Assessment every shift?

[Thebrilliantdancex]

Hello everyone!

I'm a new nurse of six months. I currently work in an acute rehab facility where I usually have 8-10 patients. On bad nights I can have up to 12 patients.

At my facility, we are only required to assess and document assessments on three to four people per shift. For example, if you have rooms 119-128, the 7-3 nurse is supposed to assess and document on 119, 120, 121, 122. The 3-11 nurse is supposed to assess and document on 123, 124, and 125. And then the 11p - 7a nurse is supposed to assess and document on 126, 127, and 128.

I was talking to my mom about this tonight, who is also a nurse, and she was flabbergasted that we don't assess every patient each shift. And it got me wondering if I should be assessing each one of my patients every shift, even if I'm not required to document it. I just don't see how that's possible timewise. I am literally running around like a chicken with its head cut off 99% of the time. Tonight I had 7 patients and then three admissions for a total of 10 patients. Needless to say I didn't get home until 12:45 after my shift ended at 11, and that's not even with assessing every patient.

Of course I do neuro checks on stroke patients, listen to lung sounds on respiratory patients, check IVs, etc even if they aren't my assessment patient that day. But I don't see how I could possibly have time to do full assessments on 8-12 patients on top of everything else that needs to be done.

I guess what I'm asking is this: in a rehab setting where the patients are more "stable", is it necessary to be assessing each patient every shift? Right now our patients basically only get assessed once each day, is that acceptable since it's a rehab setting not like a med surge setting?

Thanks in advance for your input!

[TheMoonisMyLantern, ADN, LPN, RN]

Remind mom that working rehab has its own set of standards that are different from acute care. Theoretically the patients are supposed to be stable enough when going to rehab that q shift head to toe assessments are not appropriate.

[TheCommuter, BSN, RN]

I worked at an acute rehab facility for six years. I also have certification as a rehabilitation nurse (CRRN), so I know whereof I speak.

Comprehensive head-to-toe assessments every shift are unrealistic, inappropriate and overboard in the rehab setting. They certainly need to be done upon admission and with changes in condition, but are not feasible every shift.

Abbreviated or focused assessments every shift are more timely and appropriate.

[Thebrilliantdancex]

Thank you! I know that rehab patients are supposed to be stable when they come to us, but oftentimes we are sent patients that are unstable and really shouldn't be in a rehab setting, in my opinion! But anyway thanks for your input :)

[Thebrilliantdancex]

That's what I thought. Thank you!

[chacha82, ADN, BSN]

I interviewed in a facility where this was the case. Assessments did not happen on every single patient, every single shift. Now, as soon as someone becomes unstable or there is a change, you do assess them. Different facilities have different standards and ways things need to happen. That's okay!

[Junebug903, LPN]

Upon admission, we do 72 hour complete assessment charting, then medicare charting on either 7-3 or 3-11 shift.

[bgxyrnf, MSN, RN]

Sounds like mom is doing what many nurses do... extrapolating her experience to apply to a situation which is materially different.

The standards of care vary by state, county, community, facility type, facility, department, and patient acuity.

[bgxyrnf, MSN, RN]

And frankly, they shouldn't even be mandating full assessments during the 23-07 shift unless it's warranted... patients need to sleep.

[nycNurse2b]

Upon admission, we do 72 hour complete assessment charting, then medicare charting on either 7-3 or 3-11 shift.

What does your complete assessment charting look like? I am currently in sub acute rehab and I don't think it's very thorough. Thank you in advance.

[Sassafras6]

At my facility we do 1 assessment / day, & Qshift for new admits & post incidents x 72 hrs. I work 12-hr day shift & am assigned approx. 16 pts. It is difficult to keep up with 8 assessments, 16 would be impossible.