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.......

[cwinnie]

I find it quite disturbing that physical assessments are not done. How do you know if there was a change in that patient's status during your shift if you did not do an assessment at the beginning of your shift. Nurses who practice without doing an assessment are not only putting themselves in jeopardy but also their patient.

[job.rn]

I'm in that "old nurse" category. If I'm ever at your facility, my RN had best do her assessment or I'll question if they still have their license to practice! No need to be nice here, it's my life on the line, not their license.

[Rnandsoccermom]

I find it appalling that a nurse would not do an assessment. Patients live and die based on our continuous monitoring. You base your monitoring on a baseline assessment-every shift. I am very afraid to be a patient these days.

[rn_nxt_dr]

Allowing yourself to be "bothered" by whether you are wasting your time doing the right thing should not even be a concern. Because our job should be done systematically as we know it.

Doing your job right regardless of whether others are doing theirs' around you should only be your concern if patient safety is compromised. If so, you have to do the right thing....tell your supervisor. Just stick with the facts.

Keep up the good work.

[miracleluke]

To RNandsoccermom: It is very scary to be a patient these days! As an RN I have seen this from both sides of the fence so to speak. I always advise my family and friends to not go in the hospital alone. Take someone you trust to be there with you as your advocate. Hospitals are so understaffed and Nurses are overloaded so many times in an unsafe way that the only way the needs of a patient are heard or seen are when a family member chases you down the hall to tell you what they need. I hated this part of my job in the hospital! Like I said before, I worked the noc shift 8 hrs shifts and I had 14-16 patients sometimes. You can do the math: that is 30 minutes roughly per patient! How can you give safe and effective care when you have that kind of load to carry? You can't! My unit was a surgical/oncology unit. I was admitting people that came from the EMR, recieving new post ops from recovery and hanging Chemo and monitoring those patients. When will our Health Care System wake up and see this cannot go on! And Nurses it is our licenses on the line! The hospital is not there to back you up when something happens that will jeopordize your license. I say just be very careful, pay attention and don't put yourselves in that type of situation! To all the New Grads! We need you! As a new grad I was told by a very wise professor to work a year in Med/Surg first because there you can get your time management and Assessment skills down to where you have a routine that works and then be ready to move into a more acute area. That was the best advice because on Med/Surg you see alot of different types of patients and can learn a boat-load of good stuff to prepare you to move on into the more Critical Care areas. I learned I never wanted to do EMR, OR or ICU's! That was not my cup of tea! I loved the medical/surgical setting and Oncology was fun too which helped prepare me for my Hospice choice of nursing! Be sponges and ask to learn anything new, to take part in any new procedure a doctor may be doing and never be afraid to ask questions. That is how we learn! And as Nurses we never stop learning in this profession! It is on-going! RNandsoccermom, I didnt mean to pick on you, but you brought up a very valid point in being a hospital patient today! It is not because they do not want to give you the best of care , it is because of the way these medical centers are staffing! Its all about numbers not acuity anymore. Bring a family member to be with you so you know you have someone to speak up for you! Take Care all! And for heaven sake, New Grads reap what you learned in school and continue to follow what you were taught! PA's are a very vital part of your shift and the way you care for someone! It is imperative you establish a baseline for your shift! This is safe Nursing Practice! Take care and good luck to all the New Grads!

[JomoNurse]

i guess it all depends on what area youre working in and the reason the patient is there. i do a focused assessment. i don't do the nursing school head-to-toe assessment unless it is needed. for example, listening to bowel sounds on someone who just had a BM 2 hours ago and was admitted for a broken nail is kind of pointless and a waste of time in my book. anyways, do what YOU feel comfortable doing.

[miracleluke]

Jomonurse! Are you really 94 years old and still working as a nurse? Kudos to you!

[Virgo_RN, BSN, RN]

I am required to perform and document a full head to toe assessment on each patient at the start of my shift, then focused assessments throughout the shift as the patient's condition warrants.

[HazeKomp, BSN, RN]

Honestly, I find, as a nurse of >30 years, that my formal assessment and my ongoing checks vary from patient to patient. But I work with primarily healthy young women in Labor & Delivery!

example: I don't listen for heart murmurs when I am checking for regularity of rate. At term pregnancy, many women have benign murmurs.

example: I listen quickly to four points on the anterior chest wall for lung sounds. I listen to posterior fields if I hear anything abnormal.

But there are other things I DO assess with thoroughness! Ex. reflexes, edema, I&O status, pain status, etc.

Does every patient deserve a full assessment? YES

Will I do a better job after reviewing this thread? YES

Will I discuss with my nursing students the difference between a high standard of excellence in clinical practice and "just getting by? Yes

Thanks for this thread and the reminder to polish up my assessments!

[FranEMTnurse, CNA, LPN, EMT-I]

Very well put.

[JomoNurse]

I'm not REALLY 94. I just put that because I refuse to put my real age.

[island40]

The only thing I would add is that you really should not wear your stethoscope around your neck- c6-7 injury that could plague you for the rest of your life. Put it into a pocket or hang it on one of those handy clips at the belt. :)