a pt's abdomen last week during a shift assessment when the patient said "you're the only person who's done that since I was admitted". I was surprised.
So, I started thinking... maybe I'm going overboard by always checking heart, lungs, abdomen, peripheral pulses. My assessments take five minutes or less, including the usual questions like "pain?", "last BM".
What does everyone else do out there for a shift assessment. Check everything? Skip/include things based on what is the diagnosis? I'm looking for any "time-saving" techniques given my patient load is 7-8 patients.
- 6Feb 1, '11 by MJB2010 GuideI still check everything you do! I do a quick head to toe, pain assesment. I listen to abd & lungs. I take off the socks, check their feet & pulses and I turn them and look at their bottom if they have been in the bed. I pay special attention to whatever they are admitted for, like knee surgery I check the csm & pulses etc & dressings on the knee, but I still check everything else too. I look at the I&O and all their vitals on the prev shift.
I think you should keep on doing what your doing. :heartbeat
I have found of lot of stuff that others miss due to being "new" and still doing a full assesment. Don't become one of those that don't!
There are ways to save time, cutting down your assesment is not one of them.
- 1Feb 2, '11 by blue heeleri always do listen to heart lungs and belly, check pulses, look at skin, check loc, ask about voiding and bm, are they eating, any nausea, look at all lines going in, lines going out, iv site. 5 minutes. how can you know something has changed if you don't do that?
- 7Feb 3, '11 by Orange TreeHonestly, I focus after the initial assessment. If I have an alert, ambulatory, 30 year old patient with a wrist fracture (no GI history) who has a BM daily and isn't recently back from the OR, I won't listen to bowel sounds.
And although there are slacky nurses out there, there are also patients who love to tell you how "the other nurses" are not doing their jobs correctly. Sometimes the patients are right, but at other times they are just being manipulative.
- 1Apr 30, '11 by caroRNThank you! I was starting to feel like I was the only one who did an assessment!
I'm in my 4th week of orientation and I don't feel comfortable unless I do a quick head-to-toe like yours. I've been getting pressure from some of the other nurses on the floor (not my preceptor) to skip a formal assessment because we don't have the "time". Come on - assessment is part of our job. At the very least, I'm still new and I need the shift assessment so that I can tell if there's a change later in the shift.
- 2Apr 30, '11 by gummibearim a new nurse, so i still cling on fiercly to all the stuff nursinig school taught me and seriously, doing a quick head to toe doesnt take that long and it covers ur butt in the long run b/c knowing my luck, the time that i skip doing one will be the time that i really should have...
- 0Apr 30, '11 by gummibearon a side note, when i was in nursing school, there was a pt who had been on the unit for two days before i had worked with him and it was all electronic charting, so that usuallymeans the nurses just look at what the last nurse put down and copy and paste the responses. but being a student, i went thru every single tab, asking the pt the questions regarding BM, etc... and looking at where i should look on the body when doing assessments like the skin... well, when it came to skin assessments, there was a spot that u could put in pre-existing skin stuff, like scars... and this pt had definite scars from previous surgeris, but no one had ever noticed/put it down, so i put it down, and the next day i come on and work with the same pt, i noticed that all the other RNs had copied what i had written... like seriously? u honestly couldn't have missed the scars...
- 4Sep 10, '11 by nursingpowerCardiac ICU with 2.5yrs experience out of nursing school: I do a head to toe every patient every shift. I look at med drips, every line in and out. Check my piggyback infusion make sure bag is before pump. I've gotten better at clumping all my questions together in a casual convo: Introduction, check ID band/patient's orientation. pain, cough, swallow well, belly tenderness. Then I listen: Heart, lungs (A/P all the time), belly. Then I palpate, belly, pulses. Then I test strength. Draw labs if needed. This process takes me about 10 minutes each patient.
I often time wonder the same things that you do when I see nurses sitting around talking for the first 20 minutes after getting report but being the first ones done and sitting around talking.
I feel like I am always doing something. I rarely sit for more than 15minutes each hour it seems. I see my fellow nurses reading books, playing internet games, gossiping, studying, etc. I'm like wow, I never have time to do those things. Wondering what am I doing wrong. Is it my assignment? Do I spend too much time with my patients? Am I doing things that I really don't have to do?
I have seen nurses that come in and before they look at their patient do all of their computer charting. I asked one person how, he said if there are any changes he go back in later and change it but he wants to get all his computer work out of the way.
It's nice to have these kinds of nurses available because they are always available to help others i suppose. If a code happened they are ready to go. I feel I'm so busy during my shift I rarely have time to help so when I do help (because I don't want to seem like a team player) I fall behind in my work.
My supervisors have praised me on my thoughrough charting. I've also had patients tell me that I am very thoughrough to the point where one patient asked me if I had to do all that I was during my assessment. He said, "You are the only nurse here that did all of this". I told him we have to chart and I don't want to lie and say lungs clear, skin is fine, no air leaks in chest tube, Alert and oriented, etc when I don't have a clue. I can't lie like that so I am forced to check because I am legally bound by my assessment. He said, "OK, well I'm not trying to give you a hard time, guess you gotta do your job".
I am still trying to figure out ways to shorten my shift but still do what is required of me. Sometimes i want to sit down and do nothing for an hour.