Physical Assessments: Do Any Nurses Do Them

Nurses General Nursing

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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.......

Specializes in CCU MICU Rapid Response.

I personally am not shocked, amazed or suprised by fake assessments. As everyposter has said before.. do what you feel you need to do so YOU can sleep at night. Also remember... those who fake assess will eventually get busted. Rest assured. :) Keep up the good work. Ivanna

Last summer I took a new job in a LTC and in my orientation, mind you, the nurse orienting me said, "You won't have time to get vitals, we all just make one up similar the nurse the previous shift." I was appauled and in total disbelief. However, she was not lying. The facility assigned me to 36 residents and there was so much paperwork involved relating to follow ups and MDS assessments I had no time to gather VS, do treatments, do skin assessments or any type of assessment unless it was an emergency. And I got the hell outta that place!

In addition, I never took a lunch even though they took pay out for it, no breaks, and most days had to stay over at least 2 hours to finish all my work.

All I kept thinking was that I was a better nurse than that, and I needed to get out of there because something bad was gonna happen and I wanted no part of it. I believe in ethical nursing and I strive to do all of my tasks to the best of my ability. Some days I fall short, but I never chart false information. I got angry with my supervisor a few months back at my new job because some nameless person forged my initials in the treatment book for 3 days I never worked that floor. I told my boss... I always sign my books, If I accidently leave a hole I usually catch it the next night. The days in question were blank the whole month because the nurse who had the hall those nights never signed her books, ever, I told her I was angry because I consider that false documentation and I that I was very unhappy about the situation.

Well the reply I got was... I posted a note for all nurses stating there were holes in the TAR that needed signed. I did NOT single you out, why do you always take things I say so personally. If I was talking about you personally I would have addressed you personally. As far as someone signing your initials. I'll look into it.

Needless to say, it's still a mystery. But I suspect it was the bosslady herself. Hasn't occured again.

Specializes in Telemetry.

I don't know what hospital you work at but it really worries me when you say that nurses are not doing assessments. Depending on what your patient diagnosis is and what condition your patient is in, will determine how you'll do your assessment. Someone who just had surgery for a broken leg, a nurse will be sure to check for proper circulation to ensure that compartment syndrome isn't occurring. Whereas a female who had a mastectomy will have her drainage and tubes checked.

You always assess.....ASSESS ASSESS ASSESS and then IMPLEMENT.

Specializes in ICU/Critical Care.

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.......

Please continue to assess your patients. Great nurses do assessments.

Specializes in LTC, CPR instructor, First aid instructor..
I'm not REALLY 94. I just put that because I refuse to put my real age.
To each his own. We are all different and that's a very good thing.

That's funny Jomonurse! I was just wondering,because it is possible to still be working and 94! There are a handful of those people still out there! I was just going to be so amazed and awed by that fact! Age is just a number! How you take care of yourself and live your life tells the real story, right? I am 49 and look and feel more like 100! LOL! Take care! All my best!

Specializes in LTC, CPR instructor, First aid instructor..
That's funny Jomonurse! I was just wondering,because it is possible to still be working and 94! There are a handful of those people still out there! I was just going to be so amazed and awed by that fact! Age is just a number! How you take care of yourself and live your life tells the real story, right? I am 49 and look and feel more like 100! LOL! Take care! All my best!
I'm 66, and don't feel a day older than 12 mentally, but I won't even mention my decrepid age.:D
We do them on our floor at the beginning of each shift and as needed. However, I was in my own hospitals PCU (intermediate care unit) for chest pain and I was NEVER touched by a nurse the entire time I was even there, even though the chart indicated that I had been. I reported it to the manager up there but no one did anything about it.

Diane,

I just spent 4 days in a tertiary care hospital that granted had many sicker patients on the floor than me but not once was I examined by a nurse. Not sure what my chart said other than I did read what the doctors wrote who said I was comfortable. Curious to see what the admission form said on it since I know they have quite a detailed form to fill in and there is no way it could have been completed accurately. If I didn't work at the hospital I would complain.

As I mentioned in another forum it was a horrible stay. I was admitted for pain and one time it took 2 hours to get pain meds another time 3 hours. I was crying and wanted to scream. When my mother complained they said they were busy and I should ask for the pain medicine before I needed it. You can't ask for pain meds before they are due and you should have to anticipate you are going to be in pain so you ask for them ahead of time.

Specializes in Med/Surg, Geriatrics.

The last time I was in the hospital was when I had my baby at Dekalb Medical Center 10 years ago and after I delivered, no nurse laid a hand on me the entire time I was there. Maybe it's different on mother-baby but I didn't think so.

OP, I think you already know the answer to your own question.

i don't think i'd ever report anyone for their type of assessment. RNs do their own thing and i think it's their freedom to do so. but i just wanted us all to get a little honest here. how many of us have charted radial and pedal pulses (on a healthy, walkie talkie patient) and haven't actually tactually checked them? Ok, Ok, if you actually DO check them every time regardless of what type of patient it is then that's your thing. But from what I've seen I can strongly say that a lot of false charting goes on (when you want to get technical about it). I think RNs develop their own way of doing things and again, that's your freedom to do so.

*if you're working in ICU and you aren't doing a thorough assessment then there's a problem! Med-Surg patient's aren't nearly as complex and some of the patient's that come in are quite healthy.

Specializes in MICU, neuro, orthotrauma.

i've always done pulses as part of a normal check, it takes seconds and isnt hard?

As an "older" RN, (I have been in practice over 25 years) It is imperitive to do a complete assessment on each patient in your care and those of any LPN/LVN's under your direction. Not doing a complete assessment leaves you open to not only legal issues but ethical issues as well. How can you report a patients condition to their PCP if you do not know what is going on with that patient? I know many of us are stretched too thin to many days, but you became a nurse to care for patients. Do not let what others do influence the care you provide, no matter how busy you are. You will have the advantage of knowing you are doing the very best for the patients assigned to you, and will be known and respected as a nurse the physician can rely on to be the eyes and ears that will produce the best outcome for each patient. :nurse:

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