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.

[scattycarrot, BSN, RN]

Further to some of the other posts re: doctors in the uK, on most mediacal admissions units a team of doctors is on 24/7 and do not float else where. On the wards a house officer(junior doctor) will be on call and often, on a busy unit they are there most of the time. During the day, there is usually a team of docs on the ward doing ward rounds, etc... but ultimately there is usually someone around at all times. At least, thats my expereince,it may be different elsewhere!

How does it work here in the states?

[SKM-NURSIEPOOH, BSN, RN]

this scares me - there has been more than one time where i go in and do my assessment and pts (who have been there for days, mind you) say, "oh, nobody has done all that before". yikes! i've also had pts ask me, "wait, are you my doctor or my nurse?" and when i say nurse (which, of course, i always tell them when i first meet them), they are surprised about me doing an assessment, which leads me to believe that maybe people aren't doing it. but i don't know whether they do or not.

i work with at least one nurse who charts for the entire shift at the beginning - her q2h checks (we have little boxes for like, resps regular/unlabored, etc) and everything. if she sends a pt to the unit or someone dies or something, her charting is going to be a big problem for her. but she has been a nurse forever and that's just the way she does it. that scares me too!

sometimes i wonder if nurses even look at pts - i've heard stuff in report like, "it says on my sheet that he has an ng, but i don't know if he does or not." i mean, an ng is pretty obvious, isn't it? all you have to do is walk in the room for that one. my favorite was a few weeks ago - i had had a confused pt for a couple of days, and i got back for my last day of the stretch, and when i went to chart on him, i saw that it said he had a sw in his right hand. i was like "no, he took that out and they said not to bother restarting it because we didn't need it..." so i went back in and looked again just to make sure i hadn't missed it. he had no iv access (hadn't for days), but they had been charting it like it was there all along! not good!

interesting that you've mentioned this. my very first nursing job in a *facility* was in a long term care. there (ltc), rarely is/was an assessment done on a shift-by-shift, let alone, a daily basis for every pt. and actually, the people living there are referred to as "residents" & not "patients" due to the fact that they live there & it's their home. also, it's not necessary to do a head-to-toe assessment on everybody if they're condition is stable. the only residents that were assessed with vital signs (either because of they type of meds they're on like antibiotics or they're newly diagnosis with diabetes & bg were needed, etc). the findings are then documented on a shift-by-shift basis times 3 to 5 days on the 24 hr report sheet whom required *follow-up* assessment from a previous injury/re-admission/etc. the op didn't mention what kind of facility they worked at, but if it's ltc, that probably would explain the other nurses "lack of an assessment."

now, having gone from ltc to critical care, i definitely see the difference between a typical head-to-toe assessment done in ltc & one that's done on the units (ccu, icu, pacu, ed, etc). i also know nurses in critical care will do a thorough head-to-toe assessment at the beginning of their shift, but will do an quick assessment the rest of the shift. one can, for example, can readily see/hear changes in say hemodynamic/pulm areas (especially if the pt's monitored/vented) this may or may not require shooting numbers or listening to lung sounds &/or sending abg's. one can, i.e., quickly assess the status of a pt from the door just by talking to them (providing they're not vented of course). once vitals are obtained, & the patient is pink in color, their heart rhythm is stable/unchanged, their map is over 60, they can talk without being sob, can clearly state their name/location/time, their foley has clear/yellow urine present, iv site is patent with the correct fluids running. one has done a visual assessment of their pt & can return to do a full/complete one with bowel/heart/lung sounds a little bit later (especially if their other pt is unstable & they know they'll be in that room for a while). actually, doing a visual assessment is becoming more of a trend now with the electronic icus. these nurses rely on what they see in the video & what ever they can hear through the camera's & document their findings as a back-up to the critical care nurses whose doing the actual physical assessment.

unfortunately, nurses today are working so short shift that we're often forced to find other *ways* to assess which may be bordering on the short-cut line, but usually in these cases, i believe nurses still perform their jobs to the best of their abilities which includes doing assessments. some will & do "skip" what they think to be unimportant & will justify that by stating they're prioritizing what they feel is important/non-life threatening & leaving the other stuff to follow-up later. unfortunately, it's becoming the norm that the *other stuff* isn't followed-up due to emergencies occurring like having other nurses' pt's code on the floor & you've gotta help them in the code which backs everything else up. then the non/life-threatening stuff gets pushed onto the next shift for them to follow-up & if they deem it's still at the bottom of their priority scale ~ well....need i say any further. this is how things can get *missed* for more than one shift at a time unfortunately. yeah, every nurse is responsible for his/her own assessment & i'm not making any excuses for them, but i think the nursing shortage & working short staff is a major factor for stuff not getting done or being missed.

cheers :cheers:,

moe

[suehp]

Further to some of the other posts re: doctors in the uK, on most mediacal admissions units a team of doctors is on 24/7 and do not float else where. On the wards a house officer(junior doctor) will be on call and often, on a busy unit they are there most of the time. During the day, there is usually a team of docs on the ward doing ward rounds, etc... but ultimately there is usually someone around at all times. At least, thats my expereince,it may be different elsewhere!

How does it work here in the states?

That is hw it worked in our hospital in the UK too...usually always a Doctor about - if it wasnt the Consultant or Registrar doing the hose it was a Sneior House Officer or Junior House Officer about...

Here where I work the Doctors do their rounds in the mornings and on days they are doing surgeries they call round after or they have their PA's or NP's to do rounds initially....I work nights but still see Doctors doing their rounds but if they arent here then we have to call their service and have telephone orders.... completely different to what I am used to...lol