Slooooow!

[fallrisk2008]

I have been on a clinical rotation on a surgical unit for about eight weeks. I graduate from nursing school next week. So far the feedback from my preceptor and teacher has been positive--until last night. I'm caring for three patients and it took me until exactly change of shift to get everything done. My preceptor, a nurse for over twenty years, pulled me to the side and said: "I noticed that when you do assessments you are very thorough, even on the second assessment. I notice you spend a lot of time doing things like checking for pedal pulses which slows you down. I don't even bother checking for a pedal pulse. You will need to be a lot faster when you have up to five patients. Focus on the areas that are most important. If they've had an abdominal surgery, focus on the abdomen."

Firstly, I disagree with her advice. Since surgery patients, especially ones confined to bed are more prone to DVT, I will continue to check pedal pulses and do a very thorough assessment. With time, I know will become faster. I'm also a triple-checker when it comes to medications because an error could be extremely detrimental. But, I do agree with her that I am slow and do need to be faster. My plan is to spend a few days creating a cheat sheet I can carry with me (until it becomes routine) to condense all of the nursing actions into less trips into the patients' rooms. For instance, flush lines, do assessment, pass meds, draw labs, etc.

I would appreciate advice from experienced nurses about ways to be more efficient or to speed up. Thanks!

[widi96]

A thorough assessment is great - but I would have to tend to agree with your preceptor that maybe you could cut out some of the details on follow up assessments. If a patient has great pedal pulses with your first assessment, and do not have major risk factors for that to change, I would tend to call that good. Of course if they started complaining of pain, discoloration, etc, you would recheck. It all comes with time though - learning what is more of a priority. At least you are more thorough and concerned about your patients - that is a complement to you and your work.

[Mo_RN]

I don't have any advice, but I can relate to your story. Just before I graduated, my instructor told I was "thorogh" also and said that I was too slow. She also liked that I was SAFE, but said I shouldn't seek a telemetry/cardiac position because I'd never leave the floor. :chuckle I believe she was probably trying to show how to prioritize your time, though I think every nurse is different and you should never try to be someone you are not. Better be safe than sorry. :wink2:

[Becca608]

I would do 1 full assessment during the shift, but make one more focused.

For example, when you start your shift and have meds to do as well, then I would use the info on the Kardex and from report to quickly prioritize the order of assessments. Since you already have a good idea about each client, do a focused assessment pertinent to the presenting complaints. Once meds are done and things settle down, then go back to each and do a thorough assessment.

Remember--its your license and your means.

[RheatherN, ASN, RN, EMT-P]

you will in time do what you need to do for yourself. if that makes sense. BUT. the first assessment is meant to be the full assessment and the second is the reassessment. i know what you mean that every part is important, but that is why the pt will get another complete assessment when the next shift starts. you will learn to what things can change rapidly, and what kinds of things you may be checking for that wont matter in the amount of time you do your first until the 2nd assessment. the second assess is called the "focused" assessment, and thats what you worry about. if its an abd thing, yeah- there may be more than you would do for other pt's, but there still should not be as much as the first assessment unless you notice something wrong or otherwise stated. it takes time, time and more time to get a flow to get what you need done i the time you have. if you dont, and it gets to be OT a lot, or no lunches a lot, your NM will be on you for that and not approve that OT. and probably get on you about organizational skills. i think its WONDERFUL that you are going to make a cheat sheet, but dont worry or get nervous, because that will change over time also.

once you are on your OWN finally, i am telling ya, and i think others would agree- things make soooo much more sense when you have to think about the entire picture yourself. be methodical; take your time; and dont worry about what your mentors are saying to you, unless you are endangering a pt of course, but they do what they do, you will do what you do. just think, if this is the worst of your problems, you are in the right place to be stressed out! just starting and this website!! :)

GL! you will do GREAT!!!!

-H-RN

[Xbox Live Addict]

A thorough assessment is great - but I would have to tend to agree with your preceptor that maybe you could cut out some of the details on follow up assessments. If a patient has great pedal pulses with your first assessment, and do not have major risk factors for that to change, I would tend to call that good. Of course if they started complaining of pain, discoloration, etc, you would recheck. It all comes with time though - learning what is more of a priority. At least you are more thorough and concerned about your patients - that is a complement to you and your work.

Many of the NCLEX questions will be about time-management and prioritizing - which patient, from several with widely varied diagnoses and levels of acuity, should you assess first? Which patient's condition warrants more immediate attention?

[kmoonshine, RN]

Speed will come with time. You have to become comfortable with patient assessments under YOUR terms, not someone elses terms. With time you will develop a routine, and you will be able to quickly pick up on things that "just don't seem right".

Being able to do a good assessment is very important. It determines if a patient needs their ordered meds, or whether new meds need to be obtained. It also determines if a call to the doc is necessary, or perhaps a transfer to another bed in a different unit entirely (such as ICU).

I can't tell you how many times I've found MAJOR things wrong with a patient when I do my initial assessments...even if another nurse just finished assessing my patient (and its amazing how different these assessments were).

Keep chugging along, and do what YOU need to do - its is your license, afterall...

[sam20007]

Hi,

I agree with you 100% every assessment needed to the patients in order to provide them with full care, however, after few years you will be expert in assessing your patients and you will be faster and also you will know when it is important or not. Just as a start continue doing what you think it is right because when something goes wrong you will be blamed alone and no one will help you.

Cheers

Sam

I have been on a clinical rotation on a surgical unit for about eight weeks. I graduate from nursing school next week. So far the feedback from my preceptor and teacher has been positive--until last night. I'm caring for three patients and it took me until exactly change of shift to get everything done. My preceptor, a nurse for over twenty years, pulled me to the side and said: "I noticed that when you do assessments you are very thorough, even on the second assessment. I notice you spend a lot of time doing things like checking for pedal pulses which slows you down. I don't even bother checking for a pedal pulse. You will need to be a lot faster when you have up to five patients. Focus on the areas that are most important. If they've had an abdominal surgery, focus on the abdomen."

Firstly, I disagree with her advice. Since surgery patients, especially ones confined to bed are more prone to DVT, I will continue to check pedal pulses and do a very thorough assessment. With time, I know will become faster. I'm also a triple-checker when it comes to medications because an error could be extremely detrimental. But, I do agree with her that I am slow and do need to be faster. My plan is to spend a few days creating a cheat sheet I can carry with me (until it becomes routine) to condense all of the nursing actions into less trips into the patients' rooms. For instance, flush lines, do assessment, pass meds, draw labs, etc.

I would appreciate advice from experienced nurses about ways to be more efficient or to speed up. Thanks!

[RN1982]

I disagree with your preceptor too. What if the oncoming nurse the next shift finds that the patient's leg is red/swollen/painful and possibly has to have dopplers because the patient now has a DVT? There are too many "what ifs" to not assess a certain area. Do your assessment your way. It's gonna be your license on the line in the next few weeks. Once you get used to do assessments it won't take you long to complete one.

[Crocuta, RN]

Firstly, I disagree with her advice. Since surgery patients, especially ones confined to bed are more prone to DVT, I will continue to check pedal pulses and do a very thorough assessment.

I'd like to point out one problem with your assessment. Pedal pulses are not an assessment component for DVT. A DVT is a "deep vein thrombosis." Pedal pulses (arterial) will not be affected by the presence of a DVT. DVT signs and symptoms are calf or groin tenderness and pain, and sudden onset of unilateral swelling of the leg. Homan's sign (pain in the calf with dorsiflexion of the foot) is accurate in only around 10% of DVT's, has a high false positive rate and is of questionable utility. Compare the site with the opposite limb and look for warmth and redness.

Pedal pulses are a useful assessment in peripheral arterial disease, acute peripheral arterial occlusion, aortic dissection, lower extremity fractures or crush injuries (from compartment syndrome or arterial damage.)

With time, I know will become faster. I'm also a triple-checker when it comes to medications because an error could be extremely detrimental. But, I do agree with her that I am slow and do need to be faster. My plan is to spend a few days creating a cheat sheet I can carry with me (until it becomes routine) to condense all of the nursing actions into less trips into the patients' rooms. For instance, flush lines, do assessment, pass meds, draw labs, etc.

I would appreciate advice from experienced nurses about ways to be more efficient or to speed up. Thanks!

Speed comes with experience. With time, you will ingrain your assessment into your brain until it becomes as natural as writing (do you think about how to form each letter - no, it's just muscle memory now). One day you'll find that you performed a portion of your assessment as you were walking into the room without even thinking about it. Do focus on the key components of each disease process to ensure stability and then move out from there. When I first come into work and take over patients, I want to see each one very quickly to make sure that I know the status of that patient (I can accomplish this in 5 minutes) and then I prioritize my more thorough assessments based on severity and stability. Again, you'll get this with time. Right now, focus on learning the norms and you'll get faster at catching the abnormal.

[fallrisk2008]

:imbar I'm having a "duh" moment. But, when I'm checking those pedal pulses I'm assessing the lower extremities--so hopefully, I'd notice if there was a DVT. Thanks for setting me straight on the purpose of checking the pedal pulses. I wonder now why none of my instructors ever corrected me on that point (LOL!) I appreciate the comments thus far. I have two job options: hospice or a med-surg unit and need to pick one in the next couple of weeks. I wonder how differently my assessments will need to be depending upon which I choose...

[respect all nurses]

I have been on a clinical rotation on a surgical unit for about eight weeks. I graduate from nursing school next week. So far the feedback from my preceptor and teacher has been positive--until last night. I'm caring for three patients and it took me until exactly change of shift to get everything done. My preceptor, a nurse for over twenty years, pulled me to the side and said: "I noticed that when you do assessments you are very thorough, even on the second assessment. I notice you spend a lot of time doing things like checking for pedal pulses which slows you down. I don't even bother checking for a pedal pulse. You will need to be a lot faster when you have up to five patients. Focus on the areas that are most important. If they've had an abdominal surgery, focus on the abdomen."

Firstly, I disagree with her advice. Since surgery patients, especially ones confined to bed are more prone to DVT, I will continue to check pedal pulses and do a very thorough assessment. With time, I know will become faster. I'm also a triple-checker when it comes to medications because an error could be extremely detrimental. But, I do agree with her that I am slow and do need to be faster. My plan is to spend a few days creating a cheat sheet I can carry with me (until it becomes routine) to condense all of the nursing actions into less trips into the patients' rooms. For instance, flush lines, do assessment, pass meds, draw labs, etc.

I would appreciate advice from experienced nurses about ways to be more efficient or to speed up. Thanks!

Just have one suggestion which has always worked well for me. As soon as you get your assignment, before the narc count and taking report, take a moment and "eye your pts" to make sure they're alive, not in distress. For example, once prior to getting report... I went to eye a pt transferred from ccu who had been previously been on the unit and had a extensive med. hx. This pt had "coded"! A quick pre-assessment has always worked for me, doesn't take up much time and can improve pt outcomes. Sounds like you're off to a great start, establishing your routine/check list etc. Good Luck and Congrats!