So disappointed in hospital RNs and MDs

Posted

I'm an RN, now FNP x 5 years with over 15 years of ER/CCU and ICU experience. Is it old fashioned to expect RNs to do a full assessment at the beginning of their shift?

I have a colleague/NP friend who has been in the hospital now x 1 week. I will spare the details, but she was admitted, discharged, admitted urgently to another hospital and then transferred back to the original hospital. In her whole WEEK of admission, she says just ONE RN and one MD even put a stethoscope to her back. A pleural effusion was MISSED because no one did this basic assessment. Is this the norm now? Do med/surg RNs chart their "make believe" assessment every day?? How do they do this and just flat out lie every day without being caught ? She spoke up at first, but soon tired of feeling like some crazed out NP who was being so picky about her care. She thought it would be interesting to see who would and who would not do an assessment. She says the new RN will come on shift, say hello, walk up to the in room computer and start charting a bunch of notes, pass meds and then continue with the same pattern all day. No bowel sounds auscultated, no lung sounds auscultated. Magical patient care without touching the patient !! This is at a pretty major size hospital too in a major metro area. I have to say I experienced something similar a few years ago but not nearly as bad.

Thoughts?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 17 years experience. 5 Articles; 10,674 Posts

It's unrealistic with the current trend of high patient loads to a single RN in addition to the customer service focus most facilities are pushing for a complete assessment to be done in the beginning of the shift on each and every patient. Quick, focused assessment based on admitting diagnosis and the remainder in bits and pieces throughout the shift (skin when turning, etc) seems to be the more common method according to nurses I know who work/have worked on the floors (I've never worked on a floor). However, to never assess lung or bowel sounds does sound unusual.

Jigae

1 Post

I know nurses who do a complete assessment and others who just focus on the main diagnosis. I agree with Rose_Queen and with the focus so much now a days on patient satisfaction scores when the patient to nurse ratio can be 6:1 it can be challenging. Also some nurses work their shifts straight so they may have the same patients again, thus may not do the complete assessment each shift.

carachel2

1,116 Posts

Since her diagnosis was sepsis, anemia (secondary to ulcerative colitis) with oxygen saturations of 88-93% and tachycardia...I think she would have been happy to have someone put a stethoscope to her back at least and listen. Seriously.It's astounding that it's not being done. I think one could forego the neuro,skin, etc. assessment but listen to the lungs and bowels please !

Barnstormin' PMHNP

Specializes in psychiatric. Has 4 years experience. 349 Posts

I was recently in the hospital and I won't go into details, but I too only had minimal assessments done on me, and that by one nurse when I was admitted. I was surprised as well, as I am a nurse who does/did the full assessment. I was a "walkie/talkie" but I was receiving tx that requires frequent checks, needless to say , I saw them only when I rang the bell. Med surg is tough but there was no way I should have been left in my room without someone laying eyes on me frequently. I know "I" would have been nervous as he// to have left someone in my medical situation alone for so long.

Rose queen has good points, but it is still worrisome.

KelRN215, BSN, RN

Specializes in Pedi. Has 15 years experience. 1 Article; 7,349 Posts

The last time I was in the hospital, I had to ask the admitting nurse if she wanted to reconcile my meds and despite being in the ICU/on the monitor, never had anyone respond when every time I stood up my heart rate skyrocketed to the 150s d/t orthostasis. No one bothered to check a standing BP on me either.

With my own doctors, only my Endocrinologist and my Primary actually use a stethoscope on me. Most of my doctors just talk to me without doing any kind of exam. It would amuse me to read their notes some time.

JBudd, MSN

Specializes in Trauma, Teaching. Has 41 years experience. 1 Article; 3,836 Posts

I teach a 3-5 minute head to toe to my students for beginning of the shift; mental, resp effort, quick listen to lungs, belly, check the ankles for edema/circulation, then IV site and wounds. Doesn't take long if you practice it.

Had one of my own graduated students come in when I was fresh post op, told me how nervous she was to have a former instructor! Did not listen to my lungs, nor did any other nurse the whole 24 hours I was there. My surgeon did once. Since I had a surgical bra on, not to be changed, nobody messed with it, but shouldn't somebody have looked for bleeding through it? sigh.

SierraBravo

Has 3 years experience. 547 Posts

I'm an RN, now FNP x 5 years with over 15 years of ER/CCU and ICU experience. Is it old fashioned to expect RNs to do a full assessment at the beginning of their shift?

I have a colleague/NP friend who has been in the hospital now x 1 week. I will spare the details, but she was admitted, discharged, admitted urgently to another hospital and then transferred back to the original hospital. In her whole WEEK of admission, she says just ONE RN and one MD even put a stethoscope to her back. A pleural effusion was MISSED because no one did this basic assessment. Is this the norm now? Do med/surg RNs chart their "make believe" assessment every day?? How do they do this and just flat out lie every day without being caught ? She spoke up at first, but soon tired of feeling like some crazed out NP who was being so picky about her care. She thought it would be interesting to see who would and who would not do an assessment. She says the new RN will come on shift, say hello, walk up to the in room computer and start charting a bunch of notes, pass meds and then continue with the same pattern all day. No bowel sounds auscultated, no lung sounds auscultated. Magical patient care without touching the patient !! This is at a pretty major size hospital too in a major metro area. I have to say I experienced something similar a few years ago but not nearly as bad.

Thoughts?

I only have one word for that scenario: scary! I don't care how busy med/surg nurses are and whether they've had the same patient for several days, they should be doing a head to toe assessment q shift. As we all know, things can change in the blink of an eye so someone who was walkie/talkie the day before can be in the ICU the following day. If they are not actually doing an assessment but are documenting that everything is WNL then that is falsification of medical records and they should be disciplined immediately. Let's face it, you can't know what a person's lungs or heart sound like by just looking at them, you need to use a stethoscope.

wanderlust99

Specializes in ICU/PACU. Has 10 years experience. 793 Posts

It's poor care and I'm embarrassed to admit it, but I have done it before - skimped out on part of my assessment. There's no excuse really. There are things that need to be checked on every patient, lung sounds, bowel sounds, edema, pulses, etc...

I remember being in the hospital and there was only 1 nurse who didn't do an assessment on me. I think the other nurses assessed me because they knew I was a nurse.

carachel2

1,116 Posts

Seriously. This makes me ill. I'm not naive enough to think a full head to toe will get done on every patient and ohmyword I remember the patient satisfaction stuff. But I would've been sweating bullets even if just ONCE I would have charted that I did something I did not do. Even now, as an FNP I will be finishing notes and maybe realize I didn't assess one particular system that may have contributed a bit to my final plan or differential list and it makes me crazy! I have been known to call people back and say "hey pop in the back door for a second, I meant to look at X." I have given a deposition before (they were going after the MD, not me!) and wow...I had to answer for every.single.word. I had typed into that chart.

Also, my own FNP who took care of me for a few years at a family practice office got more than complacent and once documented a full exam she did not do and billed me for a higher level visit. Umm, NO ...do not think you are going to document a full lung,neuro,GI and ENT exam when you put your stethoscope on two spots of the front of my chest ! I totally called her on it, talked to the practice manager and told it was flat out fraudulent and got the level of the visit reduced.

Libby1987

3,726 Posts

I'm in home health and I see and hear a lot of what's missed, but considering the acuity we're seeing at home I can't imagine being a floor nurse.

I'm so glad that I can do thorough assessments and med reconciliation (and oh man the errors I catch and correct) and have good working relationships with our local dr's so we can make timely corrections.

VANurse2010

Has 6 years experience. 1,526 Posts

I think there's a certain element of "why bother?" (not saying that's OK) when so little of medical decisions are made based on physical assessment, and in most hospital environments the nursing assessments are not read or taken seriously.