Physical Assessments: Do Any Nurses Do Them

  1. 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.......
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    About romie

    Joined: Mar '06; Posts: 391; Likes: 210


  3. by   pinksugar
    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.
  4. by   SunnyAndrsn
    How could you go wrong doing a physical exam of these basic systems? Other nurses have to worry about their licenses, you worry about yours. If you are checking off in an assessment that "lung sounds are clear" you can only know that if you auscultated their lungs. I too find it frustrating when I suspect other nurses around me are cutting corners.
  5. by   darkangel_05b
    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...
  6. by   jean36
    pls keep up with your complete physical assessment spirit, don't lag behind like many of us. the truth is many nurses don't do complete physical assessment and there are legitimate reasons in some cases and depending on the unit. however, it would always be prudent to do it.
  7. by   ONCRN84
    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...
  8. by   eriksoln
    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).
  9. by   twinner2
    I agree with some of these earlier comments: Definitely do your assessments. I have been a nurse less than a year, and I do a PA on all of my patients. Corners should not be cut by forgoing an assessment on each patient.

    Keep up the good work!
  10. by   RNperdiem
    The assessments you describe are standard for my unit, we check those things and more every 2-4 hours.
    I sometimes leave my stethescope in my bag.
    Sometimes my unit has a lot of isolation patients, and you have to use the cheapie hospital provided stethescope found in each room, so there is no point carrying your own.
    I am concerned that a new grad is not being taught to assess a patient the right way.
  11. by   Otessa
    How can anyone chart"Meets Standards" if they haven't actually assessed their patient????

    No PA?? I was a bedside nurse for over 15 years and I always did a full head to toe on my patients-I floated throughout the hospital-all different kinds of patients.

    All I can say is WOW!!!

  12. by   netglow
    OP, my most recent clinical site was similar. I did not see a nurse with a stethoscope. Only once when I reported no sounds, my RN did ask to use mine at least. A good thing for me to remember to look for when interviewing! That speaks volumes about the floor, huh. After all, these people would be so out of practice, do you really think they are good enough for you to gain any real skills from? I know that sounds kinda upitty from a newbie, but hey I'm expecting a lot from my new job. This is where you make or break it. Gotta learn!
  13. by   ghillbert
    Whatever field you work in, there are good and bad, motivated and lazy staff. Part of being a new nurse is observing and deciding whose practice you want to emulate. Just because some people are lazy (and it's not the "older" nurses, it's the lazy ones), does not affect your practice.

    There are certain things I learned at nursing school and never did again (fundoscopic exam, otoscopic exam, reflexes, etc) due to the types of floors I've worked on. Lung/heart/bowel sounds, brief neuro exam, cap refill, extremity warmth, pulses are a minimum that I do on everyone.
  14. by   Daytonite
    so my question is, am i wasting my time physically assessing my patients?
    we can only be responsible for our own actions. what would your nursing instructors have told you? do what you know is the right thing to do.
    am i doing something wrong?
    no. in fact, you are doing everything correctly.
    suggestion. . .(1) check the policy and procedure manual. see what the documentation guidelines are for your facility. they have them because it is actually a jcaho requirement that each patient be assessed and it can be found in the jcaho accreditation manual for hospitals in the section for provision of care, treatment, and services:
    standard pc.2.130 - initial assessments are performed as defined by the hospital.

    elements of performance for pc.2.130:
    1. each patient is assessed per hospital policy.
    2. each patient's initial assessment is conducted within the time frame specified by the needs of the patient, hospital policy, and law and regulation.
    3. a registered nurse assesses the patient's need for nursing care in all settings, as required by law, regulation, or hospital policy.
    standard pc.2.150 - patients are reassessed as needed.
    the scope and intensity of any further assessments are based on the patient's diagnosis; the setting; the patient's desire for care, treatment, and services; and the patient's response to any previous care, treatment, and services.
    each patient may be reassessed for many reasons including the following:
    • to evaluate his or her response to care, treatment, and services
    • to respond to a significant change in status and/or diagnosis or condition
    • to satisfy legal or regulatory requirements
    • to meet time intervals specified by the hospital
    • to meet time intervals determined by the course of the care, treatment, and services for the patient
    element of performance for pc.2.150

    1. each patient is reassessed as needed.
    although the jcaho manual element of performance is continually saying: "each patient is reassessed as needed" that doesn't mean that the hospital nursing staff has carte blanche to determine when to assess patients. jcaho will expect that the nursing department will have policies and procedures directing nurses when assessments are to be done. (2) in some hospitals staff nurses are permitted to become members of a nursing council where these kinds of issues are addressed and managed and you can still maintain a staff nurse status. otherwise, consider working toward becoming a supervisor or manager so you can get involved in policy, procedure and enforcement and can do something about the people who are not doing things the way the facility policy and procedures say they should.

    if you know others are falsifying their nursing documentation by recording assessments that they are not doing, that is a violation of the nursing law of just about every state. if you know that is happening, you need to report it to your manager. if the manager ignores you report it to the person who is the manager's boss and keep going up the chain of command until someone listens to you. in most places i worked falsification of the records was serious grounds for termination and when i was a manager we (the director of nursing and director of human resources) fired a nurse tech who was making up vital signs and blood sugars and posting them in the individual patient charts. we had another rn in a nursing home where i was a supervisor that was doing it with blood sugars and medications that she was charting and not doing, but she quickly packed up and quit when she realized she was being watched and evidence against her was being collected.

    i am never pleased about managers that would hire new grads to work on a telemetry unit. that alone, i think, is indicative of poor judgment made by the person(s) who hired you. it tells me they don't care about the nurses. managers that will do this are usually only interested in filling holes in their work schedules. only experienced nurses should be hired to work on telemetry units. i worked on one for many years. i am not criticizing you. i think it's commendable that you are surviving there. i'm willing to bet that assessment problems are only the tip of the iceberg and that there are probably all kinds of policy and procedure violations going on.