Courtesy Assessment

[kdbsmom]

Hello,

I have a concern with an unwritten practice that is done on my floor and I am trying to change it. I would like to hear what others might think.

We do something that is called courtesy assessments-which means the off going night shift nurse will have all patients who are going for a procedure assessed with vital signs, bathed, prepped, etc. I do not have a problem doing any of this. I completely support it because I know how hectic 0645-0800 is. My concern is where this assessment is to be documented. I refuse to document my assessment and vital signs on the part of the flowsheet that is designated for the day shift, because of this many on my floor are frustrated with me. I tell each of them that 1. it is not safe to document on a shift I am not working, 2. I don't think it is legal, 3. I am not doing this assessment so that you do not have to do one for your shift, I am doing it so that if the patient is called for their procedure before 0800 you don't have to rush around to get everything done, and 4. I discussed it with my manager and she said I am right to do what I am doing. Yet, I still have nurses getting upset and telling me that I am wrong. I am told that my assessment won't count for their shift, I am told that if I would document it on their shift then they won't have to do an assessment until afternoon, and a few other reasons that I can't remember at this time. What they expect us to do is go in and cross out their 0800 blocks and write the time we do the assessment, like 0530 or 0615.

This has been done for years now. It all started so that first case procedures would be ready as soon as they are called to go down. It was started as a kind act so that the day nurses wouldn't be coming straight out of report and being hit with patients leaving the floor unassessed. Then it turned into an expected thing and now everyone just assumes it is policy, it isn't.

If your flowsheet was designed in 11p-7a, 7a-3p, & 3p-11p sections with four 2 hour blocks per shift for each body system from 2400-2300, where would you chart an 0530-0630 assessment 11p-7a and the 0600 blocks or 7a-3p and the 0800 blocks?

Well, maybe I am making a bigger deal about this than it really is, but we chart by exception, so I like for my blocks to be available. I don't think you can over assess any patient and I make it habit to always assess all my patients at the start of my shift and then I do a second assessment for my next flowsheet since I work nights. I don't always assess every patient before I go off duty, but I always check on every one and do what I feel is necessary.

Thank you in advance for your opinions. If you reply, please send to the board, my email is messed up. Time for this night nurse to get to bed.

Good morning!

[Quickbeam, BSN, RN]

I was the night charge on a small 12 bed rehab unit for about 8 years. We had this issue all the time. Since we connected to a hospital, we had to have people going for procedures ready at 0700. I also refused to make it look like this was a day shift assessment. I drew up a separate pre-procedural flow sheet and documented what I did at the actual times done.

Of course this was back in the stone age of paper files. But it worked well. After I left and the unit went to computer charting, they did scan and rework my flow sheet into an on-line option.

Good luck.

[burn out]

Your fellow nurses are setting the facility up for a JACHO violation. The day shift assessment must occur on the 7-3 shift so crossing out 0800 and writing 0530 does not count for day shift. Yes JACHO will cross reference back and see what shift you were working and what time you clocked out on a specific day if they suspect something wrong. I would think your manager would put a stop to this if she knows about it. I work day shift and I know how busy it can be but I still do not trust another nurse doing my assessment and me taking responsibility for it. What if something changes in the patient from 0530 to 0800...that does happen and if the patient isn't assessed in the mean time no one would notice the difference.

Stick to your guns and be the proper role model your unit needs. Good job.

[Sarah, RNBScN]

What is on this?

Can you describe it?

Sarah

[Mulan]

I don't see any problem with your doing it as long as it is charted for the actual time done.

On the other hand, if you don't have to do it, and the other nurses are complaining about the way you are doing it, which is the correct way, charting it for the time actually done, then to heck with them, don't do it at all.

I would chart it for the actual time and in the block where it belongs.

Sounds like they are trying to bully you into doing it their way which is for their convenience.

[santhony44, MSN, RN, NP]

I don't see any problem with your doing it as long as it is charted for the actual time done.

On the other hand, if you don't have to do it, and the other nurses are complaining about the way you are doing it, which is the correct way, charting it for the time actually done, then to heck with them, don't do it at all.

I would chart it for the actual time and in the block where it belongs.

Sounds like they are trying to bully you into doing it their way which is for their convenience.

:yeahthat:

Even if you do an assessment just before the patient leaves, they still need to assess the patient when the patient returns to the floor. Particularly if the patient had some sort of procedure!

If you do an assessment at 6:30, the patient leaves the floor at 7:15, then comes back at 9:00, it makes no sense whatsoever to wait until 2:00 to assess the patient!!

I don't understand this, nor why your head nurse has not addressed it with the day staff. As another poster said, things can indeed change in a short period of time!

[ckben]

frankly, these nurses sound lazy. not only that, but apparently documentation of patient care is more important to them than actual patient care itself. if you charted that you did the assessment on their shift, would that protect them in a court of law? no, it wouldn't. it would actually incriminate them, since they neglected to assess the patient they were assigned (if it wasn't charted, it wasn't done. and lawyers as well as JCAHO know how to check which shift each nurse was working at a specified time).

i can't believe that, if you've got the patient and the paperwork ready for them, and all they have to do is assess the patient (which takes all of 5 minutes if you are really slow), they are still so lazy and ungrateful as to try to get out of charting, too. i know charting's a beyotch, but it HAS to be done by each nurse each shift. i would just tell them that if they don't chart their own assessments for their own shift, that's considered patient abandonment. therefore, by my refusal to chart for them, i am forcing them to protect themselves and their licenses. they'd probably hate me for it, but i doubt they'd ask again.

as a better alternative, i'd inform the nurse manager of the situation and insist that somebody do some teaching or inservice on the situation and the proper way to handle it. they may not take your reasons coming from you, but they will (grudgingly and b*tchingly) take it from management. and if there are still problems, you can remind them that "Sally, NM said it's to be done this way, so that's how it's to be done. Didn't you make it to that staff meeting?" in the meantime, it might not be a bad idea to get together with the rest of the night staff and determine if anyone else is charting for them, and explain your reasoning for why it's not a good idea. if none of the night nurses does this for the day shift, then not only will they stop taking their anger out on you personally (instead, it will be displaced to the entire night shift), but after much griping they will either shut up and and just do what they're supposed to or go to the nurse manager. who, if you've already explained the situation to him/her, will just tell them that you are doing the correct thing and they need to get their acts together.