Nurses not doing assessments - page 5

I am RN with 6 years experience and never have I seen anything like this. I am a new employee at a hospital in California with majority of the nurses are Filipino. I was on orientation and I had 4... Read More

  1. by   bethem
    Quote from XB9S
    I have posted a response in the UK section but thought I would answer it here as well. I think that nursing in the Uk is very different to nursing in the US. I have worked in many different areas within the UK and have also taught nursing students as a nurse lecturer (many years ago).

    As far a I know the clinical examination skills are not routinely part of the nurse education system.

    I am now a NP so I do listen and have been taught examination skills but before I did my NPs MSc if I had a patient who had a deteriorating respiratory status I used other observations, looking at your patient, do thye look distressed, short of breath etc, respiratory rate, O2 sats, other CVS observations, if I was worried then I would get a medic to review the patient.

    To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different
    I can't speak for every single Aussie nurse, but it's the same everywhere I have worked and had prac. Doctors listen to the heart and lung sounds, assess JVP, and all that other stuff.
    Nurses take vital signs and use O2 sats, resp rate, observation of work of breathing, ECG strips, a lot of other things apart from lung sounds. While I agree it may be beneficial to assess heart and lung sounds, it's not the be-all and end-all of assessment.
    I must say, I have long thought American nurses get a more thorough education than I got at my particular university; or, from what I can tell, many other Aussie unis. We learn an awful lot on the job and are really just taught the most basic of things about nursing. It's bizarre.

    As to why we wouldn't have time - we don't have CNAs as much as you do in the US (we call them AINs or PCAs anyway), so RNs are still the ones doing the washes, toilets, all the meds, chasing bloods, chasing doctors, making beds, we feed patients who need feeding... whatever needs to be done for a patient is done by the RN (or EN) looking after him or her. AINs don't seem to take on quite the role your CNAs do.
    Last edit by bethem on Jun 1, '07
  2. by   dardeedee
    I work with a filipino nurse at night who is excellent. She does a head to toe assessment, turns on the lights, wakes them up, looks at every orfice, rolls them over.... etc. She doesn't care if they just got to sleep. She is an excellent nurse and fun to work with. Especially if you have to explain American slang to her.
  3. by   Hoozdo
    How's this one....... The nurse previous to me marked strong pedal pulses bilat in his charting. Fine, but this patient was a BKA
  4. by   XB9S
    Quote from Susan9608
    I'm curious about this. In my job, most of my time is spent on assessments, reassessments after interventions, etc. What do UK nurses do that don't allow them to have time for full examinations? (seriously, I'm not trying to be derogatory; I'm interested to know how the UK is different)
    I can only speak from my experierience so this may not be the same throughout the UK although I am fairly sure there will be little difference.

    If I work on the wards (as I say I am an NP but do shifts as a ward nurse to earn extra money in a different hospital where I work once or twice a month on a surgical admissions ward) You get on duty and take handover, the wards are 36 beds and these are split into 2 sides. I will work on only one side with 18 patients. On an early shift, at handover we walk around the ward meet the patients the shift going of will hand over at the bedside - confidential info will be given in the office so at the bedside it is more of an introduction, obs chart and med chart hand over and it gives me the chance to eyball the patient.

    After that myself and the support worker will work through making sure all patients who need washes have bowls and their wash stuff to hand those that need assistance we will assist. Whilst going round we make the beds and change sheets.

    during the washes I assess mobility and any patients who are unable to mobilise I will check pressure areas and skin integrity, also checking observation charts and dealing with any problems that arise from this. Our patient self medicate if able so I check the med charts and sign that the meds have been taken, and then give any analgesics. If not able then we give their medications. We need to assist those patients that need feeding and during all of this if we have patients who are incontinent or unwell the qualified nurse will need to deal with these as well. This does not take into account answering telephone enquiries. At about 830am the surgical doctors will do a ward round and the qualified nurse will need to be present,

    the washes, and mobility assistance goes on throughout the shift.
    We dont listen to heart and lung sounds but that doesnt mean we dont assess, react to those assessments etc etc. I think that nursing within the UK (and by the sounds of it Australia) is very different to the US, personally from my training listening to heart and lungs is not nursing as I have been taught it is more in the medical domain.

    To me nursing is assessing your patients activities of daily living, and assisting them with those that they are unable to do for themselves, at the same time promoting self care to allow them to gain independence and return to how they were before illness - if that is possible, if not then helping them to adapt to the changes within their life.

    Just because we dont listen to heart and lung sounds does not mean that we dont assess our patients, our assessment are different to your but equally as valid.
  5. by   TazziRN
    Quote from chuck1234
    Post# 26 gucci rush stated that "wondering if assessment were taught in their country. I also work with other filipino nurses who are very thorough and do their job well." Again, in post# 1, gucci rush stated that "My question is in other countries are they taught different because we all know here in the U.S. that assessing your patient is the first thing you are taught to do in school."
    It is very interesting to see that gucci rush brought out the argument and then she gave the contradictory answer to her owe argument.
    If that wasn't what other countries have taught, then how come some of gucci rush's coworkers did their job well as stated in post# 26. Apparently, they were taught about what to do. Otherwise, gucci rush has to change the original statement. It is very important not to attack your own argument, as I was taught in English 101.
    Anyhow, I think it is not only one specific group of people who are doing it. Black, white, Asian and Latino nurses are doing the same thing. Whether they graduated from colleges in other countries or colleges in our own backyard. I think the problem is caused by some other problems rather than they were taught in school or not.

    ????? The only one contradicting anything here is you. Gucci wanted to know if nurses in other countries are taught assessments, not specifically Filipinos. By saying that she's worked with Filipinos who are great nurses, that took race out of the original question.
  6. by   PiPhi2004
    Isnt is against the law to make up information and chart it? That is extremely unethical and horrible to do! People have done it at the hospital I worked at too. Lazy nurses make me angry
  7. by   Ophelia78
    I just had a patient this week who was on the vent, CMV with a rate of 20. This gentleman was a quad as well. The night shift nurse had been floated to the ICU from the floor. All night she documented hourly RR as 16, 18, 15 etc. Um, no. Just to give her the benefit of the doubt, I verified with RT that nothing funny had been going on with the vent at night. Nope.

    When I was a caseworker I had a coworker that was canned for charting weekly hour-long visits for a client that she never performed. She actually hadn't seen the woman in 5 months when it all came out. She was lucky she didn't get prosecuted for Medicaid fraud.
  8. by   Silverdragon102
    Quote from XB9S
    I can only speak from my experierience so this may not be the same throughout the UK although I am fairly sure there will be little difference.

    If I work on the wards (as I say I am an NP but do shifts as a ward nurse to earn extra money in a different hospital where I work once or twice a month on a surgical admissions ward) You get on duty and take handover, the wards are 36 beds and these are split into 2 sides. I will work on only one side with 18 patients. On an early shift, at handover we walk around the ward meet the patients the shift going of will hand over at the bedside - confidential info will be given in the office so at the bedside it is more of an introduction, obs chart and med chart hand over and it gives me the chance to eyball the patient.

    After that myself and the support worker will work through making sure all patients who need washes have bowls and their wash stuff to hand those that need assistance we will assist. Whilst going round we make the beds and change sheets.

    during the washes I assess mobility and any patients who are unable to mobilise I will check pressure areas and skin integrity, also checking observation charts and dealing with any problems that arise from this. Our patient self medicate if able so I check the med charts and sign that the meds have been taken, and then give any analgesics. If not able then we give their medications. We need to assist those patients that need feeding and during all of this if we have patients who are incontinent or unwell the qualified nurse will need to deal with these as well. This does not take into account answering telephone enquiries. At about 830am the surgical doctors will do a ward round and the qualified nurse will need to be present,

    the washes, and mobility assistance goes on throughout the shift.
    We dont listen to heart and lung sounds but that doesnt mean we dont assess, react to those assessments etc etc. I think that nursing within the UK (and by the sounds of it Australia) is very different to the US, personally from my training listening to heart and lungs is not nursing as I have been taught it is more in the medical domain.

    To me nursing is assessing your patients activities of daily living, and assisting them with those that they are unable to do for themselves, at the same time promoting self care to allow them to gain independence and return to how they were before illness - if that is possible, if not then helping them to adapt to the changes within their life.

    Just because we dont listen to heart and lung sounds does not mean that we dont assess our patients, our assessment are different to your but equally as valid.
    :yeahthat:

    just to add when I worked on the wards we did medication rounds as patients didn't self medicate. Staffing was usually 1 RN and 1 health care assistant for anything between 10-18 patients (depends on type of ward) with an extra health care assistant covering both teams. Sometimes struggled to give basic care although did manage to give it but with doing everything else from basic care, moving beds, answering telephones and management putting more and more stuff on us but not willing to pay the time to do it or employ the extra staff.
  9. by   miko014
    This just got me thinking - not too long ago, I got pulled to another floor. I had been working with my pts since 3pm, and at 6:40 they told me that I had to go to the other floor at 7. Well I had just gotten a brand new admission and a transfer (at the same time and while I was in the process of hanging chemo no less). I had not eaten dinner, and I had to finish all of my charting/admission, etc. So, I hit the other floor around 7:30 (there was no way I could have been there any sooner!!), and by the time I had gotten report, it was 8:00. They had given me 6 pts, and I was only there till 11:30. I didn't even see my last pt until 10pm. I didn't feel very safe there, and I will admit - I didn't do full head-to-toe assessments on everyone. I did heart and lung sounds, bowel sounds, looked at any dressings/incisions, and did a quick look over on everybody (like, if I knew that the person had a swollen arm, I made sure to look at that arm, etc). But that was all I could do. I had to ask the charge nurse to help me pass a few meds, and I still didn't finish everything until 11:30 on the nose. That was scary to me, to not be able to do a full assessment, but what choice did I have? I basically had 3 (maybe 3.5) hours for 6 pts. But I did the best I could - I can't imagine how it would feel to just not assess anybody, ever!
  10. by   TazziRN
    But Miko, you didn't chart that you did do a full assessment, right? That's different than not doing it but charting that you did.
  11. by   scattycarrot
    I think the difference in the UK and Us training is purely historical. It wasn't that long ago that nurses in the uK were considered 'handmaidens' and were their to assist the doctor and provide very basic nursing care to the patients and carry out the doctors orders. I have worked with some very 'oldschool' doctors,who still insist on nurses setting up their dressing and suture trolleys (which makes me furious as if I am capable of setting up my own sutue trolley, why can't they?)and clearing up after them(Ha!). Nurse training in the Uk still harps back to the olden days in some ways and clinical assessment skills are skills that doctors utilise and not nurses. Now, as someone else pointed out that does not mean that UK nurses do not have effective assessment skills because they do. Uk nurses are taught to do full assessments and use all the skills that a US nurse does except listen to chests;that is the only difference. If a UK nurse found something on initial exam that was concerning then she would request that a doc see the patient, which is the same end game as US nurses,no? Now, alot of UK nurses do listen to chests but mostly in areas such as ITU, ER, Primary care, advanced practice, etc... and it is taught in continuing education as opposed to during nursing school. I have just finished a BSC and was taught clinical examination during that and I will admit that the skills I learnt have made me a more well rounded nurse. It hasn't made me any better than a nurse who doesn't listen to chests, it just means I have acquired different skills and am able to utilise them. I still think that all nurses(hopefully all!) can recognise a patient who is deteriorating with or without listening to their chests. Having said that, I think these skills should be taught to all nurses in the UK and I think in some nursing schools, they are.
    As for whether all nurses will want to learn extra skills, I am not sure about that as they are hardpressed to do the jobs they do at the moment ,let alone adding to their workload. As other UK nurses have pointed out, we do not have the support staff that you have over here. In the ER I worked in we were lucky to have one health care support worker per shift. So, no LPN's, RT's, EMT's, ECT's, etc.. and the RN has do everything. This doesn't leave much time to do head to toe assessments on all the patients. I know on the wards, its just as bad. Patients are lucky to get basic care unfortantly and thats not because they are bad nurses(far from it), its just the system is on its knees. So, don't look down on nurses in the UK or Oz for not being able to listen to chests...that skill alone does not a good nurse make! Our trainings are different, not worse, not better, just different.
  12. by   XB9S
    Quote from scattycarrot
    Our trainings are different, not worse, not better, just different.
    Scatty thats just what I was trying to say only you said it so much better
  13. by   KaroSnowQueen
    I know my hospital hires a lot of "international" nurses and the nurse educators have said they have to hold special classes to teach some of the nurses assessment skills because in their countries (which ones I do not know for certain), the nurses didn't do assessments, just the docs.

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