Physical Assessment Skills for BSN students

[NPTeacher]

Several faculty members are having a disagreement about the depth of knowledge for a BSN student vs a MSN student (with a role focus as an NP).

I won't tell you which side I am on - just want to get lots of feedback.

1) One side says that BSN students shouldn't learn skills such as how to use an ophthalmoscope, do deep abdominal palpation, or be taught to palpate the liver or spleen. This side believes that these are all skills that should be reserved for advanced practice nurses.

2) The other side says that the difference in BSN and MSN is not the level of the skill - but what you do with the knowledge. That the BSN should be taught all skills and they are to be able to recognize normal from abnormal. They then refer the abnormal. The MSN should be able not only to perform the skill, recognize normal from abnormal, but then should be able to diagnose and treat the abnormal findings.

Any comments or suggestions??????

[Paulsm]

Deep abdominal palpation can have risks if done improperly or in the wrong clinical situation. In my 20 years of nursing, I have never seen an R.N. (BSN) use an opthalmoscope--except to do pupil checks (because they didn't have a small flashlight) or to peak in a childs ear to find the missing peanut.

I believe there are some assessment skills that should be reserved for advance practice nurses who are diagnosing and treating. Certainly all BSN's should be taught basic assessments and normal from abnormal---but there are some skills that REQUIRE advanced knowledge and training to be safe and effective.

Will be interested to see other opinions. Good Luck!

[renerian, BSN, RN]

I did all those things in my Associate program? Our nurses on the unit I worked on did those evaluations all the time?

renerian

[CardioTrans, BSN, RN]

I go with option 2.

[VickyRN, MSN, DNP, RN]

I have mixed feelings about both. We definitely DON'T allow deep palpation for our ADN's, but otherwise go along with #2 :)

[NPTeacher]

Thanks for your replies. We are still in the mist of trying to "iron out" the differences in opinions in our own faculty. I am the one on the side of teaching all skills to students. I am a very firm believer that the students need to know how to perform these skills properly - then what to do with the information gathered. BSNs should refer abnormal findings, while MSNs should manage them. I started my career as an ADN, went on to get my BSN, MSN and will soon have a PhD. In the meantime, I also earned a certificate as a CNM. In My ADN, BSN, and CNM programs, part of the curriculum was physical assessment courses. In each one of these courses, there was no distinction made about any skill being an advanced practice skill. (OK - except for internal exams such as pap smear, colposcopies and prostate exams). I realize that most of the nurses that our students see in practice do not use these skills, but that doesn't mean that they shouldn't. There is one nurse on Labor & Delivery that does a full assessment of her patients when she is assigned a new patient. A lot of the other nurses on the unit laugh at her, but thankfully, that hasn't deterred her (at least, not yet) from doing a great assessment. By doing this, she has caught several potential problems. I also know RNs that work for insurance companies and do physical assessments for these companies. I think that if physical assessment is a part of nursing (which it certainly is), then our students need to be taught the proper way to do the skills - which includes some instruction on the dangers if the skill is done improperly.

[mari2]

I have had BSRN's who have worked under me who do ear lavages who have needed to know what a normal ear looks like inorder to know when they should stop lavaging or if they have removed the cerumen etc. THey can assess they ear correctly because they have been taught correctly. If they are going to be irrigating an eye for you the same thing holds true. They need to know how to assess and use the assessment equipment properly and know what normal is. Then when they see something abnormal they can tell the NP or MD; that's what the Assessment course is really ALL about Critical Thinking Skills combined with Good assessment Skills. Mari2

[llg, PhD, RN]

As someone with a staff development background ... my opinion is that specialized skills not required on the job by a large percentage of practicing nurses should not be emphasized in an undergraduate program. If most of your graduates are required to perform those skills as new graduates, then they should be a part of your program regardless of the academic degree offered. If most of your new grads will not be required to use those particular technical skills early in their careers, then the school should not invest the students' limited time in learning them. The few who need those skills (or any other specialized skills) will learn them through continuing education or job orientation when and if they ever need them.

Working with new grads in a hospital setting, I can say that I don't really care all that much about most of the technical skills that students learn or don't learn in school. I am more concerned about their ability to think, to understand, and to learn. If they have a good head on their shoulders and the desire to learn a technical skill, we can do a good job of teaching any skill they need to know. And because each school uses different equipment and different procedures for the various skills, we pretty much expect to at least review all the skills they will need as part of their orientation program.

I would much rather the schools focus on basic principles, underlying knowledge, critical thinking, etc. to provide a good foundation upon which we can add the job-specific technical skills than spend a lot of time of skills that are only used regularly by a few new grads in their first jobs.

llg