Nurses not doing assessments

[gucci rush]

I am RN with 6 years experience and never have I seen anything like this. I am a new employee at a hospital in California with majority of the nurses are Filipino. I was on orientation and I had 4 different nurses that I worked with and not one of them did an assessment didn't listen to the heart, lungs, abdomen,didn't touch the patient with a stethoscope. I couldn't believe it. How can you chart and give report to the oncoming shift that the lung sounds were clear when you didn't even listen. I am happy that I was taught better and know better. My question is in other countries are they taught different because we all know here in the US that assessing your patient is the first thing you are taught to do in school.

[miko014]

This just got me thinking - not too long ago, I got pulled to another floor. I had been working with my pts since 3pm, and at 6:40 they told me that I had to go to the other floor at 7. Well I had just gotten a brand new admission and a transfer (at the same time and while I was in the process of hanging chemo no less). I had not eaten dinner, and I had to finish all of my charting/admission, etc. So, I hit the other floor around 7:30 (there was no way I could have been there any sooner!!), and by the time I had gotten report, it was 8:00. They had given me 6 pts, and I was only there till 11:30. I didn't even see my last pt until 10pm. I didn't feel very safe there, and I will admit - I didn't do full head-to-toe assessments on everyone. I did heart and lung sounds, bowel sounds, looked at any dressings/incisions, and did a quick look over on everybody (like, if I knew that the person had a swollen arm, I made sure to look at that arm, etc). But that was all I could do. I had to ask the charge nurse to help me pass a few meds, and I still didn't finish everything until 11:30 on the nose. That was scary to me, to not be able to do a full assessment, but what choice did I have? I basically had 3 (maybe 3.5) hours for 6 pts. But I did the best I could - I can't imagine how it would feel to just not assess anybody, ever!

[TazziRN, RN]

But Miko, you didn't chart that you did do a full assessment, right? That's different than not doing it but charting that you did.

[scattycarrot, BSN, RN]

I think the difference in the UK and Us training is purely historical. It wasn't that long ago that nurses in the uK were considered 'handmaidens' and were their to assist the doctor and provide very basic nursing care to the patients and carry out the doctors orders. I have worked with some very 'oldschool' doctors,who still insist on nurses setting up their dressing and suture trolleys (which makes me furious as if I am capable of setting up my own sutue trolley, why can't they?)and clearing up after them(Ha!). Nurse training in the Uk still harps back to the olden days in some ways and clinical assessment skills are skills that doctors utilise and not nurses. Now, as someone else pointed out that does not mean that UK nurses do not have effective assessment skills because they do. Uk nurses are taught to do full assessments and use all the skills that a US nurse does except listen to chests;that is the only difference. If a UK nurse found something on initial exam that was concerning then she would request that a doc see the patient, which is the same end game as US nurses,no? Now, alot of UK nurses do listen to chests but mostly in areas such as ITU, ER, Primary care, advanced practice, etc... and it is taught in continuing education as opposed to during nursing school. I have just finished a BSC and was taught clinical examination during that and I will admit that the skills I learnt have made me a more well rounded nurse. It hasn't made me any better than a nurse who doesn't listen to chests, it just means I have acquired different skills and am able to utilise them. I still think that all nurses(hopefully all!) can recognise a patient who is deteriorating with or without listening to their chests. Having said that, I think these skills should be taught to all nurses in the UK and I think in some nursing schools, they are.

As for whether all nurses will want to learn extra skills, I am not sure about that as they are hardpressed to do the jobs they do at the moment ,let alone adding to their workload. As other UK nurses have pointed out, we do not have the support staff that you have over here. In the ER I worked in we were lucky to have one health care support worker per shift. So, no LPN's, RT's, EMT's, ECT's, etc.. and the RN has do everything. This doesn't leave much time to do head to toe assessments on all the patients. I know on the wards, its just as bad. Patients are lucky to get basic care unfortantly and thats not because they are bad nurses(far from it), its just the system is on its knees. So, don't look down on nurses in the UK or Oz for not being able to listen to chests...that skill alone does not a good nurse make! Our trainings are different, not worse, not better, just different.

[XB9S, BSN, MSN, EdD, RN, APN]

Our trainings are different, not worse, not better, just different.

Scatty thats just what I was trying to say only you said it so much better

[KaroSnowQueen, RN]

I know my hospital hires a lot of "international" nurses and the nurse educators have said they have to hold special classes to teach some of the nurses assessment skills because in their countries (which ones I do not know for certain), the nurses didn't do assessments, just the docs.

[pickledpepperRN]

I can't speak for every single Aussie nurse, but it's the same everywhere I have worked and had prac. Doctors listen to the heart and lung sounds, assess JVP, and all that other stuff.

Nurses take vital signs and use O2 sats, resp rate, observation of work of breathing, ECG strips, a lot of other things apart from lung sounds. While I agree it may be beneficial to assess heart and lung sounds, it's not the be-all and end-all of assessment.

I must say, I have long thought American nurses get a more thorough education than I got at my particular university; or, from what I can tell, many other Aussie unis. We learn an awful lot on the job and are really just taught the most basic of things about nursing. It's bizarre.

As to why we wouldn't have time - we don't have CNAs as much as you do in the US (we call them AINs or PCAs anyway), so RNs are still the ones doing the washes, toilets, all the meds, chasing bloods, chasing doctors, making beds, we feed patients who need feeding... whatever needs to be done for a patient is done by the RN (or EN) looking after him or her. AINs don't seem to take on quite the role your CNAs do.

I have worked with nurses from countries where the doctors work shifts with the nurses. They start the IVs and perform much of the assessment that is the responsibility of the RN here.

I have also been through the registry to a hospital that does not allow nurses in critical care to inflate the balloon to get a pulmonary artery wedge pressure or do a cardiac output. I had to assist the intensivist.

He also assessed each patient between 8:00 pm and midnight. This was in California, USA.

But we are discussing nurses who do not do what they should.

Nurses charting ahead of time is unethical. It ha NO PLACE IN NURSING.

We MUST be honest.

We must NOT allow dishonest practices.

If nurses are assigne too many patients to perform the Nursing Process which begins with assessment it is time to work together for safe staffing.

[ZippyGBR, BSN, RN]

i dont understand how aussie and uk nurses arent taught to routinely assess heart and lung sounds!?!. How do you protect the pt as we all your own self if the pts condition deteriorates...what baseline would you have then? How would you know if the lung sounds are clear upon auscultation or if there are crackles...or if their heart sounds suddenly are abnormal?

becasue historically UK hospitals have had access to on tap in house medical cover 24/7/365 ...

the biggest problem is the perception by some that it's a 'doctor's job' therefore it's getting ideas above your station to do that... also core competnecies for registration lag somewhat behind core competencies for practice in Acute settings ( things like cannulation, venepuncture , and chest assessment spring to mind all skills people working in emergency / critical care areas acquire fairly quickly ...)

in settings where Nurses are empowered to initiate or substantially change treatment where it's relevant then they do, as for the rest of us - depends if someone has taught us properly and we are confident of doing so - also if you can't determine that someone is wheezy from other signs and their symptoms - listening to their chest is only going to confirm it...

[ZippyGBR, BSN, RN]

I'm curious about this. In my job, most of my time is spent on assessments, reassessments after interventions, etc. What do UK nurses do that don't allow them to have time for full examinations? (seriously, I'm not trying to be derogatory; I'm interested to know how the UK is different)

from my point of view as a nurse working on an assessment unit

- looking after patients who really need RN input ( given that Uk critical care areas only take patients who are really sick - and we also act as overspill for patients 'too sick' to go to ordinary units / are mandated for speciality beds e.g. cardiology /ccu or poorly respiratory patients who don't need NIV

- performing full assesments on the upto 12 new patients a shift - ( this is an assessment unit so turns over beds rapidly) including top to toe ( yes including chest assessment if approrpaite) assesment , bloods ( becasue our phelbotomy service are frankly a waste of space apart from routine montoring on stable patients) , IV access, ECGs, other samples... requesting those tests ( at least we only have 7 or 8 patients at a time on the medical side of the unit, it can be 12 on the surgical side which doesn't stick to one patient one bed + the dvt pathway ambulatory care patients ( only ever a couple at any one time) that the medicla side has

- checking the demographic information we have so (in hours) the ward clerk can put them onto the baed state and out of hours putting people onto the bed state system

- organising -transfers ( both within the facility and inter facility or back home) / psych evaluations / finding background and collateral history ...

-answering the questions of patients and their relatives / friends

- dressings/ catheters etc - as well as assisting the HCAs with turns, hygiene etc..

[XB9S, BSN, MSN, EdD, RN, APN]

But we are discussing nurses who do not do what they should.

Nurses charting ahead of time is unethical. It ha NO PLACE IN NURSING.

We MUST be honest.

We must NOT allow dishonest practices.

If nurses are assigne too many patients to perform the Nursing Process which begins with assessment it is time to work together for safe staffing.

Spacenurse the UK and Australian nurses were specifically asked in the different international forums and within this thread, what we were taught during our training and if we were taught to listen to heart and lungs, this is why you are getting the responses you are reading.

[NurseRotten]

Wow! Up to 18 patients with only one nurse. Gotta love socialized medicine. Remember that, US nurses, when you vote.

[suehp]

I am also originally from the UK...never taught how to listen to lungs and heart sounds - I also work with a french nurse who said the same about her training.

I agree with he other UK posters.....our assessments are basically the same except the listening of heart/lungs.

I now work in the USA and now do the heart/lung assessments.

Going back to the OP, it could be these nurses are just plain lazy or just ignorant and dont know how to do it...it happens where I work but thankfully it is in the minority...I often get Patients saying to me that I am being thorough and all I am doing is checking their heels and other pressure areas...isnt this just basic stuff???

[P_RN, ADN, RN]

So on a ward in the UK you might have 18 patients? WIth how much help? I know I've unfortunately had 15 on a shift with 1/2 tech (care provider, CNA) and 1/2 LPN (aka enrolled nurse in OZ & UK) and they all got assessed. Now given that was on 7pm-7am and not days. Days (usually) was no more than 10 with an LPN (enrolled) to give meds to the 10 or share a team 50/50. Here an LPN cannot assess but they can "collect information" that the RN then assesses.