Have you ever noticed ...

  1. I was just curious if any other nursing students have noticed this ...


    Working on the floor I have noticed throughout all my clinicals and also my preceptorship that ALOT of nurses don't perform assessments. I've also noticed that many nurses don't even bring stethoscopes to work to assess breath sounds, bowel sounds, etc.


    Has anyone else noticed this?
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  2. 13 Comments

  3. by   colleen10
    YES!!!! I have noticed that at a lot of places I have been also.

    I have also noticed a lot of nurses not wearing gloves when they should, ie. blood draws, giving injections, emptying urinals and bedside commodes.
  4. by   NurseWeasel
    About the assessments: Bet they ARE doing them, just not the long, involved ones you learn in school. With experience (and necessity due to staffing levels) you get to where you are really fast and run on intuition. There's no way you can do a "nursing school" assessment (and document it properly) on 4+ patients within the first hour you're on shift... to say nothing of reading care plans, reviewing meds, and dealing with emergent issues. I've learned that the best thing to do is a mini-assessment right away when first going on shift, documenting that, then going back later as I have more time, and doing the more thorough assessment.

    Just my .02
    Last edit by NurseWeasel on Apr 13, '04
  5. by   NurseRatchet26
    :uhoh21: :uhoh21:
    That is not only unsafe and unsanitary, its just plain gross!! EW! EW! EW!

    Quote from colleen10
    YES!!!! I have noticed that at a lot of places I have been also.

    I have also noticed a lot of nurses not wearing gloves when they should, ie. blood draws, giving injections, emptying urinals and bedside commodes.
  6. by   orrnlori
    My preceptor in my first job had the amazing ability to do assessments while sitting in the nurses station eating frosted mini-wheats!!!!!

    I never saw her handle a stethescope, she didn't own one, and this is the person who was suppose to be overseeing me, a brand spanking new nurse. Although I was suppose to be precepted for 8 weeks, I begged the DCN to allow me to go it alone after 4 weeks and she let me. Thank God. My preceptor was the worst nurse I ever worked with. I think she volunteered to precept so she could sit on her hindend.
  7. by   VioletX
    My preceptor was exactly the same way.

    She hardly ever did anything related to patient care while I was on the floor. Anytime I asked her a question she would either answer "I don't know" or "look it up" and then had the audacity (?) to write on my final evaluation ...

    "Amanda need to collaborate more with healthcare team about procedure she don't understand how to perform & treatment she haven't done. There is nothing wrong in not knowing. It's wrong when you don't say, I don't know or will you show me or explain to me, a procedure. Hospital policies are available on all procedures."

    Hopefully my instructors will see the spelling and grammatical errors and think exactly what I think "what an idiot!".
  8. by   Gompers
    I don't know how it is on the floors, but I work in an ICU and we certainly do full assessments and if we forget our stethescopes we feel lost and naked! Then again, my patients are tiny so it takes all of 90 seconds to do a head to toe assessment including vital signs.

    But I hate to say it...recently when I was a patient in a med-surg unit, I think over the entire 24 hours I had a stethescope against my chest once, maybe twice. They took my temperature twice, and never once got a BP. I was in for a procedure that ended up being cancelled, so I wasn't sick or on any pain meds so I was "with it" the whole time. It was also near impossible to get a nurse in my room, probably because I wasn't really sick. My IV tape had all but sweated off and it was over 4 hours before I could get someone in to change it - and at that point I had undressed the whole thing and pressed the call button with my nose, asking the nurse to just bring me a Tegaderm and some silk tape so I could retape it. She flipped out on me! (Of course once she came and put the tegaderm on, she asked if I was okay to do the silk tape to secure it on my own, as she had to run.)



    It was my first (and last) experience with that particular hospital.
  9. by   Ortho_RN
    Ahh yeah.. Well if you can find time to do a "nursing school" assessment on 13pts on Night Shift let me know... I do assess my patients.. But I just cover the main points... I work on an Ortho floor so our assessments steer towards whatever part had surgery, checking for swelling, movement, Cap refill, temp, etc... But I do listen to my patients lungs and heart..
  10. by   colleen10
    About the assessments: Bet they ARE doing them, just not the long, involved ones you learn in school. With experience (and necessity due to staffing levels) you get to where you are really fast and run on intuition. There's no way you can do a "nursing school" assessment (and document it properly) on 4+ patients within the first hour you're on shift... to say nothing of reading care plans, reviewing meds, and dealing with emergent issues. I've learned that the best thing to do is a mini-assessment right away when first going on shift, documenting that, then going back later as I have more time, and doing the more thorough assessment.
    This is true, I once was paired w/ an RN who was accepting a new admit to the floor. She could do a whole assessment in under 3 mintues. It was really cool to see how she could do two things at once like check placement of the nasogastric tube while rolling the patient into a proper position in the bed and checking skin integrity to boot.
  11. by   Tweety
    You don't know what those nurses are doing and when they are doing their assessments. Don't be so quick to judge.

    It is scarey though that so many of you say "a lot", so I'm sure it's happening.

    To me an assessment is an ongoing affair all day long. You might not see me do a full head to toe assessment when I first see the patient. But later on when I get him up to the bathroom, I'm going to note edema in the lower extremities and pedal pulses. But if they are in for pneumonia, I'm not going to necessarily to check their pupils. (I'll leave that for the students to do. ) I focus my assessment based on their diagnosis.
  12. by   VioletX
    I am not saying that it should be a "nursing school" assessment. I don't even do that and I'm in nursing school. But you know, heart and lungs are always important, pain, skin integrity. Then whatever is specific to that patient. Most nurses I know probably do assessment to the point that they assess what ever they can without touching or moving the patient at all with all the covers on top of the person. This is what I consider lazy. I understand being busy, but damn ... if you have a patient that just had an abdominal surgery .. take a half a second and atleast look at the bandage!
  13. by   Tweety
    Quote from VioletX
    I am not saying that it should be a "nursing school" assessment. I don't even do that and I'm in nursing school. But you know, heart and lungs are always important, pain, skin integrity. Then whatever is specific to that patient. Most nurses I know probably do assessment to the point that they assess what ever they can without touching or moving the patient at all with all the covers on top of the person. This is what I consider lazy. I understand being busy, but damn ... if you have a patient that just had an abdominal surgery .. take a half a second and atleast look at the bandage!
    Exactly. You know when you're working with someone who is doing their charting after 15 minutes on the floor, then they didn't do an assessment. Not only are those nurses lazy, they are scarey.

    I worked with a nurse who got caught filling out her midnight and 4:00 assessments (we did q4h in neuro) at 8pm by a doctor. It was on one of his patients. She got in major trouble.

    But also don't assume because they didn't lift up that blanket, that they aren't ever planning on assessing the dressings. Maybe just not at that moment.

    We have enough business of our own without worrying about what the next guy is doing anyway.

    Cheers.
  14. by   Marie_LPN, RN
    When i've seen this happen, it's been a new admission, and the nurse was putting the unperformed assessment in the computer. For example, clicked "lungs sounds clear A and P". Well you never even TOUCHED the stethoscope, how do you know they're clear A and P???

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