LPN discouraged about 'assessment' skills...

  1. 0
    I have been an LPN for two years now. I started in corrections where I had a slew of RNs and Physicians around me. I was good at my job and knew exactly what to do all the time. I am now in LTC in a level III res care setting. I feel that my assessment skills are low and the RNs around me expect me to know a lot more than I do. I manage a unit of only 20 residents who are healthy for the most part, I know that I am a good nurse but I am very afraid that I am going miss something...
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  3. 9 Comments so far...

  4. 1
    Don't let anyone bring you down you're doing your best keep your head up
    AngelicDarkness likes this.
  5. 3
    I understand what you're saying. I started in corrections as a new grad, and where I worked all LPNs did was pass pills. The RNs did everything else. Then I moved to LTC, where LPNs do everything and it's impossible to tell a RN from LPN unless you look at their name tag.

    Be honest, tell them you still need time to learn your role. Assessment skills are learned through practice, and you will have plenty of that as a nurse in LTC. Just don't feel pressured pretend you know more than you actually do. Nothing is more dangerous than a nurse who's afraid to admit they don't know the answer and who's too afraid to ask for help.
    HazelLPN, Orange Tree, and Fiona59 like this.
  6. 2
    I thought LVNs were more hands-on in corrections?

    Well - even if you don't, your coworkers should take that into consideration, I think.

    Throw a LTC nurse on a medsurg floor and they may flounder a bit. It's been ages since they've used certain skills.
    Throw an ICU nurse in an LTC and they might be somewhat overwhelmed by the pt load+paperwork+CNA drama...and that damned phone! LOL Sure, ICU is totally complex but 30-50 residents in your care will take some getting used to. An ER nurse will probably shine, though. They seem to be more like 'generalists'.
    Throw a pedi nurse on a psych floor and they might be completely out of their element. Unable to manage the pt's or function in a sometimes chaotic environment. An ER nurse (again) would probably shine.
    Throw an admin nurse...well, anywhere and you can expect them to be a little rusty.

    My point is, we all specialize and every nurse WON'T have the same skill-set.
    If they understood where you got your start, maybe they'd be more understanding.
    You really shouldn't be so hard on yourself. You have skills and now you're perfecting new ones.
    Starr1966 and LTCNS like this.
  7. 2
    Never be afraid to ask a question when you're not sure about something.

    "Hey nurse so-and-so, I think my patient has xyz....can you come with me and take a look and tell me what you think."
    LTCNS and Fiona59 like this.
  8. 0
    my advise find an old brute hard nosed nurse follow her notes (mentally) as far as assessment for me it was simply knowing the pt I had 32 pt 4 CNA's for 16 hrs sometimes, after u get used to them you can tell when something is wrong start with the worst of their Dz processes COPD pay attention to lungs and heart skin color resp pattern ect, for dementia, pain what makes pain worse is it anxiety, pain or over-stimulation, constipation or do they need med intervention did they start on something new is the behavior worse... my assessment is always as follows, what is dx...what do they look like...IS IT NORMAL...how's mentation can they communicate with me... IS IT NORMAL...skin and eyes, head to toe... problems interventions and who i notify,ex:

    huh pt is COPD, skin pale circcumoral cyanosis, resp patter shallow but non labored, speech is garbled, noted much situational confusion, O2 set @ 6 L/min... think think... lower O2 give pt support encourage deep forceful breathing clearing lungs each time check O2 sat.... long term intervention, at the end of shift especially if your new, just report to oncoming nurse what happened and what you did and ask her that sound good to you? or idk what do you think? she'll give you her/his opinion, next day pay attention to her documentation se if you see what she did, then next time you know next time trst me with old folks it's going to happen again when the have chronic issuses
    Last edit by malenursega on Jan 25, '13 : Reason: missing letters
  9. 1
    Go ahead and let your guard down. Most of us are weak in at least some areas. If you have no idea what a pleural effusion sounds like, get the word out that you want to listen to any patient's lungs with that diagnosis. I used to get nervous asking about things I felt I should already know. Now that I freely admit my shortcomings and ask for help, I find people approach me with the same types of questions I ask them.
    BrandonLPN likes this.
  10. 0
    Thanks guys! You are right, I should be letting the other nurses know my weak areas so that they can show me things with patients that I haven't seen. I have been reading other people's notes so that I can see the terminology that they use and any interventions done.

    I corrections the skill set I obtained was so different- I have great wound care skills, opiate/alcohol withdrawal knowledge, and am great with meds- it's the disease processes and normal aging process that I am really second guessing myself on.

    Confidence and asking questions, I'll get through it! : )
  11. 0
    Ask one of the RN's or other LPN's that you see to co-assess random patients with you *OR* ask them to come get you to assess THEIR patient if they see something different/ interesting so you can compare. Many (not all) nurses LOVE to show off (i do). It feels good to have someone ask for your help, especially when improving their practice. I think you'll be surprised!
  12. 0
    It will come with time Don't be afraid to seek new opportunities to practice your assessments with a peer if you have time, or even buddy with a mentor at work for their assessments.


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