How has nursing assessment changed?

cinlou, BSN, MSN, RN · Jun 7, 2014

We had to start IV's on each other, too, and give IM injections to each other. I now work with nurses who have never started an IV. We had to know how to accurately assess our patients, because we did not have little "sat probes" to pull out of our pockets, either. We had to intubate in ACLS, something new nurses don't have to do. When I worked with babies, we had to be able to intubate them, too. There is actually a lot of stuff that has been taken away from nursing, not added to it. Things that only doctors used to be able to do? That was really way, way back in time, not just the past few decades. I can think of more things that nurses "used to do" that have been taken away from nurses, instead of more things that only the "doctors used to do." Medications? We couldn't just look things up on the internet; we relied on drug books, and hoped the new med was actually in the drug book, because we usually didn't have the newest edition. We pretty much had to memorize them. Hospital pharmacies weren't open 24/7; usually just open on dayshift. Otherwise, you were on your own. IV fluids didn't come with potassium already added. YOU added everything, and it had better be right, or you could kill your patient.

So true, we had to pull our own meds after hours, and on the night shift we did a great deal more than the day shift, because there was no one else around to call.

Cuddleswithpuddles · Jun 7, 2014

I don't think you sound cranky. These things that they are coming up with now are good but the old fashioned care and turning of patients is still the best no matter what we use.

This is why I put in a little caveat in my post. I do not mean to disparage the advances in wound care nursing and the wonderful stuff that nurses have pioneered in that field but, yeah, there is no replacement for turning and cleaning.

And things do come full circle. We now have medical grade honey for wounds. I am not sure if the food snob in me would agree it is honey but I bet ancient Egyptians would be pleasantly surprised to see how much we have come to agree with their wound care methods.

cinlou, BSN, MSN, RN · Jun 8, 2014

This is why I put in a little caveat in my post. I do not mean to disparage the advances in wound care nursing and the wonderful stuff that nurses have pioneered in that field but, yeah, there is no replacement for turning and cleaning.
And things do come full circle. We now have medical grade honey for wounds. I am not sure if the food snob in me would agree it is honey but I bet ancient Egyptians would be pleasantly surprised to see how much we have come to agree with their wound care methods.

So true, many things come full circle, we just give them a different name, and make them sound like something new.

calivianya, BSN, RN · Jun 8, 2014

I have read this thread through and I can't say I see any proof that new graduates today are less educated than new graduates from the past, or vice versa.

I just graduated last year and I started IVs on my classmates as well as on patients. I'd probably done at least 20, though I'm sure many of you did more before graduation. I still suck at them. I think I'm just too impatient. Before I graduated, I worked with a preceptor for 36 hours a week in an ICU for 6 weeks, so yes, I worked one on one with a nurse in critical care before graduation. I did lots of med calcs in school and I still do them today. My main hospital's policy is that critical drips are hand verified by two nurses at initiation, and they have to be signed off by the oncoming nurse at shift change, which requires math. My PRN job just has a basic IV pump where I can program in the volume and the rate, and this is how most drips are hung. Most of the doctors write orders for "infuse over 30 minutes" or "infuse over 1 hour" so yes, I do plenty of math at my job. If pharmacy mixed the drug they will sometimes have an infusion rate written on the bag, but pharmacy leaves before I get there for night shift so any new drips ordered after 6 PM are mixed by the nurses. I have mixed insulin drips, protonix drips... haven't had to mix pressors yet but we do that too. I take manual BPs whenever I am suspicious that the automatic cuff isn't accurate, like when I have a dementia patient wigging out. I just graduated last year - these are all things brand new nurses educated today are trained to do.

We had a semester long assessment class that was INCREDIBLY thorough... but I am pretty sure I forgot most of the things I learned in there already because they are used so rarely. For example, I remember learning moves to do to check for meningitis, something to do with the legs... but I would have to look them up again if I suspected a patient had meningitis because I have never done them or seen anyone else do them since I graduated. I have also never had to calculate a drip rate with my watch, so that is something I would need help with. I know it's something like volume over time multiplied by the tubing drip factor... but I have never done it outside of school.

I feel like we learn a ton of things in nursing school today, but then we never get the chance to apply some of those things and the knowledge just disappears.

cinlou, BSN, MSN, RN · Jun 8, 2014

I have read this thread through and I can't say I see any proof that new graduates today are less educated than new graduates from the past, or vice versa.
I just graduated last year and I started IVs on my classmates as well as on patients. I'd probably done at least 20, though I'm sure many of you did more before graduation. I still suck at them. I think I'm just too impatient. Before I graduated, I worked with a preceptor for 36 hours a week in an ICU for 6 weeks, so yes, I worked one on one with a nurse in critical care before graduation. I did lots of med calcs in school and I still do them today. My main hospital's policy is that critical drips are hand verified by two nurses at initiation, and they have to be signed off by the oncoming nurse at shift change, which requires math. My PRN job just has a basic IV pump where I can program in the volume and the rate, and this is how most drips are hung. Most of the doctors write orders for "infuse over 30 minutes" or "infuse over 1 hour" so yes, I do plenty of math at my job. If pharmacy mixed the drug they will sometimes have an infusion rate written on the bag, but pharmacy leaves before I get there for night shift so any new drips ordered after 6 PM are mixed by the nurses. I have mixed insulin drips, protonix drips... haven't had to mix pressors yet but we do that too. I take manual BPs whenever I am suspicious that the automatic cuff isn't accurate, like when I have a dementia patient wigging out. I just graduated last year - these are all things brand new nurses educated today are trained to do.
We had a semester long assessment class that was INCREDIBLY thorough... but I am pretty sure I forgot most of the things I learned in there already because they are used so rarely. For example, I remember learning moves to do to check for meningitis, something to do with the legs... but I would have to look them up again if I suspected a patient had meningitis because I have never done them or seen anyone else do them since I graduated. I have also never had to calculate a drip rate with my watch, so that is something I would need help with. I know it's something like volume over time multiplied by the tubing drip factor... but I have never done it outside of school.
I feel like we learn a ton of things in nursing school today, but then we never get the chance to apply some of those things and the knowledge just disappears.

Wonderful response from a new grad. As a DON we teach many things in school that are not even used out in the real world, so to speak, and this is something I am trying to correct within our curriculum. One of the things I can note, is that if nothing else the education consistency and quality is unfortunately inconsistent at best, depending on state, area of the state, school, etc. I think even during my time things I learned and was doing other students in other schools were not doing.

I had a couple of tough Army nurses, that were wonderful, tough, expected respect, and received it because they earned it, and they were the most caring, kind, and helpful people I have ever known.

Some schools provide more than others, and often that depends upon what or how something is taught, also depends on the educator. Their experience, their generation, what they were taught.

Case scenarios and experiential teaching I believe is very helpful for students to help learn how to retain the information. But what if your teacher only spent a year or so with limited experience, this changes how they teach, they have to teach through others experiences.

You learn a lot in school that unless you work in a particular specialty area you may never see them post nursing school. I remember reading a small paragraph on Guillian Barre, then never saw one until I started working in a Neuro ICU and we always had someone with it on the vent. Now treatments delay and can stop the ascending paralysis.

That is why life long learning is so important. And I strongly support certification in the area of a persons specialty, it provides you with an outline and guideline to follow for what you should know to work that area.

laKrugRN · Jun 10, 2014

I am a new nurse (Graduated last month). I feel I was taught a good and thorough assessment. When I was a CNA, I always did blood pressures, pulses, etc. manually. Sometimes I just don't trust machines! I got a lot of good IV experience, injections, med passing, etc. I am fortunate to have had 3 years of clinicals! However, I am FAR from perfect and I know I have a LOT to learn. :notworthy: :nurse:

cinlou, BSN, MSN, RN · Jun 10, 2014

It does not matter how much we were taught in school, we all have a great deal more to learn. The day anyone thinks they know it all, then maybe it is time to retire. Nursing is lifelong learning, things are always changing. There is not enough time in school to teach nor learn everything that is needed to work in the world, therefore it is up to the individual nurse to continue to pursue their ongoing education.

laKrugRN · Jun 10, 2014

Agreed cinlou! You never stop learning! :) we are so lucky to work in a profession that we are always learning and growing. I can't wait to land my first job to REALLY get the feel for nursing!