Physical Assessments: Do Any Nurses Do Them

Nurses General Nursing

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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.......

It seems to me you probably already know the answer to your question. Dont change your values based on what you observe others doing. I know what you are saying is true, I have seen it myself, more often than I care to think about. Repeat the following statement in your mind whenever you feel like cutting corners. "Own your practice."

You will continue to see this for the rest of your nursing career, sometimes to a lesser and sometimes to a greater degree. You can ONLY control your actions, so focus on being the best nurse, Do your assesments every time!!!!!!

Specializes in Pediatrics, ER.

That's too bad. At my hospital I do wear a stethoscope and every one of my patients gets a head to toe every single shift. Not only that, but they also get a problem-focused assessment every four hours. The same practice remains consistent for every nurse on the floor and we have excellent patient satisfaction ratings and above all else, we give very safe care.

I work on a med-surg floor and I can say that only about 5% of the nurses on the floor do full assessments. This is very unfortunate and as a new grad, I am not learning things the way they should be done. Yes, some of the nurses are lazy but the main reason that we need to rush things and cut corners is because we are so short-staffed. We are a 39-bed unit and we usually work on 4s, about 10 patients per nurse. Sometimes we work on 3s. Even if I rush everything, my shift ends at 8am but I end up leaving at 10am in order to finish charting (no overtime pay). The obvious solution is for me to find a new job but nobody wants to hire new grads these days with only 3 months of experience. All in all I wanted to say that this thread has shown me what's important and that I need to rethink the way my nursing career is going...

What??? I think that many nurses are lazy, not just older ones as I have seen younger new grads do the same thing! I worked on a Surgical/Oncology Unit a few years ago and we all had 14-16 patients each on the noc shift! It always took me longer to get done with my initial rounds and pass meds than the rest of them! They were always finding time to run around and visit each other or go to other floors or just sit and talk at the nurses station. I was floored by this practice. All I could think of was, "One day it would come back and bite them in the butt big time!" I knew I was responsible for my own work and documentation and if I didnt do it, it did not get done! That was my feeling. I made notes on my "brain(report paper)" I carried around all shift and most noc's would not get done and be ready to start my charting until I reported off to the next shift! I was that busy! I rarely took a lunch break! We had cows(computers on wheels) that we took with us into the room to chart and scan meds when meds were given and when I had the chance to sit down it was usually a quick note here and there but my major charting was saved until I could do it uninterupted in a corner after I gave report and no longer had to run every time someone called and needed something. I don't know about anyone else in the nursing field but I worked damn hard for my license and I am not going to jeopordize it by cutting corners! Besides it is a human life we are dealing with, and I think if I was in that bed I would expect my nurse to be on top of things so that my recovery period is not extended due to an unobserved complication! Put yourself in each one of your patients places and think of how you would feel if someone neglected to make any necessary observations early enough to fix the problem or nip it in the bud! Good Luck and I hope you continue to operate as a nurse on the floor with a conscience and not worry about who gets done first or gets the most credit! Our jobs are not ones meant to be competitive! We are working with human lives here people! This just angers me when I see it! I can not work among people who are careless and also put my license on the line because we are part of a team! This makes no sense. I now work with Hospice patients and believe me I am still making the thorough assessment with each patient I see! They arent dead yet and deserve the right to have all their symptoms addressed as they pop up!:wink2:

Specializes in Med-Surge, ER, GI Lab/Scopes.

If you don't do a PA on each pt, how can you call yourself a nurse? Passing meds and knowing what to click on a computer screen does not a conscientious nurse make..

Getting angry about it isn't going to change the fact that it's happening, probably not just on my floor but in other places as well. Good for you for willing to stay after your shift to chart but when that happens to me, I can barely think or see clearly and I am both mentally and physically exhausted. I am not saying that I need to ignore doing assessments in order to leave work on time but I realized I need to figure out a way to get everything done within the shift. I want to leave at 8 am because I'm tired, not because I think nursing is a competition or race. At this rate I'll be experiencing burn-out within the year. We don't get hour breaks like everyone else and we don't have conveniences such as computerized med carts, etc. Our hospital is in nyc so acuity is always very high. There are no excuses for leaving out assessments but all I was doing was pointing out the way things are done on my floor.

Damn I was just being thankful for this thread because it gave me an epiphany but it seems to me that being judgmental and sarcastic override being supportive and giving helpful advice especially to us newbies.

Just remember this.

A good thing will always be a good thing and bad things will always be a bad thing even if everyone does it. Ok?

I am also a new nurse and I always apply all the things I learned from school especially assessment. Just do the right thing to do. Mind your patient and your license not too much on your co-staff nurse.

Specializes in Tele, Med/Surg, Case Mgmt, Ins. Rev.

In reference to Lauramae 18's comment about new grads, and where they start......

I was fortunate enough to start on Tele, and it was the best well-rounded training I received! You get everything there, more so today than 18 years ago. Take every continuing ed offering your hospital offers! Also check with other area hospitals and Community College. You are still in the learning/studying mode, so it will be a little easier for you.

Good luck!

Specializes in Tele, Med/Surg, Case Mgmt, Ins. Rev.

"Damn I was just being thankful for this thread because it gave me an epiphany but it seems to me that being judgmental and sarcastic override being supportive and giving helpful advice especially to us newbies."

Dear Sunnydaysss,

I think you may be mistaking our passion for criticism. Many of us have seen the lack of PA, and we are sayin that this is not right, and our encouraging you, and our fellow nurses to always do a PA.

Please continue to do the right thing. This unit may not be the right fit for you, but put your year in, then start exploring your options.

Best of luck, and kudos on doing the right things as a nurse.

Specializes in Management, Emergency, Psych, Med Surg.

We do them on our floor at the beginning of each shift and as needed. However, I was in my own hospitals PCU (intermediate care unit) for chest pain and I was NEVER touched by a nurse the entire time I was even there, even though the chart indicated that I had been. I reported it to the manager up there but no one did anything about it.

Do a full assessment! Your helping your patient and the doctor's when you find a change that needs handled!

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