4-hour Floating and Assessments

[AWanderingMinstral]

As a travel nurse, I am prepared to float at any point. Whenever I work a 12-hour daylight shift (7a-7p), I don't usually float (unless the majority of staff works an 8-hour shift). I recently floated from 3-7p and, having already assessed and charted on 6 patients for 8 hours on another unit, I did not assess the patients. I received a thorough report and I knew what issues I MAY have with each patient. Instead, I did their vital signs (this was total care of 4 patients), administered any medications that were due, completed blood sugars (and administered insulin coverage as ordered), and ultimately wrote a 2-4 sentence summary at 630p or so of anything that occurred during the 4 hours. I had a manageable group of individuals, but it's NOT always like that. I'm SURE someone will tell me that I'm a "bad" nurse because I didn't assess the patients, but I do NOT feel that 4 hours with them should trump a nurse coming in for 12 hours at 7p. What do YOU do?

[AWanderingMinstral]

O.k. i guess then you would have to base it on your own comfort level and not on how other nurses think about it, since when push comes to shove you would have to legally defend your position in a court room if that patient should have something go wrong during your 4 hrs and wind up coding. I guess i just think it makes sense to go ahead and assess each patient since i dont want to give a board of nursing any reason to take away my license or god forbid a judge/jury decide i am guilty of negligence if that patient happen to die. We all make our own decisions though. :

I understand and respect your opinion. I feel as though I cover my bases under these circumstances. I also invest in the maximum malpractice insurance. Thank you and be well.

[NedRN]

Happy to support you in your endeavor to learn. The Socratic method will help you learn to problem solve in the future. I don't think validating the wrong course of action is supportive.

You stated you did not assess a group of new patients and want some direction on whether that was the right course of action. I can't imagine why you would need our opinion unless you had already been told it was not the right course of action. I tried to frame my questions so you can come to that determination for yourself.

[MendedHeart]

Im a new nurse and it was drilled into us that we HAVE to assess our patients even if we are caring for them for a short period of time. I would NEVER.trust another nurses assessment when im taking care of a patient. And I would never base something I was unsure of on what another nurse says they do. Big nono. I think that by not assessing a patient, it is going against our standard of practice. How would a nurse know what a patient needed without assessing first no matter the time length. Just because a RN has good insurance doesnt mean they cant be held responsible for something that hapoens. Ive seen licence taken away promptly for substandard care.

[NedRN]

I also invest in the maximum malpractice insurance.

Seriously? That might be comforting to you, but it is not comforting to me to have such a nurse taking care of my mother. Think about your mother in the care of providers taking shortcuts.

[42katrn]

I think there is a difference between not assessing a patient and not fully documenting a full assessment in the form the facility uses for assessments.

I always assess my patients no matter how long of a shift with them. The last hospital i worked at allowed a focuses assessment instead of complete documentation for four hours.

I could be wrong but I am assuming that the original poster assessed her patient, but did not due a full head to toe assessment on each patient and did not document as such. That to me doesn't equate with not assessing her patient and providing substandard care. Does every nursing interaction no matter the time frame require a full head to toe? Must you check the 18 year old in for external fixation of their arm who report said was walking the halls for past 2 days and erw

[BostonFNP, APRN]

You passed meds without doing an assessment? It's been awhile since I was a bedside nurse, but that seems pretty risky to me.

[42katrn]

And great bed mobility be checked for All systems complete head to toe? I don't think it is necessary and it is a fair question what others do for documentation for a four hour shift.

[miam]

i know others have said it, but i have no idea why the amount of malpractice insurance you carry has to do with the price of beans. Does that give you the right to be an unsafe nurse, and rely on the assessments of your co-workers to allow you to care for patients? Kinda scary if that is the premise you are working by.

[RainMom]

I float frequently (about once a week) from 7p-11p. I always do an assessment but it does tend to be more focused. We also do not have to do quite as extensive charting for a 4 hr shift, but are required to chart system assessment & for pain. If surgical, I'll chart a wound/drain assessment as well, & I always do I/O for all pts. But otherwise, IVs, foleys, pca, education, care plan, etc. charting isn't required. If there would be a significant issue with any of these though, I would add it as well.

[RNperdiem, RN]

I do quite a few four hour shifts and I always do and document the assessment. Without an assessment, you don't really know your patient. In ICU, where I work, assessments are frequent.

When giving a report to the next nurse, I can report my own findings.

[hysrn]

I work ICU...No matter which area you work in, it's ALWAYS best to ASSESS!!!! Anytime you pick up a new patient, that is NEW to YOU...you need to give them the 'once over'....CYA, my friend!!!! I have also floated to various and sundry areas and every time I get my new peeps, no matter for how long, I assess them. You never know what you might find that the other nurse missed or something new....I would not care what the 'policy' is....I just do it :) Hope that helps!!! Keep on ASSESSING and you'll NEVER be GUESSING :)

Good luck!!