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!
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
Lemon Bars,
Nursing school was a culture shock for me as well. I currently work as a psych nurse. Often the psychiatrists and medical consults will quote the nurses notes and assessments in their H&P/progress notes/ consults. My assessments are expected to be thorough and extremely well expressed and include physical and mental health issues.
As a camp nurse, I did some pretty thorough assessments as well, as our MD had only two hours in the clinic, so I had to make sure that only the most important issues were scheduled for that time.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
A&Ox6 said:
Lemon Bars,
Nursing school was a culture shock for me as well. I currently work as a psych nurse. Often the psychiatrists and medical consults will quote the nurses notes and assessments in their H&P/progress notes/ consults. My assessments are expected to be thorough and extremely well expressed and include physical and mental health issues.
As a camp nurse, I did some pretty thorough assessments as well, as our MD had only two hours in the clinic, so I had to make sure that only the most important issues were scheduled for that time.
I totally agree with you about the physicians relying on the nursing assessment, I've actually seen them copy and paste it in their own notes Or they'll chart a completely negative assessment on a patient that I know has certain issues
To the OP, the Dr. may see the patient for 5 minutes a day while they are in Acute Care. It is up to the nurse to notice any changes in the patient assessment and you will need to know their baseline to do that.
Your facility that you work for will have an assessment sheet to follow I work on a med surg unit. We assess our patients initially(looking at vitals, assessing for problems , listening to breath sound, HR, bowel sounds, and focusing mainly on their dx) If you get an admission it is a more detailed assessment, where you go through each system with the patient, sometimes you will need the help of family members or doctors notes. Unless you would work in a specialty unit you wont need to know cranial nerves or a specific arrythmia in heart sounds. You get better with practice. We are clinicians but we are not allowed to diagnose, we report our findings, the doc assesses, and then we have orders to resolve the health issues. You learn to listen, look , feel, and ask questions at the same time. For example if you have a 32 year old patient with diverticulitis and you can talk to him appropriately you wouldn't need to do a full neuro assessment. You can tell by speaking with him and the way he moves his body that he is AAOx3. You'll be focusing on his bowel sounds, appetite, stool etc
You need to go shadow a nurse. You seem to have entered this field with very little knowledge of what actually goes on. You are overthinking about many things. You are still a student, a fairly new student, so you need to relax and see what else they teach you. You mentioned assessing diagnosing planning intervening and evaluating in a separate thread being the realm of the doctors but if you wait and read or listen to your professors you will learn that it is part of the nursing process. Please, take a breath, go shadow a nurse and find out what this profession entails. You need to learn how to walk before you run.
If only all aspiring students would do this, there would be less threads like this, or threads stating job dissatisfaction, or "I didn't know it was going to be like this, I thought blah blah blah..."
Alright everyone. I'm a starting to get a clearer picture of what RNs can do in various settings. For the last few years I have been working at entry level jobs such as nurse aide, medical scribe and health aide at a kid's camp, and all I'm used to hearing is, "No, you can't do this. No, you can't do that. That's out of your scope of practice. Only doctors to that, etc, etc." It's taking me awhile to wrap my head around the tremendously expanded scope of practice of an RN. Thanks for you're replies! I feel a bit more settled now. :)
Specializes in LTC, assisted living, med-surg, psych.
The most thorough assessments I ever did were when I was an admissions nurse in a SNF. Full head to toe, allergies, medical history, social history, advance directives, spiritual needs, vaccinations, the works. It usually took at least an hour, uninterrupted...longer if there were wounds or the patient was a poor historian and there was no family to help.
We were taught some advanced assessment technique such as percussion, deep palpation, and assessment of reflexes in school but these are skills I have probably never used as an RN. They are more likely to be used by an advanced practice nurse.
A basic head to toe nursing assessment is generally required at least every shift by acute care hospitals. The assessment will be tailored to the patient. I will do a more comprehensive neuro assessment on a patient who comes to the ER for a headache, fall, dizziness, stroke symptoms, or altered mental status vs my typical assessment of GCS and orientation status on my other patients. Contrary to what Joy Behar used to think, nurse DO use stethoscopes - the ones doctor's use. I would say nurses working in critical care - such as the ICU - do the most comprehensive assessments on a day to day basis.
As far as taking histories - a lot of this is done by the ED. I will ask my patients about their medical history as it relates to the reason they came in. The MDs get the more comprehensive history in the ED setting. It will vary from setting to setting.
Even in the ED, you will find yourself doing a quick comprehensive assessment along with a focused assessment among other things. For example:
Kiddo comes in with crying, eyes shut; parents poor historians as to what happened. Noticed CN XII involvement, fencing posture; performed and could identify which CN involvement due to having learned a thorough assessment in Health Assessment.
Ear pain? Able to properly use an otoscope to visualize a red, inflamed tympanum, a rupture tympanum, or a normal tympanum. Yup, learned that in health assessment.
Kid comes in with headache and stomach ache...hmm...take a look at their tonsils...you'll be surprised what you will find based on those symptoms.
Trauma assessments are based on an advanced health assessment; however, knowing how to to a comprehensive health assessment as the foundation is key.
Sometimes people come in with a different complaint and you find something else when you do a quick head to toe in the ED...Even when I do an initial focused assessment, I still do a quick complete assessment; sometimes appearances aren't what they seem, and as a nurse anticipating a surprise is key-that's why assessment is key to our practice.
While I agree that shadowing an RN is an excellent idea, to learn more about the RN role, I find that many RN's are unable to clearly articulate what they are doing and why they are doing it to a new learner. Some of this is related to pace -- a staff nurse usually is very busy and cannot efficiently summarize years of study and experience while continuing to manage a full patient load. When I was a new RN, I expected my RN preceptors to be able to provide well-thought out, clearly articulated answers to my questions, but later found that watching RN's with time management and prioritization and researching questions at home on procedures, medications, disease, etc., was more helpful. Some RN's are committed to continuing education, and other RN's, from what I observe, seem less aware and dedicated to this aspect of nursing practice. I feel you will get more joy from your chosen path if you continue to invest time and energy in your learning, even if it doesn't seem so applicable. All the best. Julia
Or they'll chart a completely negative assessment on a patient that I know has certain issues 
A&Ox6, MSN, RN
1 Article; 572 Posts
Lemon Bars,
Nursing school was a culture shock for me as well. I currently work as a psych nurse. Often the psychiatrists and medical consults will quote the nurses notes and assessments in their H&P/progress notes/ consults. My assessments are expected to be thorough and extremely well expressed and include physical and mental health issues.
As a camp nurse, I did some pretty thorough assessments as well, as our MD had only two hours in the clinic, so I had to make sure that only the most important issues were scheduled for that time.