Is assessment of a patient considered.........

  1. an automous practice or a hospital mandated practice?

    One the one hand, hospital policy requires RN assessment on all patients.

    On the other, the RN makes the decision and how to assess and what to focus, and that's an autonomous practice.

    I'm working on a paper that analyzes my day and I have to break it down to autonomous practice and hospital mandated, as well as MD directed, and patient/family directed. I'm stuck where to put patient assessments?

    Any comments?
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    About Tweety, BSN

    Joined: Oct '02; Posts: 60,156; Likes: 15,637


  3. by   Nurse Ratched
    Our facility specifies in a policy the components of a head to toe assessment - that is, all the systems that should be evaluated. From that standpoint, I believe it is hospital mandated (for insurance purposes as much as for pt care purposes.) (There should be a whole separate category of "stuff we have to do because some 3rd party outside of the hospital dictates it" lol.)
  4. by   UM Review RN
    My choice would be "autonomous." Part of this is because I don't need to work for a hospital to have that as part of my job description as defined by the BON.

    It might help you to use the legal definition of RN. I think--and this is just my opinion--that the hospitals only mandate RN assessments because that is what RNs, and only RNs--do.

    A nursing assessment is separate and distinct from an MD assessment, and other levels of nurses are not allowed to assess. That is my thought and rationale.
    From the Florida Nurse Practice Act, Part 464:

    [font=Tahoma](3)(a) "Practice of professional nursing" means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

    [font=Tahoma]1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.

    [font=Tahoma]2. The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments. [font=Tahoma]3. The supervision and teaching of other personnel in the theory and performance of any of the above acts.
  5. by   Nurse Ratched
    So perhaps we could say that assessment itself is autonomous, but the definition of what assessment entails is mandated (per facility)?

    This is a great question, btw.
  6. by   UM Review RN
    So perhaps we could say that assessment itself is autonomous, but the definition of what assessment entails is mandated (per facility)?
    I like that, too. Could you answer "Both"?

    I'd be more inclined to say that the profession really regulates our assessment skills, setting the standards for what we actually assess and what we do about it, but the hospital (actually JHACO) defines how frequently we do them.

    And I agree, this is a very provocative question.
  7. by   elkpark
    I agree it's a v. interesting question. I'm always a big fan of reframing these kind of questions, so:

    If the hospital didn't mandate a thorough assessment, would you (as the RN; presumably a competent, conscientious RN) still assess your patients?

    If the answer is yes (if it isn't "yes," please don't ruin my day by telling me so :chuckle ), then it's an autonomous practice.

    Actually, I would have said "autonomous" without the reframing exercise -- it's not that we need the hospital's permission to do it; the hospital mandates it because it's an integral part of nursing practice.
  8. by   Fiona59
    As an LPN, I was responsible for the incoming assessment of patients transferring to Transition Care from Acute Care, I was also responsible for any patients arriving on my beds in Active Treatment.

    Depends on hospital policy who does the assessment.
  9. by   nursemaa
    Actually, I believe that hospitals require nurses to practice according to commonly accepted standards- it is considered "best practice" for an RN to assess patients every shift, therefore your protocols and standards should reflect that. Just as it is "best practice" to turn a patient with high risk for pressure ulcers every 2 hours, and therefore that is incorporated into most hospitals' policies and/or protocols. But you don't need a physician order to turn your patients. Autonomy refers to the ability to perform the functions of a job independently. So assessment in itself is autonomous, because it doesn't require a physician order, but how often the assessment is required is usually due to practice standards, or regulatory standards such as JCAHO. Does that make sense?
  10. by   Tweety
    Thanks for taking the time to answer. Thanks Angie for that great site!

    I'm going with autonomous. Different patients get different assessments. My closed head injury patients is getting a different assessment than my fractured femer patient who is getting a different one than the pneumonia patient. It's up to me to decide how, what, and when to assess.

    Now about charting?...........just kidding.
  11. by   Tweety
    Quote from Nurse Ratched
    So perhaps we could say that assessment itself is autonomous, but the definition of what assessment entails is mandated (per facility)?

    This is a great question, btw.

    Thanks. That's about how I look at. The profression/nurse practice act/hospital mandates that patients get an RN level of assessment. How it is manifested by the profressional RN is an autonomous decision/act.
  12. by   Antikigirl
    I do head to toes because I need to know my patient..I do it for me so I can do my job better! But HOW I do it is up to me! I can do a head to toe by watching someone walk, talk, smile, complain, move in bed, and even as I watch their body language and alertness when I walk in for the first time .

    If my clinical opinion is on the seems insane not to do a head to toe assessment! I will get it if I miss something, and my patient will suffer for me not noticing!