Was I wrong?

[st4304]

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). We are not given assignments because something nasty always comes through the doors and we are called back to the cath lab.

The other day I had to float to our cardiac step-down unit. When I arrived to the floor, the charge RN gave me my assignment. My assignment was to do the first assessment of the shift on 6 patients. She started to give me a mini-report on each when I asked, "Am I being assigned these patients?" I had no problem with this as long as she had a back-up plan in case I had to leave suddenly. But she said, "No. These are Betty's (an RN) patients and she wants you to do her assessments."

Me: "What will Betty be doing?"

Charge: "Passing meds and dressing changes. You know, tasky stuff."

Me: "Wouldn't it be better if I did the "tasky stuff" and she assessed her own patients?"

Charge: "This is how she wants to do it."

I refused in the nicest way I could, but ended up with the manager of the floor, who for some reason felt she had to get involved, being very rude to me in the process. But I still refused.

So I started doing the tasky things. . .started a couple of IVs, passed meds, gave a few pain meds, answered call lights, walked a patient, etc.

After a couple of hours, the charge RN approached me and asked me if I would help Mary RN admit her new patient. "Sure!" I said. I get into the room and Mary tells me, "Why don't you do her physical assessment while I go check her orders." Huh? What is it with this floor? I again refused. And again I was the bad guy. And you guys, I have to interject at this point that I am very nice and easy going. It really bothered me that I was making people mad at me, but I felt like no one was listening to my reasoning. I was made to feel like I was being lazy or acting like a "snooty" cath lab nurse which was not the case at all.

The reason I was refusing to do these assessments is: When an RN accepts her assignment, is it not her duty under her state practice act to assess her patient and then plan that patient's goals around that assessment? (I realize I way over-simplified that, but for the sake of time. . .) What I was being told was that the law requires each patient be assessed by an RN each shift and they didn't care who the RN was doing the assessment just as long as it got done.

I just could not get through these nurses heads that THEY SHOULD WANT TO DO THEIR OWN ASSESSMENTS!!!!! How would they know what was going on with their patients if something would go wrong? Sure, it would have been documented. But, honestly, I just could not believe a nurse would accept her assignment and not want to do her own assessments. Especially a new admit!

I have had a few nurses on that floor stand up for me, which makes me feel better, but I am the type of person that wants everyone to like me and it really bothers me if someone thinks bad of me. (I think this is my "Middle Child Syndrome" rearing its ugly head!)

Anyway, does anyone out there think I was wrong? Should I have done those assessments?

Please be nice. . .I bruise easily.

Thanks!:roll

[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

[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. :)

[mattsmom81]

I agree Kimberly, As a 'float' out of ICU many times I will be 'admit nurse' on the floors and do ALL the admission asessments for the nurses. I am always careful to document " admission asessment report given to patient care nurse_____" on the form.

I guess one could do the same with daily asessments but it seems like a waste of time relaying all that info to the care nurse.......

As a float, I don't blame you for speaking up as you were not comfortable and we are all accountable for our practice. In reality, floor RN's sometimes must do asessments for other nurses; in my facility policy requires a full RN asessment q 24 hrs, so if I'm working with an all LPN staff it can get hairy...LOL!

[lm57lm57]

I agree that the assessment is the primary nurse's responsibility. I think that in this very busy job, I see people so overwhelmed they try anything to lighten the load. Assessments are not the thing to get out of. It is the foundation of taking care of the patient. I would much rather do my own assessments. Sorry it got so nasty for you....take care and know you ARE supported

[shipslitehse]

I agree with your stance 99.9%. The only way I've experienced another nurse doing anothers assessment work positivly was during my preceptorship in SICU...We all stormed the room of a new admit and while the primary nurse interviewed and wrote on the chart we all set up and called out the physical assessment findings, but the primary nurse was IN the room and gathering all the info.

I too hate to be thought of negatively....I hope i will be able to have the courage you displayed when faced with a similar situation.

[scrappy]

I won't comment on whether she was right or wrong because I don't know what she was thinking, but I do want to say that I just wouldn't feel comfortable with someone else doing my assessments. That really is my baseline for how I am going to prioritize my day (well, night). Also, I want to know what is going on with my patients.

[dstout-rn]

fergus

You are lucky enough for them to crump mid-shift mine always wait until right before shift change:rolleyes:

[live4today, RN]

I, too, insist on doing my own patient admits and initial assessments. I also insist on double checking vital signs with patients who have high risk diagnosis, too. :)

[whipping girl in 07, RN]

My initial response to your story was "lazy floor nurses, doesn't surprise me a bit."

My next response was "snotty cath lab nurse, doesn't want to do that crappy floor nurse stuff...:roll OK, you can laugh now, I was just kidding...I actually want your job!!

Then someone said that maybe the nurses didn't like drowning in paperwork (me neither!) and would like to be nurses, so if you did the paperwork it would really help. Makes sense to me.

Except there's a problem. If the nurse ultimately responsible for the patient does not ASSESS the patient, how can s/he possibly care for the patient? It would be like planning your day's actions from report without going in and checking for yourself. I can't believe someone would do it.

As for the admission assessment, the floor nurse could do it and someone else could enter it in the computer. We do that all the time; the same goes for orders as well.

Our hospital policy is that the nurse caring for the patient has to do an initial assessment at the beginning of their shift. In ICU we assess every two hours; if I have to pick up a patient for only 4 hours, I still have to do that long initial assessment again that the former nurse had done only eight hours earlier. But if the patient had had the same nurse for the entire twelve hours, there would have been only one long assessment. Sigh...paperwork really sucks! I feel when I'm writing that I'm really only covering my ass, because the only people who ever look at the chart again are the attorneys when they supoena it for their malpractice suit...

I think I'm too new to already be this jaded!