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.
That said, as a "hospital RN" with extensive experience in critical care, I can say with absolute certainty that overall, mid-level providers (NP's and PA's) do the worst assessments, have a highest ratio of wrong diagnoses, and contribute more to poor patient outcome than RN's and MD's.
Just sayin...
The research I've seen on this topic has shown the opposite of what you're saying.
Is there evidence of this lower standard of care from something other than your personal experience?
I have been an RN for less than 1 yr and I sincerely hope this is not a "trend" among new nurses. I was fortunate enough to be hired onto a surgical floor at a mid level hospital and I have seen falsified documentation in my practice and it comes from RNs with varied yrs of experience. I cannot speak for all new grads, but I do not falsify my documentation. At times it is difficult to do an entire skin assessment, but necessary as we all know. A complete assessment is not a lost art, but alive and thriving. It is the first skill that I learned in nursing school. I was taught and believe that we are often PAs, NPs and MDs eyes and ears. I am frequently asked by doctors "How is this pt doing?" Our assessment skills are critical to our job, but we practice medicine it is an imperfect science being practiced by imperfect individuals, myself included.
Well, I previously posted that I was not assessed by my nurses last fall, after my mastectomies (24 hour stay). This week I was in for a week with various problems, and every single nurse came in during their shift and did a full assessment, down to the ankle edema and pedal pulses. The way they switched around I sometimes had 4 nurses in a day. Same floor, great care and my doc listened to me.
They lie. I do one assessment that will include auscultation of all lung fields, and two focus assessments after that per shift, per patient. I am always behind on the mound of e charting my hospital has us do because, uh, I am trying to do my job! Something has to change that will empower and allow health care workers to do our jobs. Before we all ge t burned out. I too am disappointed. From what I've seen in my short time as a nurse, all we do is just to get THE MAN the money. ?
That said, as a "hospital RN" with extensive experience in critical care, I can say with absolute certainty that overall, mid-level providers (NP's and PA's) do the worst assessments, have a highest ratio of wrong diagnoses, and contribute more to poor patient outcome than RN's and MD's.
Just sayin...
Just sayin what?
What's your source on the patient outcomes? Your own diagnosis? Please post a link to the data.
We all know that there are NP programs that have no experience, no references, no interviews, no GRE and only a 2.5 GPA , a checkbook and fewer clinical hours than an LPN required.
Can you link to an accredited NP program with no required clinical experience?
Specializes in Mental Health, Gerontology, Palliative.
I have found that no one ever jumps up and down if I dont get an assessment done exactly on time. However I dont live in a country that seems to have a fire at will policy over sometimes what appears very small and insignificant things.
I dont condone false charting.
That said, if a nurses time is taken up with a whole bunch of stuff that may or may not be about direct patient care that has to be done or else the nurse is at imminent risk of unemployment I can see why it happens.
This is not an us vs them post - RN vs FNP - it's a post that brings to light a situation the OP experienced and needs to be discussed. It happens. It's appalling - because assessments are basic nursing care that must be done for good reasons. (BTW LPNs/LVNs know how to assess - but it's called 'data collection.' and many of us know how to critically think regarding our assessments and know when we need to intervene because of our 'data collection.' CNAs however do not - this is in response to a poster talking about the difference between RNs LPNs and CNAs prior - its just that in a hospital setting and many state BoNs the responsibility for assessment falls on the RN) I once had an MD 'listen' to lung sounds by briefly putting the bell to patient' upper back only - without ever putting the ear tips in his ears!! (He did lose his privileges - thank goodness!) Assessments are the basic medical care necessarily to care for your patient appropriately, safely - end of story. Falsification of any documentation needs to be discussed to determine whether documentation and practices are necessary and meet approved standards of care. Identifying a problem is (hopefully) the first step in fixing it.
dejackson51
1 Post
They make liars of us.