Nurses not doing assessments - page 6

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   pickledpepperRN
    Quote from bethem
    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.
    I have worked with nurses from countries where the doctors work shifts with the nurses. They start the IVs and perform much of the assessment that is the responsibility of the RN here.

    I have also been through the registry to a hospital that does not allow nurses in critical care to inflate the balloon to get a pulmonary artery wedge pressure or do a cardiac output. I had to assist the intensivist.
    He also assessed each patient between 8:00 pm and midnight. This was in California, USA.

    But we are discussing nurses who do not do what they should.
    Nurses charting ahead of time is unethical. It ha NO PLACE IN NURSING.
    We MUST be honest.
    We must NOT allow dishonest practices.
    If nurses are assigne too many patients to perform the Nursing Process which begins with assessment it is time to work together for safe staffing.
    Last edit by pickledpepperRN on Jun 1, '07
  2. by   ZippyGBR
    Quote from muhaha
    i dont understand how aussie and uk nurses arent taught to routinely assess heart and lung sounds!?!. How do you protect the pt as we all your own self if the pts condition deteriorates...what baseline would you have then? How would you know if the lung sounds are clear upon auscultation or if there are crackles...or if their heart sounds suddenly are abnormal?
    becasue historically UK hospitals have had access to on tap in house medical cover 24/7/365 ...

    the biggest problem is the perception by some that it's a 'doctor's job' therefore it's getting ideas above your station to do that... also core competnecies for registration lag somewhat behind core competencies for practice in Acute settings ( things like cannulation, venepuncture , and chest assessment spring to mind all skills people working in emergency / critical care areas acquire fairly quickly ...)

    in settings where Nurses are empowered to initiate or substantially change treatment where it's relevant then they do, as for the rest of us - depends if someone has taught us properly and we are confident of doing so - also if you can't determine that someone is wheezy from other signs and their symptoms - listening to their chest is only going to confirm it...
  3. by   ZippyGBR
    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)
    from my point of view as a nurse working on an assessment unit

    - looking after patients who really need RN input ( given that Uk critical care areas only take patients who are really sick - and we also act as overspill for patients 'too sick' to go to ordinary units / are mandated for speciality beds e.g. cardiology /ccu or poorly respiratory patients who don't need NIV

    - performing full assesments on the upto 12 new patients a shift - ( this is an assessment unit so turns over beds rapidly) including top to toe ( yes including chest assessment if approrpaite) assesment , bloods ( becasue our phelbotomy service are frankly a waste of space apart from routine montoring on stable patients) , IV access, ECGs, other samples... requesting those tests ( at least we only have 7 or 8 patients at a time on the medical side of the unit, it can be 12 on the surgical side which doesn't stick to one patient one bed + the dvt pathway ambulatory care patients ( only ever a couple at any one time) that the medicla side has

    - checking the demographic information we have so (in hours) the ward clerk can put them onto the baed state and out of hours putting people onto the bed state system

    - organising -transfers ( both within the facility and inter facility or back home) / psych evaluations / finding background and collateral history ...

    -answering the questions of patients and their relatives / friends

    - dressings/ catheters etc - as well as assisting the HCAs with turns, hygiene etc..
  4. by   XB9S
    Quote from spacenurse
    But we are discussing nurses who do not do what they should.
    Nurses charting ahead of time is unethical. It ha NO PLACE IN NURSING.
    We MUST be honest.
    We must NOT allow dishonest practices.
    If nurses are assigne too many patients to perform the Nursing Process which begins with assessment it is time to work together for safe staffing.
    Spacenurse the UK and Australian nurses were specifically asked in the different international forums and within this thread, what we were taught during our training and if we were taught to listen to heart and lungs, this is why you are getting the responses you are reading.
  5. by   NurseRotten
    Wow! Up to 18 patients with only one nurse. Gotta love socialized medicine. Remember that, US nurses, when you vote.
  6. by   suehp
    I am also originally from the UK...never taught how to listen to lungs and heart sounds - I also work with a french nurse who said the same about her training.

    I agree with he other UK posters.....our assessments are basically the same except the listening of heart/lungs.

    I now work in the USA and now do the heart/lung assessments.

    Going back to the OP, it could be these nurses are just plain lazy or just ignorant and dont know how to do it...it happens where I work but thankfully it is in the minority...I often get Patients saying to me that I am being thorough and all I am doing is checking their heels and other pressure areas...isnt this just basic stuff???
  7. by   P_RN
    So on a ward in the UK you might have 18 patients? WIth how much help? I know I've unfortunately had 15 on a shift with 1/2 tech (care provider, CNA) and 1/2 LPN (aka enrolled nurse in OZ & UK) and they all got assessed. Now given that was on 7pm-7am and not days. Days (usually) was no more than 10 with an LPN (enrolled) to give meds to the 10 or share a team 50/50. Here an LPN cannot assess but they can "collect information" that the RN then assesses.
  8. by   Roy Fokker
    I always do heart/lung/bowel assessments - irregardless of patient's chief complaint. It takes me an extra 30 seconds or a minute = total of extra 6-10 minutes for all my patients. I consider it time well spent - since most of my patients are post-ops, I cannot tell you how many times I've caught someone heading south and intervened before things became worse....

    As to non-charting/non-assessing nurses:
    I've come to dread following certain nurses on the floor - their assessments are shoddy and their charting worse. :uhoh21:

    Not only is it potentially unsafe for the patients, it also means I have a lot of slack to pick up on!!
    Last edit by Roy Fokker on Jun 1, '07
  9. by   chuck1234
    Quote from TazziRN
    ????? 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.
    Read the first post and then the post #26, read and re-read then think a little be deeper...she was zeroed in on certain group. And to say, she had 6+ experience and she has never seem anything like that..Should she combined post#1 and post#26...the outcome is totally different...she basically answer her question in post#26...all you have to do is to go back and forth...and think....
  10. by   anonymurse
    Quote from SueIP
    I am also originally from the UK...never taught how to listen to lungs and heart sounds - I also work with a french nurse who said the same about her training.
    Highly recommend "Secrets Heart & Lung Sounds Workshop" audio CD with booklet by Dr Salvatore Mangione. Explains how to reason through the sounds you hear. Got mine through Amazon.
  11. by   pickledpepperRN
    Do you have doctors working on the units along with nurses?
    Are they present all the time?
  12. by   TazziRN
    Quote from chuck1234
    Read the first post and then the post #26, read and re-read then think a little be deeper...she was zeroed in on certain group. And to say, she had 6+ experience and she has never seem anything like that..Should she combined post#1 and post#26...the outcome is totally different...she basically answer her question in post#26...all you have to do is to go back and forth...and think....
    I did go back and forth and I'm not seeing it. She said that she is working with mostly Filipino nurses who are not assessing, and then her last question is:

    My question is in other countries are they taught different because we all know here in the US that assessing your patient is the first thing you are taught to do in school.
    In her second post she clarifies that she's asking about nurses trained in other countries, not here in the US.

    What are you seeing that I'm not?
  13. by   pickledpepperRN
    Quote from XB9S
    Spacenurse the UK and Australian nurses were specifically asked in the different international forums and within this thread, what we were taught during our training and if we were taught to listen to heart and lungs, this is why you are getting the responses you are reading.

    Thank you.
    I know I am impressed with the skilled kind nurses I work with. They are from every continent except Antarctica. And England, Ireland, and New Zealand.
    We have a common purpose and body of knowledge.

    Nursing is very special as a caring profession.

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