Physical Assessments: Do Any Nurses Do Them

[romie]

It has become apparent to me early in my nursing career that many RNs are no longer performing thorough PA at the beginning of the hand off of care. Not one single nurse during my orientation as a new grad had a stethascope around their neck to ausculate lung, heart, bowel sounds. Not a single RN palapated a patient's abdomen or pedal pulses. When I started at a a new hospital as a new grad, my preceptor said to me as she observed me assess a patient "wow, that was a good and thorough physical assessment." I'm thinking to myself, this is what I was taught to do as a basic skill during my nursing school days at UIC.

I work on a tele unit and I am one of the few RNs who actually have a stethascope and calipers. Am I missing something? I know how important it is for a s/p lap cholect. patient to have bowel sounds but how can you assess bowel sounds if you don't have a stethascope. Asking a patient if they have passed gas is subjective. I need hard data.

So my question is, am I wasting my time physically assessing my patients? Granted I do a focused assessment based on their accuity and needs, but I will still inspect the feet of all my patients. Am I doing something wrong? Do I need to reprioritize? I really need some help here because I'm a little confused after all of the time spent at UIC on physical assessment. I don't want to falsify documentation when the computer prompts me if I heard bowel sounds or not.......

[pinksugar]

Uh, I have never worked on any floor where nurses don't assess their patients. That sounds pretty shady to me. You are not wasting your time doing them. I have caught many a problem and nipped it in the bud early by doing a complete physical assessment.

[SunnyAndrsn]

How could you go wrong doing a physical exam of these basic systems? Other nurses have to worry about their licenses, you worry about yours. If you are checking off in an assessment that "lung sounds are clear" you can only know that if you auscultated their lungs. I too find it frustrating when I suspect other nurses around me are cutting corners.

[darkangel_05b]

I think alot of the 'older' nurses seem to get lazy in their ways and don't think that it is as important. However, I notice that the newer nurses seem to do a more thorough assessment. I guess they just get too relaxed in their work...

About the stethoscope... I don't know why anyone wouldn't carry theirs around...all of our nurses do (older and newer)...but granted, I work in a cardiac unit...

[jean36]

pls keep up with your complete physical assessment spirit, don't lag behind like many of us. the truth is many nurses don't do complete physical assessment and there are legitimate reasons in some cases and depending on the unit. however, it would always be prudent to do it.

[ONCRN84]

When I worked inpatient, I always listened to heart, lungs, abdomen, felt for pedal pulses/edema, pain level, and checked out their mouth (oncology floor). If I found something that was wonky, I investigated a little further into that system. You can't chart an assessment you never did...

[eriksoln, BSN, RN]

My first travel assignment ever was at a LTC facility in Baltimore. It had been a nursing home at one point but it was bought by a hospital that needed a place for pt's that were not recovering on the usual time schedule. I showed up my first day with my stethoscope around my neck ready to take on my patient load.

A couple midnight nurses (I was a day shift worker) joked about my stethoscope. At first I thought they were making a jab at the fact that it was a cardiac stethoscope (very expensive, but you could hear so clearly on it). Then a few of my fellow day shift nurses showed up. Some of the comments made at me:

"What do you need that for, you are not a doctor?"

"You travel nurses are such show offs."

"What are you going to do, wear that thing around your neck all day?"

"Do you wear that thing at home too?"

I continued to think they were making fun of the fact that I had such an expensive stethoscope. I expected to see them use the cheap hospital supplied ones for their assessments. We got report, I left to do my assessments and when I got back to start passing meds...................they were all completing their charting. Not one of them had moved from their chairs. They documented their "assessments" then passed meds and then continued to spend most of the day in the report room. They were so comfortable operating this way, they didnt even put on a show and bother with having stethoscopes or anything.

Another place I worked at later on in Tacoma was almost as bad. The nurses at least had stethoscopes, but they'd complete all their charting before even leaving the nurses station after getting report. They did a drive by assessment (just stand outside the door, make sure they are breathing).

[twinner2]

I agree with some of these earlier comments: Definitely do your assessments. I have been a nurse less than a year, and I do a PA on all of my patients. Corners should not be cut by forgoing an assessment on each patient.

Keep up the good work!

[RNperdiem, RN]

The assessments you describe are standard for my unit, we check those things and more every 2-4 hours.

I sometimes leave my stethescope in my bag.

Sometimes my unit has a lot of isolation patients, and you have to use the cheapie hospital provided stethescope found in each room, so there is no point carrying your own.

I am concerned that a new grad is not being taught to assess a patient the right way.

[Otessa, BSN, RN]

How can anyone chart"Meets Standards" if they haven't actually assessed their patient????

No PA?? I was a bedside nurse for over 15 years and I always did a full head to toe on my patients-I floated throughout the hospital-all different kinds of patients.

All I can say is WOW!!!

otessa

[netglow, ASN, RN]

OP, my most recent clinical site was similar. I did not see a nurse with a stethoscope. Only once when I reported no sounds, my RN did ask to use mine at least. A good thing for me to remember to look for when interviewing! That speaks volumes about the floor, huh. After all, these people would be so out of practice, do you really think they are good enough for you to gain any real skills from? I know that sounds kinda upitty from a newbie, but hey I'm expecting a lot from my new job. This is where you make or break it. Gotta learn!

[ghillbert, MSN, NP]

Whatever field you work in, there are good and bad, motivated and lazy staff. Part of being a new nurse is observing and deciding whose practice you want to emulate. Just because some people are lazy (and it's not the "older" nurses, it's the lazy ones), does not affect your practice.

There are certain things I learned at nursing school and never did again (fundoscopic exam, otoscopic exam, reflexes, etc) due to the types of floors I've worked on. Lung/heart/bowel sounds, brief neuro exam, cap refill, extremity warmth, pulses are a minimum that I do on everyone.