Master's prepared nurses working as RNs. Do you do advanced assessments?

[dudette10, MSN, RN]

Master's programs include an advanced health assessment course as part of the core curriculum, regardless of area of concentration. If you are working as a bedside RN, do you, as a matter of course, utilize your advanced assessment skills? When do you use them? Has your advanced assessment education and practice changed the circumstances under which you would notify the doctor, as compared to before your master's program when your assessment skills were more basic?

[dudette10, MSN, RN]

This sort of reads like homework, doesn't it?

For the record, I haven't started my master's program yet. I asked the question because of an acute change I reported to the attending's NP the other day. I read her note, and I noticed her findings were the result of her advanced assessment skills, skills that I do not yet possess.

[HouTx, BSN, MSN, EdD]

It is also important to note that in terms of liability...... performance expectations (standards of care) increase with formal education and certifications. So, an MSN-prepared &/or clinically certified staff nurse would be expected to exhibit greater skills and abilities than colleagues with less qualifications. Scary, right?

[nurseprnRN, BSN, RN]

I have an MN but took no advanced physical assessment classes because my program was not an NP program. So what you are asking relates to NPs, not just MNs. There are lots of different paths for MNs, and NP is only one. (I know the OP probably knows this, but there are probably some others who don't.)

[dudette10, MSN, RN]

Hrm. I wonder if the requirements have changed for MSN. All the schools I was interested in included advanced assessment as part of the core.

[dudette10, MSN, RN]

Ok, I know what I was thinking about. The 3 P's (advanced pharm, pathophys, and physical assessment) must now be included into every master's curriculum that prepares one for a direct care role, which includes nurse educators, my chosen concentration. Apparently, nursing administration is not considered a direct care role, so those students would not have to take the 3 P's.

[tokebi]

I did take an advanced physical assessment course as part of the direct-entry Master's program (which prepares one to be a general bedside RN with an optional CNL cert). I loved the class but most of the skills simply do not pertain to the bedside RN role. For example, detailed ENT exam, CVA tenderness, tendon reflex, breast exam... things you might do in an office setting but not as an inpatient bedside RN.

I suppose there are things I do utilize... I sometimes auscultate heart sounds at different points -- pulmonic, aortic, etc -- but more as practice. I probably don't know what I'm hearing anyway...

I have tried palpating cervical lymph nodes when a patient complained of jaw pain. Didn't find anything. I notified NP/MD anyway, so my skills weren't really needed to begin with.

The skill that I do utilize everyday and am glad to have learned, is deep palpation. The finger positioning, the use of two hands, how much pressure to put... I really feel that such detailed instruction helped me a lot in daily assessment as an RN. To give you an example, I remember feeling confused whether my patient had a distended bladder or not when I was an LVN. Nowadays, I am quite confident in my abdominal assessment. Not like an MD of course, but confident enough to tell bowel vs. bladder!

[OCRN3]

I have my FNP and work per diem in the floor. I sometimes do an advanced assessment on those going down the drain but not usually. First of all being on the floor who has time for that. Secondly I couldn't write my own orders, so if someone is going down hill I will mention these assessments finding to the MD but nothing more. The hospital I work for doesn't know I am a FNP either.

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[classicdame, MSN, EdD]

I think the assumption is that if you are getting your MSN you intend to use it in a different manner than as a general staff nurse, for instance, as a Nurse Practitioner. Whether or not you work as an NP is up to you, but you would have the skills from the coursework. I do not see how advanced skills will hurt anyone! Sounds like a good opportunity for you.

[nurseprnRN, BSN, RN]

I can definitely see that a direct-entry MSN program for any purpose would have an excellent reason to teach physical assessment skills. In my (nondirect entry, brick-and-mortar) program back when Florence roamed the earth, those of us who wanted to get more skills in any areas were freely able to connect c medical and nursing faculty and clinicians to spend time in clinics or on rounds to do that. I did so in my area of specialization, but it wasn't a requirement or a formal class and I had been a working RN at the top of the clinical ladder in a really excellent ICU prior to starting the program, so I pretty much knew my way around good physical assessment. :)

[dudette10, MSN, RN]

Thanks for the replies. They confirm some of my thoughts, i.e. that I may use advanced assessment in certain situations, possibly to give more robust assessment data to the provider, but it would not change when I notified the docs.

[NurseKatie08, MSN]

I have an MN but took no advanced physical assessment classes because my program was not an NP program. So what you are asking relates to NPs, not just MNs. There are lots of different paths for MNs, and NP is only one. (I know the OP probably knows this, but there are probably some others who don't.)

Agreed. I have my MSN with a concentration in Nursing Education. I did not take an advanced physical assessment course. My core courses focused on research, health policy and theory, while my concentration courses focused specifically on curriculum development and other aspects of education.