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Primary nurse assessment

Professionalism   (1,413 Views 26 Comments)
by Mgrn Mgrn (New Member) New Member

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I'm a float nurse and about a month ago, I was told by the supervisor to do the admission assessment on a unit for the nurse. I relayed to the primary nurse that I would go over everything with the patient as far as questions,  but would leave the physical assessment for her to do.  I was then told by the supervisor that I  should do everything,  including the physical assessment just relay my findings to the patient's nurse and that she did not have to document anything.   I feel like this is in violation of nursing ethics, and want to know how others feel. 

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Do as you are told but document under your signature. Relay pertinent info to the nurse. What she does from there is on her. I would draw the line at doing all the work but allowing her to put her signature to your assessment. FWIW I worked with an LVN who told me she did home health admissions assessments but the RN signed them. Now that is an unprofessional, unethical, and illegal act as I see it. 

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2 hours ago, Mgrn said:

I'm a float nurse and about a month ago, I was told by the supervisor to do the admission assessment on a unit for the nurse. I relayed to the primary nurse that I would go over everything with the patient as far as questions,  but would leave the physical assessment for her to do.  I was then told by the supervisor that I  should do everything,  including the physical assessment just relay my findings to the patient's nurse and that she did not have to document anything.   I feel like this is in violation of nursing ethics, and want to know how others feel. 

 

I don't understand the issue here at all.

Why is it a violation of nursing ethics for you to settle a patient in a bed and do an appropriate complete assessment, including a physical assessment if that is what you are assigned to do?

Are you an RN?

No sarcastic intent here - - I just actually do not understand. Can you clarify? 🙂

 

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by Mgrn New Member
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Yes, I'm a RN. Are you? Do you do your own assessments? The issue here is that this was not my patient,  and the nurse this patient was assigned to was basically told she did not have to do an assessment.

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Knock it off with the snottiness. I was very clear that I was not attempting to be snotty with you in my first response. I asked if you were an RN because I thought maybe you were an LPN or had some other concern about doing this assessment.

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To answer your question.

You were asked to perform an assessment that you are qualified to perform. You are literally assessing and documenting the patient's condition and situation upon their arrival to the floor/unit - you are qualified to do that, regardless whether someone else is going to be freed up to take over care from you at some point.

When you are done with your assessment you give proper report to the RN who is assuming care from you, and document your hand-off.

That RN then has the responsibility to do their own prudent assessment, just as you do when you get report from someone else.

Your coworker wasn't told she didn't have to do an assessment - she was told that she didn't have to perform the initial admission assessment because presumably she was tied up elsewhere and meanwhile an RN who is perfectly capable of doing the admission assessment is available. Your coworker still retains the duty to perform a prudent assessment upon taking over care of the patient from you.

If she doesn't do it or doesn't document it, that's on her.

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3 minutes ago, Mgrn said:

No I'm a RN, but I have worked with many LPNs and they did their own assessments as well  

My only experience is having to cosign LPN assessments as an RN (which means I also have to perform them myself since I don't attest to that which I can't verify). I know things are done various ways. But that's why I was asking in the first place. 🙂

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I suspect what the supervisor was referring to was the initial admission assessment, which you are qualified to perform. The supervisor was simply saying that the other RN will not be required to perform the admission assessment that you have just performed. That does not take away his/her legal duty to perform their own nursing assessment upon assuming care of the patient.

Let's follow your line of thinking: Is the nurse who comes on duty 12 hours later also required to do an admission assessment? Why or why not?

Here is another example for comparison: In the ED, every patient gets a triage assessment - - a very similar concept to your admission assessment: What is the RN's assessment of that patient as they are coming in the door. The nurse who performs the triage assessment is almost never the nurse who is assigned to the room the patient is ultimately going into. The nurse assigned to the room is never going to re-do the "triage assessment" - -  it has already been done. But they are going to review it and then do their own assessment, which they are not going to document as a "triage" assessment because triage has already been done.

The situation you are talking about the same concept. There is an admission assessment. It needs to be done when the patient arrives. There is no ethical nursing rule that this must be performed by the person assigned as primary care nurse - - such an ethical rule just doesn't exist.

The supervisor was not saying this nurse didn't have to assess the patient (which is a permission that no one can grant to an RN) - - the supervisor was saying that the primary RN would not need to do the "admission assessment" - - because it was going to be done already. By you.

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1 hour ago, Mgrn said:

No I'm a RN, but I have worked with many LPNs and they did their own assessments as well 

We were taught in school that LPN/LVN’s do not assess, they ‘gather’ information. A big deal was made of this. Yet on the job, ever since, I have encountered where the practical nurse is expected to do just that and nobody bothers with the word games to attempt to camouflage what is happening and there has never even been any countersigning that I have seen. The LVN I described in my example was all proud of the fact that she truly was doing the RN’s job.

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NICU Guy has 4 years experience as a BSN, RN and specializes in NICU.

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7 hours ago, Mgrn said:

  I was then told by the supervisor that I  should do everything,  including the physical assessment just relay my findings to the patient's nurse and that she did not have to document anything.   I feel like this is in violation of nursing ethics, and want to know how others feel. 

This has happened to me several times. I was assigned a new admission and I am busy with my other patient when transport brings the patient. The charge nurse and another coworker admit the baby, including the physical assessments, blood draws and documentation. When I am done with my other patient, I will get a synopsis from my coworker or charge nurse. When it is time for their next assessment, I do a full assessment, but do not do the extras that are part of the admission assessment. 

Your supervisor was asking you to do the initial admission assessment, document, and relay your findings. Your job was to admit the patient and make sure the patient was stable until the assigned nurse gets time to focus on the new admission.

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