Primary nurse assessment

[Mgrn]

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.

[Wuzzie]

8 hours ago, Mgrn said:

I feel like this is in violation of nursing ethics, and want to know how others feel.

It is not a violation of any sort and I believe that you will find that the majority here do not agree with you. You were tasked with completing an admission which you are qualified to do. You do not get to pick and choose what parts of the admission you will or will not do. I can't imagine what got into your head to even think that you had any grounds to complain about it. Do you think it's ethical to leave a new patient un-assessed until the primary nurse gets a chance to do it simply because you don't wanna?

[llg, PhD, RN]

My hospital has "admission nurses" who go from unit to unit, helping staff with admissions. They do the official admission assessment, complete all the paperwork, get the patient settled in the room, orient them, etc. Then they report off to the staff nurse who uses her judgement as to what to assess for herself as she takes over the care of the patient. She would probably choose to look at any critical physical features herself, but she doesn't have to waste time asking all the questions about the home, religion, family history, etc. because that stuff has already been documented in the chart by the Admissions Nurse.

It save the staff a lot of time and each admitted patient gets a though assessment -- even on days when the staff is really busy. There is nothing illegal or unethical about it because each RN signs his/her own documentation.

[Snatchedwig, BSN, CNA, LPN, RN]

21 hours ago, JKL33 said:

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.

Couldn't have said it better.

[hppygr8ful, ASN, RN, EMT-I]

On 8/6/2019 at 2:36 AM, Mgrn said:

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

Just as a matter of clarification LPNs do not legally assess anything. Assessment is not in their scope of practice. They only observe and report to the RN.

[Hoosier_RN, MSN]

On 8/6/2019 at 5:08 AM, Mgrn said:

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.

To me, by how you described this, its like getting an admission, doing the assessments, then handing off and giving report. I've done it many times as a charge/admissions nurse. As long as I'm charting under my name, nothing illegal or unethical about it

[Dy-no-mite Nurse1, CNA, LPN]

9 hours ago, hppygr8ful said:

Just as a matter of clarification LPNs do not legally assess anything. Assessment is not in their scope of practice. They only observe and report to the RN.

At my facility, we (lpn's) take admissions and do assessments. We use to have an admitting rn nurse but they no longer have one. From what I was taught lpn's were only to gather the info and rn's do the physical assessments. Many lpns have admitted/assessed patients to their units. Maybe in a snf/long-term care nursing homes they can do it? Seems too me facilities have been getting away with it.

[caliotter3]

It is no secret that some employers push the envelope when it comes to labor law or what is in the state nurse practice act. As long as they don't get called on it they can continue to do this for years and years and then they blur the rules when they answer to any questions coming from the peanut gallery. That is why you have an occasional blow-up hit the fan when a ginormous lawsuit hits and the public sees mention in the news. Some employers love to cheat employees especially when it comes to lawful overtime. Lawsuits here and there. Utilizing LPN/LVN's to do RN specific duties in states that limit what an LPN/LVN can legally do, not far behind. I am sure there are plenty of other circumstances where employers dupe unsuspecting employees and give them a line of whoopla should they speak up. It has happened to me more than once and I have heard the same from others. The only surprising thing about all of this is when it happens to an innocent employee the first time.

[FolksBtrippin, BSN, RN]

On 8/6/2019 at 7:24 AM, caliotter3 said:

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.

I was taught that LPNs assess, but they can't do an initial assessment. The RN has to do the first assessment.

[FolksBtrippin, BSN, RN]

On 8/6/2019 at 11:23 AM, llg said:

My hospital has "admission nurses" who go from unit to unit, helping staff with admissions. They do the official admission assessment, complete all the paperwork, get the patient settled in the room, orient them, etc. Then they report off to the staff nurse who uses her judgement as to what to assess for herself as she takes over the care of the patient. She would probably choose to look at any critical physical features herself, but she doesn't have to waste time asking all the questions about the home, religion, family history, etc. because that stuff has already been documented in the chart by the Admissions Nurse.

It save the staff a lot of time and each admitted patient gets a though assessment -- even on days when the staff is really busy. There is nothing illegal or unethical about it because each RN signs his/her own documentation.

Same when I worked inpatient. The admissions nurse does the entire admission, including the admission assessment. Then hands off to the staff RN.

[caliotter3]

5 minutes ago, FolksBtrippin said:

I was taught that LPNs assess, but they can't do an initial assessment. The RN has to do the first assessment.

Apparently the LPN/LVN nurse practice act differs for each state. My state has made a big deal about couching the activity with certain "language", that is, how it is referred to by those involved. Of course, employers are going to use the language that furthers their interests in the matter. Within the past month I saw an employment ad that used the word "assessment" when referring to an LVN position. Ignorance, or flouting the employer reality in CA?

[BSN-to-MSN, ADN, BSN, RN]

It's not unethical, but I do get where you are coming from.

On my floor, the admission assessment and the physical assessment are two different assessments. We often offer to help one another by completing the admission assessment ( just bunch of random questions), and demographic profile. The physical assessment, where you auscultate, palpate, measure, etc.. is usually the responsibility of the RN who took report. The primary RN. No one ever asks another RN to do that, it's not polite. It would be like in that homeadvisor commercial: " if you know and recommend home pros, can you background check them, call them, and book them for me?"

I would offer to help with some other RN duties, so she can do the darn assessment herself. And yeah, I would be little offended too.

Thank you!

[JKL33]

53 minutes ago, no.intervention.required said:

I would offer to help with some other RN duties, so she can do the darn assessment herself. And yeah, I would be little offended too.

Thank you!

Hmm. Okay, I'll say this - - when I read the OP I guess I jumped straight to the idea that s/he was not in an assignment. While reading your post I realized that was an assumption and possibly incorrect.

If the float nurse does have his/her own assignment that is about as involved as others' assignments, so that the OP is pretty much just being told to do a lengthy process for another nurse because as a float s/he isn't part of the regular in-club, then that is crappy. As you note, it isn't a violation of nursing ethics, per se, but it is inappropriate.

If the OP was trying to write a post about feeling dumped on, that didn't come through. It very much seemed that there was a concern about patient care ethics related to assessing a patient.

I still kind of don't understand the big deal about the assessment piece...but maybe that's because I would rather do 30 physical assessments than endure one single minute of the rest of it. ?