Nurses not doing assessments

P_RN, ADN, RN · Jun 1, 2007

Let's post that query in the Aussie and UK forums and see if it is a country wide or just individual university policy.

CritterLover, BSN, RN · Jun 1, 2007

post# 26 gucci rush stated that "wondering if assessment were taught in their country. i also work with other filipino nurses who are very thorough and do their job well." again, in post# 1, gucci rush stated that "my question is in other countries are they taught different because we all know here in the u.s. that assessing your patient is the first thing you are taught to do in school."
it is very interesting to see that gucci rush brought out the argument and then she gave the contradictory answer to her owe argument.
if that wasn't what other countries have taught, then how come some of gucci rush's coworkers did their job well as stated in post# 26. apparently, they were taught about what to do. otherwise, gucci rush has to change the original statement. it is very important not to attack your own argument, as i was taught in english 101.

sorry, but i have to disagree that those statements were contradictory.

[color=#483d8b]just because a nurse is filipino in ethinicity doesn't mean he/she was educated in the phillipines. many foreign nurses are educated here. i went to school with a girl who was native to south korea, but she went to nursing school here in the us.

[color=#483d8b]it is also possible that a phillipine-educated nurse, not originally taught to assess closely, was precepted here and taught otherwise once working in the us.

[color=#483d8b]i'm not necessarily saying the above is true, i'm just saying that it is possible, and the op's questions wasn't unreasonable.

[color=#483d8b]however, i think i remember reading in the thread about the child that died from a kcl injection that it isn't common for nurses in the phillipines to assess as we do.

[color=#483d8b]see thread https://allnurses.com/forums/f195/baby-died-injected-potassium-chloride-im-213325-9.html , esp post #19. maybe i misunderstood, but i took that to mean that in their country, they arn't responsible for assessments the same way we are in the us.

[color=#483d8b]i've worked with several nurses from the phillipines, and they have all been excellent, hard working, and very good with their assessment skills. i've had no problems or issues.

our assessment flowseet has spaces for the hours across the top, and the assessment along the side. for example, for evening shift, i would put say, 1600 as my initial assessment time and fill out the boxes (apical reg, resps reg/unlabored, clear to auscultation, on room air, denies pain, has a foley and an ng etc etc). after that, each 2 hours, i go back and reassess - not a full assessment, just that resps are still reg/unlabored, still on room air, still has foley, etc. i would do that at 18, 20, and 22. the nurse i am talking about does that at the beginning of the shift. so even though it is only 1600, she has already charted all of her 2200 information. if something changes - say the pt passes away at 1800, it's going to look pretty bad if her charting says that the resps are regular (or irregular, or labored, or whatever) at 2200. does that make more sense? charting without doing? falsifying charting? i guess i would just call it "charing in advance", which, of course, is a . i know this is long-winded - i just hope it makes sense!!!

i've seen the same thing. one icu i worked in, we had to assess our vents qhr, and vs somewhere between q15 min-q2hrs, depending on acuity. our basic assessment had to be done either qhr or q2hrs (at least on the flowsheet; sometimes patient condition would require more frequent assessments, but there was only space on the flow sheet for hourly monitoring. anything more frequent had to go in narrative form).

[color=#483d8b]we had one nurse who would fill out the entire flow sheet -- complete with assessments, turns, vital signs, vent settings (including spontaneous tidal volume, peak pressures) baths, etc -- the whole thing -- at the begining of her shift. i found this one night when she was pretty busy and i was trying to help her out by doing one of her vent/vs/uop checks, and found the whole blessed flow sheet filled out until 6am. i think it was about 10pm at the time. came to find out that this wasn't an unusual occurance for her. :uhoh3: she was also known for checking meds out of the pyxis (that wern't ordered) and not charting them. but, in report, she'd tell you "i couldn't get them to calm down for anything! threw the whole pyxis at them, but they still thrashed about!" needless to say, she doesn't work there anymore. (well, neither do i; but we left for entirely different reasons. i'm eligible for rehire).

[color=#483d8b]at any rate, thorough assessment is a standard of care in the us, and any nurse that isn't doing an assessment based off of their scope of practice isn't providing acceptable care, regardless of their country of education. however, i'm afraid that it happens more often than anyone cares to admit. blame it on burn-out, blame it on high nurse to patient ratios, blame it on lack of education; it doesn't matter what you blame it on, it is still unethical in this country.

allnurses Guide · Jun 1, 2007

i dont understand how aussie and uk nurses arent taught to routinely assess heart and lung sounds!?!. How do you protect the pt as we all your own self if the pts condition deteriorates...what baseline would you have then? How would you know if the lung sounds are clear upon auscultation or if there are crackles...or if their heart sounds suddenly are abnormal?

I have posted a response in the UK section but thought I would answer it here as well. I think that nursing in the Uk is very different to nursing in the US. I have worked in many different areas within the UK and have also taught nursing students as a nurse lecturer (many years ago).

As far a I know the clinical examination skills are not routinely part of the nurse education system.

I am now a NP so I do listen and have been taught examination skills but before I did my NPs MSc if I had a patient who had a deteriorating respiratory status I used other observations, looking at your patient, do thye look distressed, short of breath etc, respiratory rate, O2 sats, other CVS observations, if I was worried then I would get a medic to review the patient.

To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different

Susan9608 · Jun 1, 2007

To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different

I'm curious about this. In my job, most of my time is spent on assessments, reassessments after interventions, etc. What do UK nurses do that don't allow them to have time for full examinations? (seriously, I'm not trying to be derogatory; I'm interested to know how the UK is different)

bethem · Jun 1, 2007

I have posted a response in the UK section but thought I would answer it here as well. I think that nursing in the Uk is very different to nursing in the US. I have worked in many different areas within the UK and have also taught nursing students as a nurse lecturer (many years ago).
As far a I know the clinical examination skills are not routinely part of the nurse education system.
I am now a NP so I do listen and have been taught examination skills but before I did my NPs MSc if I had a patient who had a deteriorating respiratory status I used other observations, looking at your patient, do thye look distressed, short of breath etc, respiratory rate, O2 sats, other CVS observations, if I was worried then I would get a medic to review the patient.
To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different

I can't speak for every single Aussie nurse, but it's the same everywhere I have worked and had prac. Doctors listen to the heart and lung sounds, assess JVP, and all that other stuff.

Nurses take vital signs and use O2 sats, resp rate, observation of work of breathing, ECG strips, a lot of other things apart from lung sounds. While I agree it may be beneficial to assess heart and lung sounds, it's not the be-all and end-all of assessment.

I must say, I have long thought American nurses get a more thorough education than I got at my particular university; or, from what I can tell, many other Aussie unis. We learn an awful lot on the job and are really just taught the most basic of things about nursing. It's bizarre.

As to why we wouldn't have time - we don't have CNAs as much as you do in the US (we call them AINs or PCAs anyway), so RNs are still the ones doing the washes, toilets, all the meds, chasing bloods, chasing doctors, making beds, we feed patients who need feeding... whatever needs to be done for a patient is done by the RN (or EN) looking after him or her. AINs don't seem to take on quite the role your CNAs do.

dardeedee · Jun 1, 2007

I work with a filipino nurse at night who is excellent. She does a head to toe assessment, turns on the lights, wakes them up, looks at every orfice, rolls them over.... etc. She doesn't care if they just got to sleep. She is an excellent nurse and fun to work with. Especially if you have to explain American slang to her.

Hoozdo, ADN · Jun 1, 2007

How's this one....... The nurse previous to me marked strong pedal pulses bilat in his charting. Fine, but this patient was a BKA :rotfl:

allnurses Guide · Jun 1, 2007

I'm curious about this. In my job, most of my time is spent on assessments, reassessments after interventions, etc. What do UK nurses do that don't allow them to have time for full examinations? (seriously, I'm not trying to be derogatory; I'm interested to know how the UK is different)

I can only speak from my experierience so this may not be the same throughout the UK although I am fairly sure there will be little difference.

If I work on the wards (as I say I am an NP but do shifts as a ward nurse to earn extra money in a different hospital where I work once or twice a month on a surgical admissions ward) You get on duty and take handover, the wards are 36 beds and these are split into 2 sides. I will work on only one side with 18 patients. On an early shift, at handover we walk around the ward meet the patients the shift going of will hand over at the bedside - confidential info will be given in the office so at the bedside it is more of an introduction, obs chart and med chart hand over and it gives me the chance to eyball the patient.

After that myself and the support worker will work through making sure all patients who need washes have bowls and their wash stuff to hand those that need assistance we will assist. Whilst going round we make the beds and change sheets.

during the washes I assess mobility and any patients who are unable to mobilise I will check pressure areas and skin integrity, also checking observation charts and dealing with any problems that arise from this. Our patient self medicate if able so I check the med charts and sign that the meds have been taken, and then give any analgesics. If not able then we give their medications. We need to assist those patients that need feeding and during all of this if we have patients who are incontinent or unwell the qualified nurse will need to deal with these as well. This does not take into account answering telephone enquiries. At about 830am the surgical doctors will do a ward round and the qualified nurse will need to be present,

the washes, and mobility assistance goes on throughout the shift.

We dont listen to heart and lung sounds but that doesnt mean we dont assess, react to those assessments etc etc. I think that nursing within the UK (and by the sounds of it Australia) is very different to the US, personally from my training listening to heart and lungs is not nursing as I have been taught it is more in the medical domain.

To me nursing is assessing your patients activities of daily living, and assisting them with those that they are unable to do for themselves, at the same time promoting self care to allow them to gain independence and return to how they were before illness - if that is possible, if not then helping them to adapt to the changes within their life.

Just because we dont listen to heart and lung sounds does not mean that we dont assess our patients, our assessment are different to your but equally as valid.

TazziRN, RN · Jun 1, 2007

Post# 26 gucci rush stated that "wondering if assessment were taught in their country. I also work with other filipino nurses who are very thorough and do their job well." Again, in post# 1, gucci rush stated that "My question is in other countries are they taught different because we all know here in the U.S. that assessing your patient is the first thing you are taught to do in school."
It is very interesting to see that gucci rush brought out the argument and then she gave the contradictory answer to her owe argument.
If that wasn't what other countries have taught, then how come some of gucci rush's coworkers did their job well as stated in post# 26. Apparently, they were taught about what to do. Otherwise, gucci rush has to change the original statement. It is very important not to attack your own argument, as I was taught in English 101.
Anyhow, I think it is not only one specific group of people who are doing it. Black, white, Asian and Latino nurses are doing the same thing. Whether they graduated from colleges in other countries or colleges in our own backyard. I think the problem is caused by some other problems rather than they were taught in school or not.

????? The only one contradicting anything here is you. Gucci wanted to know if nurses in other countries are taught assessments, not specifically Filipinos. By saying that she's worked with Filipinos who are great nurses, that took race out of the original question.

PiPhi2004 · Jun 1, 2007

Isnt is against the law to make up information and chart it? That is extremely unethical and horrible to do! People have done it at the hospital I worked at too. Lazy nurses make me angry :madface:

Ophelia78 · Jun 1, 2007

I just had a patient this week who was on the vent, CMV with a rate of 20. This gentleman was a quad as well. The night shift nurse had been floated to the ICU from the floor. All night she documented hourly RR as 16, 18, 15 etc. Um, no. Just to give her the benefit of the doubt, I verified with RT that nothing funny had been going on with the vent at night. Nope.

When I was a caseworker I had a coworker that was canned for charting weekly hour-long visits for a client that she never performed. She actually hadn't seen the woman in 5 months when it all came out. She was lucky she didn't get prosecuted for Medicaid fraud.

Silverdragon102, BSN · Jun 1, 2007

I can only speak from my experierience so this may not be the same throughout the UK although I am fairly sure there will be little difference.
If I work on the wards (as I say I am an NP but do shifts as a ward nurse to earn extra money in a different hospital where I work once or twice a month on a surgical admissions ward) You get on duty and take handover, the wards are 36 beds and these are split into 2 sides. I will work on only one side with 18 patients. On an early shift, at handover we walk around the ward meet the patients the shift going of will hand over at the bedside - confidential info will be given in the office so at the bedside it is more of an introduction, obs chart and med chart hand over and it gives me the chance to eyball the patient.
After that myself and the support worker will work through making sure all patients who need washes have bowls and their wash stuff to hand those that need assistance we will assist. Whilst going round we make the beds and change sheets.
during the washes I assess mobility and any patients who are unable to mobilise I will check pressure areas and skin integrity, also checking observation charts and dealing with any problems that arise from this. Our patient self medicate if able so I check the med charts and sign that the meds have been taken, and then give any analgesics. If not able then we give their medications. We need to assist those patients that need feeding and during all of this if we have patients who are incontinent or unwell the qualified nurse will need to deal with these as well. This does not take into account answering telephone enquiries. At about 830am the surgical doctors will do a ward round and the qualified nurse will need to be present,
the washes, and mobility assistance goes on throughout the shift.
We dont listen to heart and lung sounds but that doesnt mean we dont assess, react to those assessments etc etc. I think that nursing within the UK (and by the sounds of it Australia) is very different to the US, personally from my training listening to heart and lungs is not nursing as I have been taught it is more in the medical domain.
To me nursing is assessing your patients activities of daily living, and assisting them with those that they are unable to do for themselves, at the same time promoting self care to allow them to gain independence and return to how they were before illness - if that is possible, if not then helping them to adapt to the changes within their life.
Just because we dont listen to heart and lung sounds does not mean that we dont assess our patients, our assessment are different to your but equally as valid.

:yeahthat:

just to add when I worked on the wards we did medication rounds as patients didn't self medicate. Staffing was usually 1 RN and 1 health care assistant for anything between 10-18 patients (depends on type of ward) with an extra health care assistant covering both teams. Sometimes struggled to give basic care although did manage to give it but with doing everything else from basic care, moving beds, answering telephones and management putting more and more stuff on us but not willing to pay the time to do it or employ the extra staff.