So disappointed in hospital RNs and MDs

[carachel2]

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?

[nursecindy66]

When my son was in the hospital after having a gastric bypass surgery d/t chronic ulders, I stayed with him day and night for a week. I didn't tell anyone I was a nurse and I was shocked that his lungs were only assessed twice (once at my request when he was developing a nasty cough), and his bowels were only assessed once. He had not had a bowel movement for almost a week post surgery. I used to wonder how my co-workers had so much time to sit around the nursing station when I'm running my legs off.

[R. Obias Jr., R.N.]

this is the new trend on how some new nurses were improperly trained by their schools, they were taught to be lazy and avoid any physical contact with patients. this is also another result of using too much of training dummies while in school so nurses are afraid of making mistakes when they come in contact with real patients.

[liberated847]

this is the new trend on how some new nurses were improperly trained by their schools, they were taught to be lazy and avoid any physical contact with patients. this is also another result of using too much of training dummies while in school so nurses are afraid of making mistakes when they come in contact with real patients.

Do you have any evidence to back that fallacious claim? If this is an opinion then I respect it but let's not confuse opinion with facts.

[emergenceRN17, ASN, BSN, RN]

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.

Susie2310:

I am finishing up my first semester of an RN program and we were just taught the exact same thing. I obviously know very little but I do know that no matter what, I will always do those as part of my basic assessment. :)

[R. Obias Jr., R.N.]

doing a straight shift so that a nurse may avoid doing the same complete assessment on the next shift is an incorrect nursing practice, which endanger the life of the patient. assessments are part of a nurse's daily routine and must not be disregarded. doctors on their next rounds will base their patient orders on these assumed charting.

[VANurse2010]

doing a straight shift so that a nurse may avoid doing the same complete assessment on the next shift is an incorrect nursing practice, which endanger the life of the patient. assessments are part of a nurse's daily routine and must not be disregarded. doctors on their next rounds will base their patient orders on these assumed charting.

It's uncommon to rare that a doctor bases orders off a nursing assessment. It depends on the facility and the culture there-in, but as a blanket statement that's flat out untrue.

[Susie2310]

It's uncommon to rare that a doctor bases orders off a nursing assessment. It depends on the facility and the culture there-in, but as a blanket statement that's flat out untrue.

This is one of the worst rationalizations for poor care that I have seen. Regardless of whether an individual doctor does this, it's still the nurse's responsibility to do a proper assessment, and to document this. This documentation is evidence of the nursing care that the patient has received, and of the patient's condition at the time of documentation. How does a nurse advocate for their patient if they don't do a decent initial assessment and chart this? Don't you compare your initial assessment with what was reported to you from the previous shift, and to the patient's baseline, and observe for changes during the hospitalization? What do you base the rest of your care on? Don't you monitor your patients conditions for changes and document accordingly? Don't you need that documentation when you have to advocate for your patient's needs with the physician? How can you properly advocate for your patients without proper documentation in place? And yes, physicians do review the nurses assessments/notes when they make decisions about their patients.

And please, don't sink to the level of personal insults when you reply to me.

As nurses, don't we want to demonstrate our value to our patients? No wonder, with such attitudes, why nurses are being looked on by some as superfluous to patient care. If a nurse doesn't even recognize the value of his/her assessments and documentation, and behave with the knowledge that these are valuable to the patient and to the delivery of patient care, why should anyone else?

[SubSippi]

this is the new trend on how some new nurses were improperly trained by their schools, they were taught to be lazy and avoid any physical contact with patients. this is also another result of using too much of training dummies while in school so nurses are afraid of making mistakes when they come in contact with real patients.

It is certainly not true that students are taught to be lazy...and it seems impossible to teach nursing in a way that emphasizes an avoidance of patient contact. Personally, I know I took an entire class on assessment, and was expected to do a full assessment on each patient I had in clinicals from my first semester on.

[Susie2310]

...and it seems impossible to teach nursing in a way that emphasizes an avoidance of patient contact.

I have read on AN where students/new nurses have said that their clinicals consist/ed largely of observation. I also read of a student who reported that their clinical group spent a large amount of clinical time in the conference room, working on care plans, etc.

[dah doh, BSN, RN]

I have read on AN where students/new nurses have said that their clinicals consist/ed largely of observation. I also read of a student who reported that their clinical group spent a large amount of clinical time in the conference room, working on care plans, etc.

Some schools seem to have their students doing a lot of care plans & early conferences. I think clinical time should be hands on patient care driven. Conferences and care planning should be done before or after clinical time. Some clinical instructors don't really do follow ups with their students either. So it ends up being the nurse's responsibility to teach the student and some nurses are better teachers than others.

[Susie2310]

Some schools seem to have their students doing a lot of care plans & early conferences. I think clinical time should be hands on patient care driven. Conferences and care planning should be done before or after clinical time. Some clinical instructors don't really do follow ups with their students either. So it ends up being the nurse's responsibility to teach the student and some nurses are better teachers than others.

Twenty years ago in student clinical's we did our clinical prep the night before clinical, and spent the entire allotted time on the unit giving patient care. After clinical time was over, we went to post conference. We had two days of clinical's in a row. The first night after clinical we spent working on our care plans and other assignments, updating our med sheets etc., in preparation for the next day. After the second clinical day, that night we completed our care plans and other assignments to hand in the next day in classes. Our clinical instructor was responsible for supervising us in clinical's.

[dah doh, BSN, RN]

Twenty years ago in student clinical's we did our clinical prep the night before clinical, and spent the entire allotted time on the unit giving patient care. After clinical time was over, we went to post conference. We had two days of clinical's in a row. The first night after clinical we spent working on our care plans and other assignments, updating our med sheets etc., in preparation for the next day. After the second clinical day, that night we completed our care plans and other assignments to hand in the next day in classes. Our clinical instructor was responsible for supervising us in clinical's.

That's pretty much how it was for me in nursing school too (geez it has been almost 20 years)! The clinical instructor was spread pretty thin between 10 students on several units. We'd "page" the instructor to give meds & do procedures which she would supervise. If the instructor wasn't there, we could do the meds & procedures with the RN as well. We got quizzed on patho, meds, & plan of care by the clinical instructor. We spent our other clinical time doing vitals, assessments, baths, feeding patients, talking to the patient, etc. The CNAs loved us because they had less work for a few hours.

I RARELY see any of this nowadays! Students do meds & procedures, but not the other things. They usually only talk to the patient to get their care plan done. They sit around a lot and chat with each other. Their clinical instructor just pops by to check in but no real education. They leave it to the nurse.

Now just a disclaimer, I do work ICU so maybe the instructors don't feel comfortable in my area enough to help the students, but I know they can still quiz them on theory and practical knowledge. I know 1 instructor did but she doesn't work for that school anymore. Another instructor was teaching a student

incorrectly and probably didn't like

me correcting him in front of students.