Was I wrong? - page 2

I normally work in a cath lab and on rare occasions, we will have no procedures scheduled. On these days, we are floated to various floor as "helpers" (BTW, we are all RNs doing the floating here).... Read More

  1. by   JillR
    I agree that the nurse that admits the patients is responsible for the assessment. Occaisionally, I get that request from the med/surg nurses, when I call report to them about an admit (I work ER) they want me to complete the assessment before I bring the patient to their room. I won't do it either and have told them that they need to do their own assessments. I will give the patient any stat meds the doctor had ordered and such, but there is no way I should be responsible for someone elses admission assessment.
  2. by   SKM-NURSIEPOOH
    Originally posted by grouchy
    If one RN said this I'd just write her off as the bad apple in the bunch. To have several RNs think this is normal is disturbing. To have the charge nurse AND manager backing them up is beyond shocking. Doing your own assessments is the expectation where I work!
    I'm in total agreement with every poster here on this thread...and can't believe my eyes!!! How can any nurse ask someone whom they know may get pulled back to their respectives departments to perform six assessments; then turn around & try to trick that same person into during an administion assessment. I don't understand how people can be so...what else can I say...stupid, lazy or both!!! I have seen people all the time trying to pass-off the largest or worst assignment to the floater...which stinks...IMHO!!!

    It makes no sense in even asking someone to do this unless the nurse that wanted to get-out of doing the assessment herself was, indeed, incompetent. Perhaps that will explain the supervisor's & unit manager's intent??? It makes no sense to me because they wouldn't know your assessment ablities like they know their own staffs', unless you were pulled to this particular unit quite often in the past.

    I would like to question the legalities of what they were attempting. If something were to happened after you've assessed those patients, went back to your own department, & the assigned nurse didn't follow-up or missed any pertinent changes; I wouldn't be surprised if this staff nurse, her supervisor, & manager might try to pin it on you, st4304...you know, to cover their own a**. This is your license here...which I'm sure you've worked very hard to get.

    I only suggest that you continue to refuse any ridiculous assigment that sounds like a set-up or that may endanger patients as well as your license. I know that this sounds rough & that a lot of people don't have that opportunity to refuse, but in your case, I think you were justified in refusing. Whenever something doesn't feel right, it usually isn't.:zzzzz :zzzzz
    Last edit by SKM-NURSIEPOOH on Mar 22, '02
  3. by   kathartic
    I would like to say a few words in defense of the other nurses. The M/S floor where I work is very busy and very hectic. We are overloaded with paperwork.
    I believe that those nurses who were assigned to those patients assessed them every time they approached them. As all competent nurses do.
    I think what they were really asking of you is: "Please do this tedious paperwork for me this one time and give me a chance to be a real nurse to my patient."
    I know I would be blessed by the chance to provide care and not fill out the forms which justifies my existance to some bureaucrat. Just once, God, Please.

    Kathartic
  4. by   wrightgd
    Sherri,

    First off... you are exactly right in regard to who's responsibility the patient assessments were... Were you supposed to assess, and then give a verbal report? Often when I did floor nursing, and there was a team approach to get a new admit settled in, I would go back and re-assess within the hour, because it was my patient... Not that I didn't trust someone elses assessment, but because I was the nurse ultimately responsible for that pt's care.

    Second, please don't expect everyone to like you... Some people are just going to be disagreeable. Love yourself and those around you, do what's right, and stand behind it!!!

    Take care, and knowin your heart that you were right!

    George
  5. by   eltrip
    I don't know, Kathartic, I've worked in M/S most of my nearly 8 years as a nurse (I presently work in a call center, but I pick up shifts on the floor on Saturdays)...I would expect most RNs to assess their patients the first time they see the patient during that shift, whether they're giving meds, changing dressings, etc. That's my standard of practice, at least.

    HOWEVER

    I have also seen nurses (RNs) who didn't chart a single thing on their patient during the entire 12-hour shift. Makes me wonder if the assessment was even done?! I've also worked as the only RN on the floor, working with LPNs...I was required to do the admission assessment, & later found that the LPN caring for the patient didn't assess him herself because I already had!! These episodes happened at 2 different hospitals in different cities, about 3 years apart.

    I believe that the manager & charge nurse may expect that the nurse "caring" for the patient DID perform the assessment, but why they'd expect someone floating through to chart it is beyond me.
  6. by   Perk
    Sherri congrats on taking a stand for your beliefs, not many people would do that. I can't imagine the primary nurse for a pt. not doing the morning assesment. Did the nurse at least know your style well as nurse and have full confidence in your assement skills (I am in no way insinuating our are not a good nurse, from your reaction I am sure you are a great nurse) but what if you were one of those nurses who did a half a$$ed assesment were would she stand at the end of the day if something was missed. Hope you don't end up floating to this floor with these problems again
    Nancy
  7. by   BrandyBSN
    I am still a student, but I would say that you were right 100%! If you are the nurse doing the assessment, you would be responsible for that patient rather you get called back to cath lab or not. It would be MUCH better for the RN that will be taking the patient to do her own assessment, so that she has a complete personal picture of what is going on.

    BrandyBSN - 52 days till finals are over
  8. by   babs_rn
    Kathartic,
    I agree with you. Having been on both sides of the coin, currently in CCU - many times when we're not busy we've been called out to the floor by the supervisor to go do a new admission assessment since the nurses are busting their behinds..and i don't mind it a bit. I give the nurse assigned to the patient a quick report on anything pertinent. REALITY CHECK: there's so much paperwork to do and these girls already have 9 or 10 patients apiece and maybe one tech on a 35 bed floor, and the admission assessment is 13 very detailed computer screens long! I'll also jump in and help some of the nurses on the unit if I'm not busy and they can't type well - I can get it done in 1/4 the time it takes them to since I type about 70 wpm. Also, more often than not, the nurse assigned to the patient is busy getting all the other admission stuff done, starting IVs, taking care of stat stuff, etc, and is in and out and hearing much of what's going on with the admit assessment. The biggest part of our admit assessment is history and assigning fall risk, nutritional risk, and determining if social services is needed (through a "trigger" questionnaire that is forever long for each one) and our policy says that will be done within one hour of the patient's arrival on the floor. If not for me coming in and doing that for them, it wouldn't be done in that time frame and you can't back-time that in the computer. Hey, I'm there for 12 hours anyway, it doesn't matter what they put me to doing as long as I don't have full responsibility for the patients when I'm floating. It's all about TEAMWORK. May not be the popular response, but it's reality.

    Babs
    Last edit by babs_rn on Mar 22, '02
  9. by   babs_rn
    Oh, and by the way, I always document when I report off to another nurse...covers me.

    Babs
  10. by   danny
    Please help! Although I was born in Australia, I did nursing school in Italy....which means I don,t understand exactly all medical terms. What do you mean when you refer to a nurse doing assessment?
  11. by   babs_rn
    *
    Last edit by babs_rn on Mar 22, '02
  12. by   babs_rn
    Danny,

    A shift nursing assessment is when you go in and check out your patient, listen to their lung sounds, look at their IV site, etc, and document it. An admission assessment is when you do all that and get their entire life story and their parents' and grandparents' and siblings' medical history and document that and set up a general nursing care plan for that patient. Usually thanks to our legislative bodies that also means we check out their nutritional status to see if the dietician needs to come see them, a home situation evaluation to see if the social worker needs to come see them, ask questions about their religion to see if they have any religious objections to any aspects of medical care or dietary restrictions based on religion, what foods they like, what foods they don't like, whether or not they want to see the chaplain, if they have an advance directive or not and if they don't, whether or not they want more information on that, an evaluation of their risk for skin breakdown, an evaluation of their safety risk (are they liable to fall down if they try to get up out of bed? kind of thing - our facility has a five-section questionnaire for that one with points assigned to each "yes" answer), determine whether or not they can read and write and if so, if they can do so in English or if we need a translator (good luck finding one of those after 5pm!) and what their work habits, social habits (smoking, drinking, drugs, herbal remedies, etc), and recreational habits are. That's where we document what meds they take at home and when their last dose was, and if they understand what that med is for and if they know what interactions those drugs might have with certain foods. We also have to determine if they are at risk for MRSA isolation and institute that on admission pending nasal cultures if they fall into certain categories. There's also a TB risk assessment.

    Did I leave anything out?

    Oh yeah, and we have to document how they learn best...through reading, demonstration, or whatever.

    It's real fun to try to fill all this out if they don't have an old chart, no family around, and come up from the ER on the ventilator. Then the history portion is basically filled out with the words, "intubated, sedated, and vented. Unable to determine history" - the powers-that-be don't like that, but hey! I can't manufacture a history!

    Hope this helps. Interested to know what y'all do that parallels that where you are.
    Babs
  13. by   SICU Queen
    I would never care for a patient without doing my own assessment. However, it's not a problem for me to do an admit assessment for another nurse, report any pertinent findings to the nurse that will be caring for that patient, and documenting that I reported such findings to that particular RN.

    Having worked the floor and ICU, I can understand wanting some assistance with an admit. Working the floor can be so frantic that you don't know which way to turn, and having another nurse come in and do all that paperwork can be a lifesaver. Another RN can certainly do a complete assessment on admission and the RN responsible for the patient can get a report and quickly physically reassess the patient to verify things...

    Just my opinion.

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