Shift assessment... really?

  1. 0 I 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.
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  3. Visit  Macbs4} profile page

    About Macbs4, BSN

    Macbs4 has 'since 2009' year(s) of experience. Joined Sep '09; Posts: 40; Likes: 32.

    13 Comments so far...

  4. Visit  MJB2010} profile page
    6
    I 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.
  5. Visit  CB216} profile page
    1
    5 minutes is nothing. I have had crappy nurses during my time as a patient (broken bones and sutures and stuff). The ones that actually talk and show "care", doing their assessments, are the good ones that I will remember!

    Don't start slackin
    missladyrn likes this.
  6. Visit  blue heeler} profile page
    2
    i 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?
    mjs488 and RNDreamer like this.
  7. Visit  Carrie_MTC} profile page
    2
    I always do a head to toe assessment, with auscultation. Total assessment takes about 5 min. I do notice there are some nurses who NEVER carry a stethoscope, kinda scary!!
    Lovely_RN and Ayvah like this.
  8. Visit  Orange Tree} profile page
    7
    Honestly, 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.
  9. Visit  caroRN} profile page
    2
    Thank 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.
    onedayitllbeme and JRP1120, RN like this.
  10. Visit  gummibear} profile page
    2
    im 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...
    JRP1120, RN and serein like this.
  11. Visit  gummibear} profile page
    0
    on 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...
  12. Visit  nursingpower} profile page
    4
    Cardiac 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.
    mjs488, Macbs4, Orange Tree, and 1 other like this.
  13. Visit  NotReady4PrimeTime} profile page
    5
    Quote from nursingpower
    Cardiac 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.
    That sounds quite reasonable. It's a well-organized method of assessing and including all the vital information you need on your patient.

    Quote from nursingpower
    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?
    Most of the time I don't sit much either, and I've been doing this job for 14 years. If I'm not busy with my own assignment I'm usually helping somebody else. But it is possible that you're doing things you don't really have to do. That sets you apart from the others.

    Quote from nursingpower
    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.
    What do you think risk management and legal would have to say about that? It's certainly not how it's supposed to be done, and they could lose their license for it. Imagine if the chart ever went to court and the patient or a family member testifies that at NO time during the shift did the nurse ever touch the patient, and yet all the necessary charting has been done. Major trouble! This is one habit you do NOT want to incorporate into your practice!!!!!!!

    Quote from nursingpower
    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 find that these sort are the ones that are oblivious to what's going on around them and are actually of little help.

    Quote from nursingpower
    My supervisors have praised me on my thorough charting. I've also had patients tell me that I am very thorough 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".
    Thorough charting is fine, excessive charting not so much. Be sure that you're only charting factual, objective information. As for assessments, there are some things you can assess without actually "assessing" them. If I've seen a patient open his eyes, swallow, cough, shift position, raise a hand or foot off the bed or grasp their ETT and let go when I tell him to, then I'm NOT going to go over and say, "Okay, Bob, let's check your neurovitals. Can you open your eyes for me? How about squeezing my fingers?" After your initial head-to-toe assessment you should be doing intermittent focused assessments and charting changes.

    Quote from nursingpower
    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.
    Don't we all? Most of it comes with time.
    suzi_Q, maelstrom143, flyingchange, and 2 others like this.
  14. Visit  dudette10} profile page
    0
    I'm a new nurse, and I do a quick head-to-toe on every patient for the initial assessment and focused thereafter.

    If someone has been up and about, the neuro, skin, musculoskeletal, and GI assessment is very, very quick. I'll talk to them to determine A/O, and if they are A/O x 4, I'll ask them about weakness, skin problems, pain, BMs, nausea, overall "feeling" while I'm listening to lungs, heart (also checking lead placement and adherence), checking abdomen, and checking for extremity edema and doing IV site assessment. For these people, I also ask if any abnormal is new or something that they just live with, e.g. old fractures that didn't look as if they were set right. (Had one patient the other day with that; cool story to go with it, too!) If they have a s/l (no fluids running), I'll flush to determine patency.

    Bedfast or A/O x 2-3 or forgetful patients take more time, but I still do everything (with a careful skin inspection--those that can pull themselves over with the handrails I do by myself; others, I get help from the CNA) and note their positions. I jot down R, L, or S (for supine) and the time. Two hours later, if they are still in the same position, I reposition them and jot the new position.

    It takes time, but it's my job. I feel comfortable with my assessment routine and my charting of it. It's what to do with the acute changes is where the real nursing comes in, and, of course, as a new nurse, I seek support when necessary and debrief with the experienced nurse so that I can apply the info in the future.
  15. Visit  RNdiva505} profile page
    1
    Yea, I am still new, but I chart everything when I do my assessment. If they got a bruise I chart it, If they have excessively dry skin that is flaking or no great toe toenail it gets charted. My assessments usually take like 10 minutes or so. I like to talk to the patient and family and answer questions if they have any. Also give them a heads up on what to expect on my shift (VS q 4, walking, etc...).

    But I am still new and still very cautious
    mjs488 likes this.


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