In what setting does an RN do the most thorough physical assessments and health histories?

[Lemon Bars]

Please share your knowledge experienced nurses!

I am two weeks into a BSN program and I am enjoying it. We are learning, or at least being exposed to, the taking of fairly detailed health histories and also somewhat detailed physical exams, of the sort I previously thought were only done by an MD, DO, PA or NP. For example the textbook says, "When performing a sports physical or evaluation for work..." Personally I have only had this type of assessment done on me by a clinician, never a nurse, but I have already been told in a previous thread that I have underestimated the scope of nursing practice. I do understand that nurses round on their patients in the hospital to assess vital signs, wounds, pain and tolerance of medications. I know very little about the intake and discharge process at a hospital.

My work experience includes night shift in a hospital as a nurse aide and also as a scribe in a primary care clinic. In my admittedly limited experience, I have never seen a non-NP nurse perform these tasks. Don't get me wrong, I love learning about this stuff! I just thought that a nurse would have to go on to NP school to do these types of assessments.

My question is this: In which settings are these types of assessments (which to me seem "higher level") performed by a non-NP RN? Home health visits? Triage at the ER prior to a patient being seen by a clinician? Intake or discharge from hospital or surgery center? Skilled nursing facilities? A routine check-up at a specialist doctor's office? A visit with a Coumadin nurse? A clinic inside a prison when the MD is not available that day? A college campus? A rural clinic? Public Health outreach?

I know it's very early in my career, but I would like to steer some of my education and thinking towards RN careers where I could talk with patients and do these types of assessments routinely. Preferably, my patients would be conscious (not sedated in ICU or OR). Please keep in mind that I am a student. I may misuse terms or phrases like triage, discharge or high level assessment, so please consider the spirit of what I am inquiring about. (I misused the term 'provider' awhile back in a previous thread and caught heck for it.)

I'm the type of person who likes to look ahead to see where I'm going career-wise, because I've taken a few wrong turns in the past and wasted some time and money. I'm so sorry for the long post. Thank you if you read all that!

[dream'n, BSN, RN]

Yes, Med-Surg nurses do a head to toe every shift. An example of my basic assessment on a patient would be alert/oriented, symmetric facial expressions, bowel sounds and bowel tenderness, last BM and any bowel issues, any urination issues or decreased output, lung sounds or oxygenation problems along with any tachypnea, heart rhythm/rate and sounds, bilateral upper and lower grips, extremity movement and mobility, skin issues, radial/pedal pulses, presence of edema, swallowing or intake problems, and assess for pain. I'm sure I'm also forgetting something right now

In addition I do further assessments based upon diagnosis.

The most detailed histories I have gotten have been while previously working in an outpatient Genetic center.

And remember that the nurse is not a blind follower of provider orders. Nurses are expected to understand the treatment/medication they are giving and if the order is appropriate and safe for the patient. If a provider orders something in error and the nurse does not recognize this, he/she is accountable to the BON.

[dream'n, BSN, RN]

Lemon Bars said:

In my mind a clinician is someone who makes a diagnosis and prescribes a treatment, so I suppose nurse do meet this definition. However, at the clinic where I work, doctors, physician assistants and nurse practitioners are referred to as part of the clinical staff, whereas RNs, LVNs and medical assistants are referred to as the nursing staff. I tend to think of a clinician as someone who can make a medical diagnosis and prescribe a drug, but perhaps that is just because of the setting I work in?

FYI-Medical Assistants are not part of the nursing staff. They are not nurses.

[Lemon Bars]

Quote

FYI-Medical Assistants are not part of the nursing staff. They are not nurses.

I know. But they attend the monthly nurse meeting and share most of the same duties with the LVNs. Sometimes things they do have to be double-checked by an LVN or RN, but where my I work they are loosely considered "nursing staff."

[Lemon Bars]

Janey496 said:

I remember all the assessment stuff I was taught in school, and no - I dont use it all in my daily assessments. Our assessment class included things like looking in the ear canal and a thorough cranial nerve exam as well as assessing gait,balance, posture. It included checking several reflexes, too. I even learned percussion of the chest and abdomen to assess liver size and other organ systems. I've NEVER assessed someone in the real world by percussion and I've never seen anyone else do it, either.

But as part of an ongoing assessment that has become just part of my thought process...I do notice if their gait or posture is off, and things like that. Some of the stuff becomes just part of your brain and you dont assess it *intentionally* but you do watch it as part of your 12 hour shift of caring for that patient. Some of it you almost never use.

This is as I feared. Another long series of classes where I will intensely study everything only to find that only a small fraction of what I learn will be applicable to my job. (Just like statistics, chemistry, even large portions of anatomy where we were forced to memorize the name for every curve, protrusion and groove in every bone...) Sigh...I will learn as much as I can and hope it comes in handy some day.

[APRN., DNP, RN, APRN, NP]

To the OP:

You must first learn what to do, in order to understand when not to do it.

Everything that you learn allows you to build your ability to perform high level critical thinking, which is the hallmark of a Registered Nurse.

You Will get to use the detailed seemingly-benign information that you are learning. It will be the baseline information that you draw upon when you have to put the big picture together, later.

[applesxoranges, BSN, RN]

Lemon Bars said:

In my mind a clinician is someone who makes a diagnosis and prescribes a treatment, so I suppose nurse do meet this definition. However, at the clinic where I work, doctors, physician assistants and nurse practitioners are referred to as part of the clinical staff, whereas RNs, LVNs and medical assistants are referred to as the nursing staff. I tend to think of a clinician as someone who can make a medical diagnosis and prescribe a drug, but perhaps that is just because of the setting I work in?

It's not so much prescribing a drug. As an RN, you have to know what you want and how to get it. I had a patient who had a headache but I wanted to send up to the floor. Resident was sewing so I asked the attending if I could repeat the 4 of zofran and have 650 of tylenol for headache with enough of an assessment of why I thought that would be appropriate.

[chwcbesteph, RN]

®Nurse said:

To the OP:

You must first learn what to do, in order to understand when not to do it.

This is genius.

[/username, BSN, RN]

That's cute how you think nurses don't do in depth assessments. My ICU patients and their families beg to differ.

[CoffeeRTC, BSN, RN]

I work LTC and all I do is assess. Is it a head to toe every time? No. In my role as supervisor or floor nurse I do complete head to toes on admission and get a heathy history with the 10 million questions done. Ever other time I interact it is a focused assessment. We assess with our eyes and ears every time you have an interaction. Just because I might not be using my stethosocope it doesn't mean we are not assessing.

In LTC, there rarely are drs in house (unless they are doing rounds) so we are also formulating a diagnosis too. If I'm calling a dr, I better have a good idea why and wil most often be asked "what are you thinking about this?"

[bgxyrnf, MSN, RN]

Definitely not in the ED...

We're all about focused assessments.

[Farawyn]

/username said:

That's cute how you think nurses don't do in depth assessments. My ICU patients and their families beg to differ.

So would my HH patients.

[elkpark]

Lemon Bars said:

This is as I feared. Another long series of classes where I will intensely study everything only to find that only a small fraction of what I learn will be applicable to my job. (Just like statistics, chemistry, even large portions of anatomy where we were forced to memorize the name for every curve, protrusion and groove in every bone...) Sigh...I will learn as much as I can and hope it comes in handy some day.

I'm sure students in every other health profession, including medicine, make the same complaint. Physicians learn TONS of stuff that they don't frequently need to know once they're out of school and practicing (probably a lot more than nurses do). Yes, not everything you learn in school is something you are going to use every day. The thing is, you will often be applying knowledge without really being conscious of doing so, and a lot of what you are learning early in your program is information you need to build on as you progress in the program, to master knowledge and skills you will be using regularly.

Aren't you the same person who posted another thread questioning whether you were being trained to be a nurse or a doctor because you were being taught more than "do what the doctor tells you to"? How much research did you do before entering nursing school, and what did you think nurses know and do?