Assessment in 20 mins?

That Guy, BSN, RN, EMT-B · Feb 6, 2009

You know I laughed at my instructor when she said that too, trust me though its doable. Practice practice practice is seriously all that it takes. You learn to wrap things together and little tricks here and there.

Daytonite, BSN, RN · Feb 6, 2009

Your instructor is trying to tell you that you need to be multitasking. When I was a student many years ago we were constantly being told to "save steps" and to "make every action count". In other words you must be the picture of efficiency. When you are giving a patient PM care or assisting them with their meal tray you are doing more than that. You are watching what they are doing and asking questions, especially if you notice something or remember something you didn't ask about earlier. We are constantly looking for information--constantly. We can never find enough. You check their IV, look at dressings, check to see that the call bell is within their reach and that the bed is in its lowest position. If you are on one side of the bed you check to see what is going on at that side of the bed before you move around to the other side. Before you leave the room you ask if there is anything the patient needs before you go. When you are headed into a patient room you make sure you load up with all the things you want to take with you so you only have to make one trip.

Assessment is baseline information that you need to do first before anything else. You need to get in and look over this patient and know what is going on with them in case there is a pop quiz about them at any minute. When I was a staff nurse in the older days we could have the patient's physician walk on the floor at any time and start asking questions about their patient. If we hadn't been in and assessed the patient to know the answers their questions we would get chewed out in front of the whole world. It was embarrassing. That doesn't happen today because the hospitals get after the doctors that do that, but do you get the idea? When we got out of report the first thing we did, and most nurses still do, is make rounds on their patients and do some kind of assessment on them so they know what is going on. Never, and I mean never, take the word of what you hear in report. Trust your own eyes and ears and be quick about it. When I worked on a stepdown unit our goal was to get patients assessed and charted on ASAP. You know why? Because if the ER started dumping patients on us we got busy and didn't have time to catch up. If we had a patient go bad and code our shift was shot to Hades taking care of that patient. If we hadn't assessed everyone else and didn't know where our priorities were, we were fracked. We would be sitting there for hours after the shift was over doing routine charting and our manager would be having a fit signing our time cards.

Get assessment done and over with so you can move on to the other stuff you need to worry about. It's true that V.S. are the very first thing to be done coming out of report before anything else. When you do an actual physical assessment you learn over time to ask the ROS (review of systems--history) questions as you are doing the exam. The basic quickie is listening to the lungs and the heart, bowel sounds, palpate the abdomen, check for edema, do a neuro check--basic head-to-toe. You can customize for things like surgical incisions and other kinds of treatments like tubes, IVs and casts that the patient might have. When you listen to the lungs you will be having the patient taking deep breaths and they may or may not cough, but ask if they have had a cough anyway. When you are palpating the abdomen you ask if they have had any nausea or constipation, how have they been eating, did they have a BM today, if not when was the last one. When checking for edema ask if they have been up and walking, if they have any problems with ambulation, do they need to get up to the bathroom now. Then do hand grips and push/pulls. You will have touched the skin several times by now and will know its color and if it is warm/cool/dry/moist. You will also know their orientation by the way they responded to your questions and directions during the exam. You will also have seen what gizmos are attached to the patient (IV pumps, O2, other machines, etc.). This assessment should have taken 5 minutes or so. You should do it immediately upon entering the patient's room and greeting them. Say, "Hi, I'm xxx and I'll be your student nurse today. I need to do a quick assessment of you right now and ask a few questions." It will take longer to write it up. Then, "I'll be back later with your medications. Can I get you anything?" Or, "I show you scheduled for an x-ray of xxx today. I'd like to go with you when they take you down for that. Do you know why the doctor ordered it?"

TheCommuter, BSN, RN · Feb 6, 2009

Assume you're working an 8 hour shift in the real world of nursing with a load of 6 patients on a typical med/surg floor. If you spend 1 hour assessing each patient, you have wasted 6 hours of your shift, leaving you only 2 hours to get everything else accomplished (new orders, medications, treatments, charting, I&Os, hourly rounds, dressing changes, monitoring IVs, blood product administration, range of motion exercises, ambulation, and a whole slew of other things).

Your instructor is being very generous by stating the assessment should take 20 minutes. In the real world of nursing, a 5-minute head-to-toe assessment is more viable and realistic.

lilybean · Feb 6, 2009

If you are unable to assess a certain area, you should be able to document something like "unable to assess due to confusion," just dont leave it blank!

Galore · Feb 6, 2009

With time you will develop a routine and tricks to check several things at once, like the above posters have given you. It sounds like you are also giving total care right now that normally would be delegated to other staff, such as VS and feeding the patient, so of course you will be spending much more time with your 1 or 2 patients than you normally would as a staff nurse.

One thing that slowed me down as a student and new nurse is that you haven't really honed your assessment skills. I would find myself listening to the lungs and heart longer than an experienced RN would, because I wasn't sure about what I was hearing, for example. With time you will get better at all that.

My job is a little different since I work in the NICU now, but just to give you an idea of how quickly you can progress with a little practice: when I first started orientation, I had never set foot in the NICU. It sometimes took me 10-15 minutes or so just to get a set of vitals and figure out where and how to chart it all! Now a few months later, I can do a complete head to toe assessment, get a blood sugar, weigh the baby and take his measurements, diaper change, give meds, reposition, etc. and chart everything all in about 20 minutes.

It's good that you recognize an area that needs improvement. Maybe next time your teacher walks in you like that, you could explain your rationale. I know that we're not supposed to put our patient's comfort and needs above our "tasks", but getting a baseline assessment is really important and it's my #1 priority when I first start my shift. In the real world, your patient will not die if they eat their dinner 10 minutes later, but it will get you very behind if you are 45 minutes into your shift and haven't even assessed anyone or seen your other patients, know what I mean?

C. Thinking · Feb 7, 2009

In the managment clinicals (management of care), we have 6 pts to care for. We have 3 1/2 hours to complete all assessments with narrative focused and morning meds....as well as ND, interventions, teaching, etc. So 20 minutes to do 1 assessment is definitely doable.

inland18mempire · Feb 7, 2009

that's quite reasonable once you've become familiar with the hospital. actually, it should be around 5-10 minutes, so that's very generous. a head to toe only takes a couple of minutes and verifying meds is a matter of flipping through the MAR and looking at the orders in the chart. once you become a working nurse you won't (generally) ask 5 different things about their poop (frequency, color, consistency, blah blah blah) - that's just student busy work. so, feel better! you'll most definitely be doing a focused assessment. that is, you address their reason for being in the hospital, then address any other problems (hx of htn, for example), and then very quickly do a look over. and remember, you're only in your SECOND week of clinicals. i can't believe your instructor is even placing a time limit on it quite frankily... it seems a little rigid for the 2nd week. tough stuff! you're going to be great! try not to stress on it too much easier said than done, right?

chiquilina · Feb 13, 2009

Ok, 2nd week, assessment took about 25 minutes. . . . I think it was nerves, the fact that I didn't know where things were on the chart, since each hospital is different. I think I see what you mean about "flow" . . .I'm hopeful in a few weeks, I will be able to do my assessment in less and less time. Thanks for your input everyone.

mcknis · Feb 13, 2009

...a 5-minute head-to-toe assessment is more viable and realistic.

You get 5 minutes? I find 3 minutes goes by almost too quickly :coollook: !

CherryAims · Feb 13, 2009

Do you think it may be a time thing for your instructor? Does she have 7 or 8 other students to watch while they do their assessments. We have assessments coming up this week too. I'm taking the weekend to practice on my two boys--that way I get a little time in with them too!

I find that if you act confident, if you left something out they will think you did so on purpose. If they say you forgot something, reply "I'm just getting to that!" in a nice way of course.

NursingRocks1998 · Feb 14, 2009

"Get assessment done and over with so you can move on to the other stuff you need to worry about. It's true that V.S. are the very first thing to be done coming out of report before anything else. When you do an actual physical assessment you learn over time to ask the ROS (review of systems--history) questions as you are doing the exam. The basic quickie is listening to the lungs and the heart, bowel sounds, palpate the abdomen, check for edema, do a neuro check--basic head-to-toe. You can customize for things like surgical incisions and other kinds of treatments like tubes, IVs and casts that the patient might have. When you listen to the lungs you will be having the patient taking deep breaths and they may or may not cough, but ask if they have had a cough anyway. When you are palpating the abdomen you ask if they have had any nausea or constipation, how have they been eating, did they have a BM today, if not when was the last one. When checking for edema ask if they have been up and walking, if they have any problems with ambulation, do they need to get up to the bathroom now. Then do hand grips and push/pulls. You will have touched the skin several times by now and will know its color and if it is warm/cool/dry/moist. You will also know their orientation by the way they responded to your questions and directions during the exam. You will also have seen what gizmos are attached to the patient (IV pumps, O2, other machines, etc.). This assessment should have taken 5 minutes or so. You should do it immediately upon entering the patient's room and greeting them. Say, "Hi, I'm xxx and I'll be your student nurse today. I need to do a quick assessment of you right now and ask a few questions." It will take longer to write it up. Then, "I'll be back later with your medications. Can I get you anything?" Or, "I show you scheduled for an x-ray of xxx today. I'd like to go with you when they take you down for that. Do you know why the doctor ordered it?"

I'm a student nurse and this is sooo helpful- it is so nice of you to provide us with your wisdom. This is an awesome way to walk us through an assessment. THANK YOU :)