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.
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.
That's so hard to reconcile given how seriously my assessments are taken. When I call a clinic and report new onset of abnormalities, I get a response.
No one reads my charting, but they respond to my reporting.
However I have at least 30 min/patient whether I'm charting at night or not, I can't say I could function on the floor.
I am so disappointed in the FNP who diagnosed a my pt's dyspnea as anxiety when she had bilateral pulmonary embolisms and severe anemia and sent her home with a script for ativan.
I am so disappointed in the FNP who told my pregnant friend, who almost died of a ruptured ectopic pregnancy and had a salpingectomy and oophorectomy that her pelvic pain was nothing and did not do an ultrasound.
I am so disappointed in the FNP who told my pt to take motrin for back pain which was in fact fulminant hepatorenal failure from Crestor and who had the highest liver enzymes anyone has ever seen.
I am so disappointed in the FNP who screamed at the RT all the way down the hall to keep the BiPAP on the ER admission with a mask full of vomit.
You would do well to remember that there are members of your profession who are far from perfect.
icuRNMaggie...my comments were not at one person in the profession. My comments were at what I am seeing as a general trend. Individuals (NP, MD, RT, RN, etc. etc. ) are ALWAYS going to let you down, but when the trend in general is shabbing out of what you know is right and what you know you are supposed to do, then I'm going to call it out.
I have no doubt missed things, misdiagnosed things too. I'm not perfect. There is not an RN who is perfect and knows everything and there is no NP who is perfect either. But I have never and will NEVER ever chart something I didn't do, nor will I shirk the duty I take for the day. If you are going to be an RN, then by golly be an RN and pop that stethoscope on the back and over the tummy at LEAST.
Sadly, I think some of the RNs who don't/won't/can't do an assessment at the bedside, somehow make it onwards thru NP school....sounds like you have encountered some of those. I've been to some of those NPs and PAs. They shab out on the PH, ROS and their assessment is minimal. Very sad. I don't know how they make it through.
I can't defend RNs/MDs who don't do their jobs, but I can shift the blame to a systems failure, where everyone is pushed to do the minimum on the maximum number of people. Unfortunately, we are seeing the results of years of "do more, with less" mentalities in hospital administration. I think blaming the worker bees is a short-sighted approach and that the problem is much deeper and endemic to the hospitals' current business model.
I have to agree with canigraduate, RN. While I personally can not imagine not assessing a patient for fear of missing something, I can understand the pressure to cut corners. I was always too afraid to risk my license, and more importantly someone's life, to not do an initial assessment.
When doing an assessment, I have had patient's ask me why I am doing it and mention that another nurse didn't do so. I have also been hospitalized and have been with family members in the hospital where not every nurse on every shift did an assessment. It's scary.
With higher patient loads, higher patient acuity, more responsibilities, and customer service requirements--something has to give. One person can only accomplish so much in a given 12 hour shift (and God forbid you stay even 15 minutes over on your shift!). Granted I personally would choose to "cut corners" elsewhere. I feel assessment and medication administration should have top priority.
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.
So no proper assessment; serious problems are not caught and brought to the physician's attention; the patient suffers a bad outcome which could have been prevented, and that's acceptable? The assessment was not done, or made up, and presumably documented as done/benign/no concerning changes. The patient suffers a deterioration in medical condition because the nurse can't be bothered to properly assess them and make the effort to advocate for their needs, and falsifies charting?
To the OP, I have seen this too on occasions in recent years with my family members who have been hospitalized, I'm sorry to say.
When I was in nursing school 20 years ago I was taught to always listen to the lungs, apical pulse, check pedal pulses and auscultate bowel sounds, as part of my basic assessment.
I always stay with my family members when they are hospitalized.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
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.
Until someone sues. Then every word is taken very seriously. I'm scared to death to chart an assessment I didn't actually perform. You can't know which one is going to come back to haunt you. Are there really that many nurses not bothering to do assessments? Scary. Don't get sick.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I can't defend RNs/MDs who don't do their jobs, but I can shift the blame to a systems failure, where everyone is pushed to do the minimum on the maximum number of people. Unfortunately, we are seeing the results of years of "do more, with less" mentalities in hospital administration. I think blaming the worker bees is a short-sighted approach and that the problem is much deeper and endemic to the hospitals' current business model.
You have a point, but cutting important corners will only get the nurse hung out to dry (oh, yeah and maybe kill the patient). Most union shops have some type of inadequate staffing notification form. Typically, nurses are too intimidated to file those. At the risk of sounding like a broken record, we really need to get tough and start standing up for our patients and ourselves.
So no proper assessment; serious problems are not caught and brought to the physician's attention; the patient suffers a bad outcome which could have been prevented, and that's acceptable? The assessment was not done, or made up, and presumably documented as done/benign/no concerning changes. The patient suffers a deterioration in medical condition because the nurse can't be bothered to properly assess them and make the effort to advocate for their needs, and falsifies charting?
Did you miss the part where I explicitly stated that this is not OK?
Did you miss the part where I explicitly stated that this is not OK?
No, but the rest of your words were not consistent with that "not OK." So I understood that you think it's not OK, but that you can justify it being done, for the reasons you gave.
Libby1987
3,726 Posts
That's so hard to reconcile given how seriously my assessments are taken. When I call a clinic and report new onset of abnormalities, I get a response.
No one reads my charting, but they respond to my reporting.
However I have at least 30 min/patient whether I'm charting at night or not, I can't say I could function on the floor.