I can't do a thorough patient assessment?

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I have been an RN for 18 months on a busy paediatric surgical ward, and am getting a bit anxious that I'm losing many skills we learnt at university. Not one single nurse carry's around stethoscopes to auscultate heart/lung/bowel sounds or palpates abdomens or pulses. It's a very busy task-focused unit and whilst I've learnt a lot about time management and prioritisation, the fact that I haven't performed any of these skills for nearly 2 years has resulted in me being feeling incompetent in it. I brought my stethoscope to work to practice on patients and had multiple people - staff and patients - question why/what I was doing because nobody uses them. Practicing on patients feels foreign, I get nervous and I feel like I don't really know what to listen for or where or what I'm doing. I don't want to lose my skills and I want to be a thorough and skilled nurse and I don't really know what to do? Are there courses/volunteer work/professional development that would allow me to build these skills back up?

Thanks!

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So if no one is using stethoscopes, they're not auscultating any sounds, are they charting that they did? Because on my floor you're supposed to listen to every patient. How would you know what resp issues they have if you're not listening? That sounds like an unsafe place to work if no one is actually assessing their patients. Assuming you want to stay where you work, you need to start doing a full assessment on all of your kids so when something is abnormal you can point it out. Check cap refill, pedal pulses, auscultate everything, feel their tummies, feel their skin and temp, etc. You can always purchase a peds book like in nursing school and it should thoroughly review it all for you or watch some videos on Youtube - Sarah with registerednursern is the best. Good luck.

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Specializes in School Nursing.

It sounds like the people working the unit have become complacent.  Are these skills charted as being completed?  If so, that's a huge problem.

Many places have staff that are designated Educators. Sometimes it's not a formal title, but sometimes the person's job title is literally "nurse educator."  If they have a designated person at your place of employment, they would be a great resource.

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Specializes in Private Duty Pediatrics.
On 2/19/2021 at 6:54 PM, Hopesandsdreams said:

 Assuming you want to stay where you work, you need to start doing a full assessment on all of your kids so when something is abnormal you can point it out. Check cap refill, pedal pulses, auscultate everything, feel their tummies, feel their skin and temp, etc. 

I wouldn't go after pedal pulses on a wiggling child unless I had reason to think there could be a problem. Surgery on the leg? Check pedal pulses. Tonsillectomy? Pedal pulses are not a priority. 

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4 hours ago, Kitiger said:

I wouldn't go after pedal pulses on a wiggling child unless I had reason to think there could be a problem. Surgery on the leg? Check pedal pulses. Tonsillectomy? Pedal pulses are not a priority. 

That’s your right, but as someone who’s trying to become confident in assessments she should do as thorough an assessment as possible on all of her patients so she knows when something is abnormal. If she never feels pedal pulses then she won’t be confident looking for them in a post op surgery patient. Feel free to add any suggestions to a general assessment she should complete though, I listed a quick run down of what I do.

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Specializes in Private Duty Pediatrics.

I see your point. ?

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Specializes in Pediatric Float Pool.

I agree with what others have said here - you absolutely should be assessing your patients. No lung or bowel sound assessments post-op? That is alarming and I'm so sorry you're in a position where it's so chaotic you don't even have time to do these important assessments. ? Take to Youtube, your old nursing text books, or a CPN review book to review assessment. I would highly consider whether this is a safe working environment, though. If your patients ask what you're doing, do tell them! Let them know what you're looking for, and it's educational for them too. Good luck! ❤️ 

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Specializes in Telemetry, DD, Ortho, CCU, BHU.

So sorry you are in this situation.  There are places on the web where you can listen to examples of lung, heart and abdominal sounds.  I would definitely do a full assessment on all patients assigned to me.  Once you make it a normal practice, you will get better and quicker at it.  Start at the top and work your way down ( eyes, lungs, heart, abdomen, pulses, voiding, last BM). I would not skip anything.  If your patient is in bed for whatever reason (post surgery, pneumonia etc.) make sure you check post tibial and pedal pulses.  Check everything and chart it.  If the other nurses ask why you have a stethoscope just answer to do my assessments.  They know…

Do what you were taught to do, not what everyone else is doing.  Don’t skip things.  You will be happier doing the right thing.  You are obviously a conscientious person or you would not be questioning these practices.  Best wishes for you.

 

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