Physical Assessments: Do Any Nurses Do Them

[romie]

It has become apparent to me early in my nursing career that many RNs are no longer performing thorough PA at the beginning of the hand off of care. Not one single nurse during my orientation as a new grad had a stethascope around their neck to ausculate lung, heart, bowel sounds. Not a single RN palapated a patient's abdomen or pedal pulses. When I started at a a new hospital as a new grad, my preceptor said to me as she observed me assess a patient "wow, that was a good and thorough physical assessment." I'm thinking to myself, this is what I was taught to do as a basic skill during my nursing school days at UIC.

I work on a tele unit and I am one of the few RNs who actually have a stethascope and calipers. Am I missing something? I know how important it is for a s/p lap cholect. patient to have bowel sounds but how can you assess bowel sounds if you don't have a stethascope. Asking a patient if they have passed gas is subjective. I need hard data.

So my question is, am I wasting my time physically assessing my patients? Granted I do a focused assessment based on their accuity and needs, but I will still inspect the feet of all my patients. Am I doing something wrong? Do I need to reprioritize? I really need some help here because I'm a little confused after all of the time spent at UIC on physical assessment. I don't want to falsify documentation when the computer prompts me if I heard bowel sounds or not.......

[AOx1]

Failure to perform an assessment is a great way to be sued. The standard of care in every state I am aware of holds that you do what a prudent nurse would do in the same situation. This is the minimum standard. I personally want to exceed the minimum.

Anywhere you look it is easy to find people who do only what is needed to get by. It is true of any profession, and also true of nursing. I have met some nurses who are so lazy that I wonder if their legs will eventually become a vestigial appendage.

This "too lazy to assess" is frightening. A friend had recent surgery, and the only person who checked her incisions post-op was me! For four hours, she was left unattended unless we called repeatedly. They never checked her bracelet before giving meds, or verified allergies. I had to remind them to. They never performed any physical assessment. I asked that she be provided with a different nurse.

I think if you asked this type of person "Why don't you assess?" they might cite lack of time. Well, running a code also takes quite a lot of time. If you don't have time to run a code, you'd better assess. People who don't assess probably get away with it the huge majority of the time, but I view it as stealing. You are on the clock to perform nursing care, which includes assessment. Not doing an assessment is in my view no different than stealing supplies or med diversion. I won't provide substandard care. If I don't have enough time to care for all my patients, I speak up. But I don't cut corners. How on earth can you safely care for the patient if you don't assess?

[beachbutterfly]

I don't quite agree with darkangel 05b's comments that a "lot of the older nurses seem to get lazy in their ways" - a rather sweeping comment.I don't think doing assessments thoroughly is related to the length of time you have been a nurse- it is related to the commitment one has to your nursing standards and this is something that is carried right through from the time you get out of nursing school to the time you retire as an RN.

True,true during my nursing school days I followed an older nurse (she has been a nurse for a long time) in labor and delivery unit and to make it even more interesting she was a PRN nurse!!!May I say I was impressed with her thoroughly assessment skills-she had a patient on Mag sulflate and boy was she checking those reflexes around the clock and in overall was a very dedicated nurse,so you cant sterotype experienced nurses,everyone is so diiferent.

[beachbutterfly]

I want to thank everyone for their insight. As an RN with a year's experience, I will continue with my good habits: Head to toe assessments, checking iv access and IV fluids (I have found a few mistakes there. Luckily the patient outcome wasn't negative) and I would hope the nurse following me would do the same to catch anything I didn't see. PA's are a great way to spend some time with patients and develop rapport--plus I am such a worry wort that I can't comfortably go back to the nursing station unless I know everyone is okay. Not only does a good PA an imperative, but it makes us look good and makes the patient feel like they are "getting their money's worth".

I was shocked when I auscultated a patient's heart valves and heard a disryhthmia. I checked the chart and every nurse before me charted "regular". I asked another nurse to confirm and he said "yep, its irregular, lets call the MD." On the same unit during my orientation, I volunteered to do all the assessments on an assignment. It took me at least 45 minutes to complete my assessments. When I got to the paper chart to document, it was already done by another nurse! I had a another nurse yell at me during orientation and say, don't touch my patients, when I charted that I was unable to auscultate a psychotic patient's lungs, heart, etc. because she wouldn't let me near her. This nurse had charted that she heard her lung sounds. Please, this patient's mental illness is so acute, her paranoia so great that noone could even touch her.

Again, thanks for your support. and thanks for reassuring me not to assume the worst. I just want what is best for my patients.

Becareful in making a diagnosis of dysrythmias,sometimes the heart beats and stops but that does automatically means they are dysrythmic!!!I'm sure the doc would notice if the pt was trully dysrythmic anyway I guarantee you there will be many days where you wont have simply the time to make a head to toe assement,nursing is not a perfect world!!!!!!

[NeoNurseTX, RN]

Uh, I have never worked on any floor where nurses don't assess their patients. That sounds pretty shady to me. You are not wasting your time doing them. I have caught many a problem and nipped it in the bud early by doing a complete physical assessment.

This. I've never seen someone not do one.. and I always do mine right when I come on.

[meandragonbrett]

Becareful in making a diagnosis of dysrythmias,sometimes the heart beats and stops but that does automatically means they are dysrythmic!!!I'm sure the doc would notice if the pt was trully dysrythmic anyway I guarantee you there will be many days where you wont have simply the time to make a head to toe assement,nursing is not a perfect world!!!!!!

That is still an arrhythmia.

[GoECU]

Keep doing thorough assessments! What's the point of coming in for a shift if you are going to half*** everything. For the safety of the patient, please continue to be thorough. It is our duty to give our patient the BEST care not the easiest care. Don't follow the other nurses example. Do what is right for you and the patient!

[Bugaloo]

As a med-surg nurse, I always did thorough head to toe assessments on my patients, and I have been a nurse a long time. That being said, I highly suspected that there were some nurses who did not. Why? Because it is impossible to assess your patients, pass your meds and be finished with your charting two hours after the shift begins. There were certain nurses that I worked with that were able to do this every time they worked. They never had a bad night, they had time to read, chat and text. I never asked them what their secret was. I was afraid to know!

[homenurse12]

All good nurses do a full assessment every time they take care of a patient. Keep doing the right thing!

[AngelsRN]

many nurses where i work dont do assessments . . they may or may not carry the stethoscope, but they do not do assessments. I always do mine . . .may be later in the day, depending on how the morning started but it still gets done. Initially in the morning, i check what i need to check related to what they are there for and based on any complaints they may have . . .then follow up later with the rest. In reality, it does not take long to do a complete head to toe assessment once you have a routine. Keep doing it . . .your patients will thank you!

[DaveCRNA]

All I can say is wow! I find it crazy that an RN wouldn't do a complete assessment on every patient, at the beginning of a shift! How do you know if something changes if you haven't done an initial assessment.

A short, basic assessment takes maybe, 3 minutes! Add in the specifics for the patient type, or complaints and you can still be done in 5 minutes. OP, keep doing those assessments, someday your previous assessment will allow you to save the life of one of your patients, because you noticed a change earlier!!!!

Someone earlier posted that we can only be responsible for our own actions! I agree, but with a twist:

1. Do your own assessments and document truthfully.

2. Don't turn the other cheek when you see these lack luster nurses. Call them on their bad nursing! if that doesn't work then report them. (be sure you know what you are talking about though)

We, nurses, are the patient advocates!! It's one of the fundamental values a nurse should have. We advocate for patients. Not just our patients, all patients. I have reported bad nurses before and would do it again, if I feel patients are jeopardized. I always attempt to work things out directly first, but if that fails (sometimes it works :), I report to the nurse manager or DON.

I don't feel guilty or like a rat, I'm doing my job...protecting patients.

Sorry if this sounds like I'm on a soap box, but this is a huge issues for all of nursing and we need to police ourselves! I'm proud to be a nurse and don't want mediocre, uncaring nurses in my profession!!

[Artistyc1]

I think alot of the 'older' nurses seem to get lazy in their ways and don't think that it is as important. However, I notice that the newer nurses seem to do a more thorough assessment. I guess they just get too relaxed in their work...

About the stethoscope... I don't know why anyone wouldn't carry theirs around...all of our nurses do (older and newer)...but granted, I work in a cardiac unit...

I think that this is downright offensive to many of us that have extensive experience- where did you come up with that assertion? Perhaps you have seen a few people cut corners, and I doubt that it is "newer" vs "older" nurses, there are just lazy people out there, period. I have worked for over 32 years, and a head to toe has always been the norm, no matter what the length of experience of the nurse doing it.

[ChicagoPeds]

Okay, my first thought was "WOW, that is so scary!!!" followed closely by....gee, I actually had a similar experience as a student nurse when we were shadowing an RN. The RN didn't do a full head to toe assessment. And I also remember feeling similarly upset at this.

I work on a Peds Multi-specialty floor & I always always always do a complete head to toe assessment (every 4 hours, with a more focused assessment every 2 hours for those patients with EVDs, Lumbar drains, on continuous nebs, etc). There have been multiple times when I find things that other nurses have not noticed (i.e. PICC line traveling further into the patient, pupils being unequal in size, etc) and we have had to act on. Continue being the best RN you can be...you need to do a complete PA, after al it is your license on the line if something happens. Try to stay the way you are and don't let those other RNs influence your practice.

(On an aside, I have run into times where family members have questioned what I was doing when I did my PA because no other nurse had done that...and I simply explain, well, each RN has their own way of doing things and this is the way I prefer to do it. Towards the end of the day, I have been thanked by my family's for being so attentive).