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.......

[mgbswan]

To 2nd wind,

I agree, and I would say you have wisdom, not hubris to comment from the perspective of a new nurse. As a student entering the last semester of school I appreciated your thoughts. It will help me complete my list of what to observe when I'm evaluating potential worksites.

Thanks to all for the observations and comments.

[ElectricHellfire]

Definately not the norm. Ive been doing ICU for about 8 months now and Ive not seen anyone skip a PA.

That being said, the routine PA we do on the floor is not what we did in school but then again nothing much else is either. It is quick and dirty and gets the job done. Not the 30 minute long thing we did in school.

[CountyRat]

I hate to sound like a cranky old man asking, "what is this world coming too?" but honestly, what is this world coming too! Of course we have to assess our patients every shift. What is the point of having professional nurses in the unit if they are not using assessment skills? I could teach a high-school kid how to pass pills and order labs. The point of having a highly educated nurse there is to assess and exercise judgement. To do otherwise is dangerous.

Now get those kids off my lawn!

[luvs2readlotsRN]

Country Rat:

"Now get those kids off my lawn!"...TOO FUNNY!!!

I have to agree with the majority of posters. Do the assessment. How else do you establish a baseline?

I have worked for less than a year, on an ortho floor, and I have never caught any of the nurses not doing an assessment. And as someone else pointed out once you have it down it takes what...10 minutes if you run across something to dig deeper, less if "all systems are go".

Just do it!

[geekgolightly, BSN, RN]

A general PA neuro, heart, lungs, belly, pulses, edema with focus on each system as needed doesn't take more than a few minutes, and I do it because it saves lives.

Two weeks ago, I took a patient who was only on a cardene gtt with LE weakness admitted night before and nurse said, "Oh he will go to the floor, this is your easy guy. Pressures controlled, negative assessments, but he's weird."

I walk in, introduce myself, attempt eye contact, and ask him his name and he hesitates and smiles. I check his neuro status while continuing to ask questions and when he does answer it's in a whisper. I start to perform an NIHSS because I am nervous about his inability to answer me normally, find that he can grip but not release with one hand and one leg is a bit weaker. I enact the stroke team. Ten minutes after I assessed him, I note a facial droop, which was brand spanking new. After all is said and done, he had a clot in his ACA, and we were able to use IAtPA. His outcome wasn't particularly great, but they were able to partially dissolve his clot and who knows how bad it would have been without the intervention.

If you do not do your assessments every day and pay attention and focus them when there is something wrong, you WILL miss things and patients can die or become permanently debilitated because of your lack of basic nursing care.

Do your job, and do it well. Don't give a fig if no one else is, or if they make fun of you, do what you know is the right thing to do.

[lauramae18]

I am always the "slow" one and last one done at work because I do a very thorough assessment. I will admit, though, if it's a patient I've had for a few days and it's an easy patient - in with chest pain and now it's changed to lytes imbalance, for instance, my assessment is a much quicker re-assessment. I only work 7p-7a or nights and on nights that I start at 11, I go in the rooms as soon as I get to work to tell them that I'll be back to check them out, see them after report. And when I get a patient that complains " you are doing a lot"; "no one else did that" , etc.... - I tell them it's the law for a nurse to do an assessment and my family cannot afford for me to lose my livelihood.

Keep doing what you are doing!

[clhankin67]

Sadly, there are nurses, new and old that do not perform PA. I spent the majority of my 18 years in MED/SURG/TELE. I always carried (and used) my stethescope. Always performed at least a quick head to toe at the beginning of my shift.

Unfortunately, I frequently found that in the 45 minutes it took me to check my 4-6 patients after rounds and do PA, there were nurses that had charted all of their assesments, updated care plans, signed off orders, signed off meds, gotten coffee, and ordered take out breakfast, w/o leaving the nurses station!

It was very embarrasing when the patient's or families would say "you're the first person to listen to his heart/lungs/abd" "no one else has looked at my incision" "why are you looking at my feet", etc.

Always asses your patient's, and never copy someone else's documentation. Take pride in your job and in your license! For every slacker nurse, there are many, many of us that take pride and perform our jobs. Keep up the standards that you have set for yourself.

[FranEMTnurse, CNA, LPN, EMT-I]

You are correct in assessing your patients. These are one of the qualities of being a good nurse. I did complete assessments--both rapid and secondary during my years as an EMT, and I'm thankful I did. Otherwise i could have missed a critical area that could have resulted in the loss of life. I did the same thing in nursing. I am surprised at what you posted. I didn't think nurses would take thay kind of a shortcut. Our hospital staff does full assessments.

[jrbl77, RN]

I am one of those" older nurses", and I do an assesmant of each pt that I care for every day. It may not be in the first 15 mins after report, but it does get done. I have learned to determine which pt needs my attenetion first. If not right away then with my first med pass. I will admit that I didn't learn these skills in nsg school nessecarily, but have picked up these skills as the role of the nurse has changed in my career. i too, often have pts or family members say to me what are you doing, I have never had a nurse do this before.

[FranEMTnurse, CNA, LPN, EMT-I]

When I worked inpatient, I always listened to heart, lungs, abdomen, felt for pedal pulses/edema, pain level, and checked out their mouth (oncology floor). If I found something that was wonky, I investigated a little further into that system. You can't chart an assessment you never did...

Back when nurses were doing soapie charting, I saw many just sit down and check off items prior to even doing an assessment. How can they get away with that? I'm thankful computer charting is now in effect.

[FranEMTnurse, CNA, LPN, EMT-I]

My first travel assignment ever was at a LTC facility in Baltimore. It had been a nursing home at one point but it was bought by a hospital that needed a place for pt's that were not recovering on the usual time schedule. I showed up my first day with my stethoscope around my neck ready to take on my patient load.

A couple midnight nurses (I was a day shift worker) joked about my stethoscope. At first I thought they were making a jab at the fact that it was a cardiac stethoscope (very expensive, but you could hear so clearly on it). Then a few of my fellow day shift nurses showed up. Some of the comments made at me:

"What do you need that for, you are not a doctor?"

"You travel nurses are such show offs."

"What are you going to do, wear that thing around your neck all day?"

"Do you wear that thing at home too?"

I continued to think they were making fun of the fact that I had such an expensive stethoscope. I expected to see them use the cheap hospital supplied ones for their assessments. We got report, I left to do my assessments and when I got back to start passing meds...................they were all completing their charting. Not one of them had moved from their chairs. They documented their "assessments" then passed meds and then continued to spend most of the day in the report room. They were so comfortable operating this way, they didnt even put on a show and bother with having stethoscopes or anything.

Another place I worked at later on in Tacoma was almost as bad. The nurses at least had stethoscopes, but they'd complete all their charting before even leaving the nurses station after getting report. They did a drive by assessment (just stand outside the door, make sure they are breathing).

:eek:I'm shocked!!! It would pay every nurse to purchase a very good cardiac stethescope. As we age, our sense of hearing naturally decreases. A cardiac stethescope can help that. No wonder so many patients die in some areas.

[FranEMTnurse, CNA, LPN, EMT-I]

I've seen it too...on our computer system, you can see past treatment notes written by other nurses. I'll see people charting that an open area persists when it hasn't been an issue for days, or that someone's bilat breat folds remain pink/fungal when the area is resolved. I've also seen dressings I put on the previous evening on pts with BID dressing changes still on when I come in the next day.

It's scary...but all I can do is trust my own assessments and know that I'm doing my job...some people are just lazy.

I don't walk around with my steth on my neck typically (mostly bc having it flapping around irritates me), but it is always on my med cart, and it certainly is used!

This is very frightening!!!!!