Standards in Nursing Assessment

[Supermangw]

I have been an RN since 1995. I was recently in the hospital and had an abdominal surgery. During my stay none of my nurses assessed my breath sounds. They did not assess my incisions and did not assess anything other than hand me medications and document on their computer. I had to ask for the incentive spirometer, RT never assessed if I could use it. I got myself up out of bed to walk no physical therapy consult to ensure that I was safe to walk. I have been out of direct patient care for a number of years. This is the first time that I have encountered no type of head to toe assessment from a nurse during a hospital stay. Is this now the common practice of nursing care in hospitals?  Are nurses  now taking care of their computer systems more than they are doing actual nursing care? I did OK, but I am a nurse, what about people who have no medical background. It is scary to me. 

[mmc51264, BSN, MSN, RN]

Unfortunately, I think the pandemic affected nursing education. 😞  I don't always do a complete "head to toe" assessment in the defined sense. 

We don't have to have RT do IS teaching. We have a lot of rib fx pts so that part of care is non-negotiable. 

As far as breath sounds, unless there is a hx, me watching someone use their IS tells me a lot about resp status. Also, if a pt is yelling at me, I know they are OK (funny, not funny)

I work on a post-surgical floor, many times, we don't have access to incisions. I don't know if it makes a difference, but I am at a teaching hospital, so many times, dsg changes are done when they round between 0500 and 0600. If a dsg is OTA or has a saturated dsg, we will intervene and call provider if need be. Many of our pts may have a wound vac, so we do a lot of assessing/troubleshooting the WV. 

Because we have a very high geriatric population and an orthopedic population, PT/OT is a big component so we have extra training with PT/OT and use our bed/chair alarms for a majority of our peeps. 

If you were a pt on my unit, we would have had you call us for help to get up. 

I am sorry that you felt like you were on your own. I am not sure that it comes from you being a nurse. I had a similar experience when I had weight loss sx 9 years ago. I didn't want them to know that I was a nurse, but one of the pre-op nurses figured it out and told everyone. When I was back on the floor after surgery, the night shift was great, but day shift was awful!  My nurse, who was not a new nurse, but new to that facility, did not come and see me in the morning until I called for the charge RN at 0930 for pain meds. The preceptor came running in to see what the issue was. Then, about 1130-1200, I was hoping to go home (it was snowing in NC and that is a disaster LOL)  They did no assessment and never even asked me about how much fluids I had consumed, or if I had voided after having my Foley removed. It really was a horrible experience, that 1/2 shift that I was there. 

I am probably going to need a knee replacement in the next 9-12 months and I def am a little worried about it. Have to decide if I want sx where I work or where I had my weight loss sx. 

I am sorry you had a less than stellar experience, but you can give feedback. I did call and give feedback to the nurse manager for the unit that I was on. I did it calmly and did it in a way that was true feedback, not criticism, 

[Kristen D]

I had a recent experience with my husband in the ER/observation unit for kidney stones.  I've been an RN since '94 and remember the time of the all important "Patient Satisfaction Surveys".  I have been out of the hospital for some time now, but things have changed.  Requesting pain meds (for kidney stone pain !), waiting a good 45 minutes and nothing until I go out to the nurse's station, where they were sitting.  I remember rarely sitting on a Med Surg or Ortho floor until report at shift change to chart.   No concern, no apology from the staff. This happened multiple times with different staff members.  BS was high, over 500.  Insulin given, but no thought of rechecking the FS until I requested.  Where is the common sense?  We had one nurse out of maybe 6 that seemed to have concern and good nursing judgement.  I wrote her name down so I could celebrate her on the post discharge survey, but alas- never received one.  I don't think Hospital Administration wants to know or care about patient satisfaction anymore.  Times have changed.