Getting assessments done

EmmaG, RN · Dec 26, 2007

Half-way through a shift is probably a bit late to do assessments. If things are crazy and I can't get to a place where I can chart them right away, I'll make notes about what I assessed. But as far as doing the assessment itself, I do it when I first go in to see the patient. It doesn't take that long to do, it allows me to recognize any changes that might occur during my shift and also helps me to prioritize my day.

Sunshine0425 · Dec 26, 2007

First thing I do on my shift is organize myself first...gather my MARS, make my own little checklist from the kardex, then go assess. This should be your number one priority. See how your patients are doing before passing meds. Some patients go downhill fast and the best thing to have done is a baseline, Vitals, pulses, make sure IV's are good O2 sats are WNL, dressings are dry and intact, and especially pts on fall precautions, I never trust the other shifts "claim" that the bed alarm is set. You need to protect yourself, your license and your pt. Maybe an IV infiltrated on the other shift and they didn't catch it because they had a million and one things to do before leaving their shift. I try to have my assessments done in an hour, take a quick potty break, and then start passing meds, dsg changes, charting etc. Assessments are key!!!!

Poochee · Dec 27, 2007

When I was new nurse, I would go in early and do assessments. People would look at me funny, but it helped.:welcome:

RNperdiem, RN · Dec 27, 2007

It does take time. When I worked the floors I would really push to get all 6 assessments done and charted. It generally took about 2 hours.

Morning assessment also coincides with diabetic glucose checks, breakfast and doctors on rounds, and elderly ladies needing help to the bathroom when the 0600 Lasix kicks in.

You do not really know your patients until they are assessed, so this is a high priority.

anonymurse · Dec 27, 2007

New nurse and new poster here!
Just curious - how late is "too late" to get my assessments completed for my patients? I realize this is the first thing I should be doing when I start my shift, but I am finding that it sometimes takes me 4-5 hours into my shift to finally complete them all. Is this too much? Do I need to re-prioritize?
Thanks for your help and input!

Well I guess you could call it re-prioritizing to quit being fixated on getting full assessments done first thing. It would be a higher priority to do focused assessments on all your folks rapidly so you know what's important. You can leave the full assessment as a luxury for when you have time.

I mean, when you walk in a room, you check tubes on your way to the bed as you introduce yourself and wash your hands, you write on the board as you question the pt, and as they respond to your handshake and verbalizations, you know right away if their mentation and respirations and pain are WNL.

You know tons if they're brushing their teeth or using the urinal or grimacing or trying to pull out their PEG or staring off into space with their mouth open, and you haven't even touched them yet.

After I punch in, I highlight kardexes, read my reports, write down my CNA needs list and mini-report (I stop here to put this in the CNA's hands as I may not be able to find her once she gets in her rooms), track down last shift's nurses if I have questions, pull my strips, and get labs I'm interested in. That takes 15 to 30 minutes depending.

Then I see my pts. I check tubes in and tubes out, introduce myself, write the room phone number, date, my name and the CNA's on their whiteboard, and ask if they have any pain, problems breathing, or any pressing concerns.

If yes, I ask more questions, maybe do some focused assessment if the pt has a special issue, particularly lung sounds, CIWA, restraints, AMS, pain. All fast, for instance, pulses and groin site on cath pts take all of 10 seconds.

If a pt needs a PRN, sometimes I'll give that before continuing on. If a pt is going off floor, I'll do a full assessment and give meds. Each time I leave a room I chart what I learned.

Now I'm 30 to 60 minutes into the shift, I'm up on all pressing concerns, and if something comes up that requires my undivided attention, I'll just have some late meds and late full assessments, but rarely will I have anything pop up that can't wait.

Yeah, I think it can be a little intimidating to look at that blank flow sheet and see all those items that are screaming to be filled in. But after your initial quick focused assessment, you'd be surprised how many of those items have already filled themselves in.

Sometimes you won't even make it through the first of these quick visits when you run into something that demands your undivided attention, but since you already took report and so forth, you saw your pts in order of stability. Also (super important) keep your charge in the loop if you hit a snag (there's a reason she took report too) so she can make sure your other pts are covered.

BBFRN, BSN, PhD · Dec 27, 2007

Are you doing focused assessments, or full head-to-toes? It's best to do your assessments before giving your first round of meds and Txs, so you can assess the patient's response later on. Plus, you may need to add or hold something based on your assessment findings.

peds4now, RN · Dec 28, 2007

As an RN, assessments are one of the few things only you can do. Maybe you are very task-oriented and are thinking about everything that must be done, but ASSESSMENT is #1 on that list. By 4-5 hours into your shift you should be on your first follow-up focused assessment on a stable patient! Please don't wait until the first time you find something potentially major wrong with your patient/the equipment at the end of your shift to develop good habits.

When I come on and get my assignment, I take a deep breath. I still have to remind myself to stop and organize my day and not run into the rooms. Review all the orders (the current ones on the computer, not just your printout that may be hours old), make a matrix of what drugs are due when, prioritize who needs to be assessed first, then go in there. If it is a pretty stable patient, I'd take all the 0800 POs with me, but then do a full head to toe. You can do it in 5 minutes even if you are very slow. Check the ID band, check all the equipment and see what tubing needs to be changed and stuff, check the O2/chest tube setup, open up the bed and look at every part of the patient so you know what's there (don't chart what you heard in report). Add all needs to your "brain" sheet. Give the first meds to them, if all tubing is in order hang an 0800 IV, stop to pick up the next person's 0800 meds, and continue on. By 0900 (if you start your rounds at 0730), you should be done, even if you have a ton of patients. I think you will find that your mind will be much more at ease if you give yourself the time to assess your patients-there will be far fewer surprises during the day! And don't forget to give report to your CNA so s/he knows what's expected that shift!

jam2007 · Dec 29, 2007

Just curious to all who posted, do you find it more time efficient to do assessments first then pass meds OR do one at a time? I'm a new nurse and do all my assessments, then meds, but I don't get done until 10:00.

Virgo_RN, BSN, RN · Dec 29, 2007

A bit of advice I got when I was first starting was that I should be able to bank on my assessments. That means you get in there and get them done, and you be sure about what you're observing. Now, sometimes I only have time at the beginning of my shift to do a focused assessment, but I'd better have listened to heart and lungs and checked for pedal/LE edema at the very minimum. I can usually get head to toe assessments on all my patients within the first two hours of my shift, but often don't get them charted until the end. That's why my worksheet has space for a systems assessment so that I can note any abnormals for easy recall later when I sit down to document.

MedicalLPN, LPN · Dec 29, 2007

With me on an ideal night after I get report I start at one end of my section and begin doing my assessments, charting as I go, now if I get an admission or two during that first hour of my shift (which happens frequently) then I make notes of the assessment then chart them later. Sometimes though when you get slammed with admissions or when you have a patient going bad or a comfort care die right off the start I wind up having a couple assessments left to do by the time 2100 meds need to be passed, as a general rule of thumb I NEVER give any meds to a patient without assessing them first, so I get their meds ready go in, assess and administer or hold meds depending on what the assessment yields. As others have stated assessments are the highest priority because patients can and will circle the drain quickly and often times there's only a couple subtle things about their assessment to tip you off to it. Performing an initial assessment half way through the shift is really too late. It used to take me FOREVER to complete a thorough assessment but it's kinda like giving a bed bath you get faster and more efficiant at it the more you do it.