Why aren't we assessing patients?

[bluebelle0604]

I had a pt who was admitted two days prior and I told her I was going to take a listen to her and I did my full assessment (which is a focused assessment, however I always listen to the lungs, heart and bowels). Afterwards she thanked me for doing the assessment and stated that I was the only one who had assessed her since she was admitted. I was shocked and I went through the past assignments to see what nurses had taken care of this pt and they were all very experienced nurses. This pt was a young women and appeared to be fairly healthy, however, I never skip an assessment. That is one of our main objectives...to assess the pt and base care off of the assessment. Anyway, what do you all think? Is this a common problem? Should I have talked to my managers about it?

[ORNurseAngie]

It happens way more than you know. I don't know how many times the very same thing happens to me except I find all kinds of things such as rashes in the groin that noone knew about. My favorite was when I found scabies marks all over my patient that had been there for a whole week already. A lot of the nursing staff actually contracted scabies. I also find patients a lot of the time with distended abdomens and no bowel sounds that noone has any clue about not even the doctors.

Also a few weeks ago I had a patient that had been on our unit for three weeks and the night he was my patient was the first time I took care of him. He was passing pure blood clots in his stool (he actually had no stool it was just pure blood clots) I asked the patient how long it was going on and he said three weeks I asked the nurses aides and they said that yes the patient had been stooling pure blood for three weeks. I went through the medical chart no consult for GI or surgery no mention of bloody stools in the progress notes. One doc wrote the patient was having diarrhea. So I work nights I notified the night doctor who ordered FOB (WHICH is stupid since duh it was pure clots) His CBC'S were all stable so believe me after three weeks of it going on I certainly wasn't going to call the attending in the middle of the night. Patient was stable and such so I left a huge note on the front of the chart asking th doc if he was aware that his patient was stooling blood clots and of course asked the day nurse to follow up. I could not believe this went on for three weeks and no one said anything. Needless to say the doc was not very happy but oh well he needed to know. I don't know what is happening anymore to nursing but I don't care how high the patient load is assessments are where you are supposed to start. It is the first step in the nursing process. I just don't get it.

[Michelle123]

This is the first thing I do when I come on shift after report. I do a full set of obs and an assessment. I also look through the chart for when meds are due and to see where they are up to with their care plan.

To me, it is an essential part of the nursing process.

[LiliaBSN]

I'd say others skip it because you can't necessarily prove that the other nurses didn't do it.

Another nurse on our unit was supposed to be bladder scanning and straight cathing a patient q6h if the residual was >200. She charted that she was scanning but it wasn't over 200. I saw this and finally called the doc because it looked like he had less than 240ml of output in 8 hours. No, she wasn't doing it because she "didn't have the time" and the patient was just peeing his attends and she'd make the aids change him. Well since the supplies were in his room, I brought the nurse manager into the room at the end of my shift before she got there and we counted the supplies. When we got there twelve hours later, we counted again and it hadn't changed. Since we had proof, she then got fired for neglecting her patients.

Bottom line, your nurse manager isn't going to give a crap unless you can prove that these other nurses didn't assess this patient. Not saying that you aren't right, and that it should always be the first and most important step, but don't go being the squeaky wheel too much, because there are a lot of nurses out there that need jobs and will probably work cheaper than you.

[iluvivt, BSN, RN]

I have some words for that...LAZY and SLOPPY Nursing care. How would you feel if you or a loved one got that care...need I say more!!!

[Caffeine_IV]

I don't worry about why others don't do theirs. I just do mine and chart accordingly. However when I do have a high patient load, I do not go around assessing everyone first..I seriously check to make sure they are in their room, alive and not on the floor.

[msmoll]

Wow thats shamefull for nurses that dont check thier pts, it was constantly drilled in my head while in nursing school. I pray that nothing awful happens to the patients that aren't re-assessed, since you can't trust your lic. on another nurses assessment.

[niteowlrn29]

I too have experienced this. One time I went into a patients room and did my assessment, I was feeling for her pedal pulses and she was like "your the first nurse who has done that, did the doctor teach you that?" HA!!!

[tewdles, RN]

If I have concerns that the nurses did not assess and missed something I would speak to them about it. Nurses get busy, they lose track of things, they get distracted and forget, they get sloppy, and sometimes they just make bad choices. Other times, they choose to "skip" the assessment of the young stable patient with a simple diagnosis for time management reasons. The experienced nurse may hear the report, glance at the pertinent data, eyeball the patient and determine that it is fine to move on to more pressing needs.

Good collegial relationships are important in a nursing unit and speaking with your nursing supervisor, unless you have a genuine concern about the safety of the patients, may create an unhappy atmosphere which no one will enjoy.

Having said all of that...I applaud you for being professional and precise in your patient assessments. I wish all of our peers shared that focus and determination.

[I<3H2O, BSN, RN]

I too have experienced this. One time I went into a patients room and did my assessment, I was feeling for her pedal pulses and she was like "your the first nurse who has done that, did the doctor teach you that?" HA!!!

LOL generally speaking, I have at least one pt. per week ask me why I am checking pedal pulses. For that matter, we had one of our RNs in the hospital for a lap chole. She actually spent 2 days in the hospital so I'm guessing at LEAST 4 RN assessments during that time. I went in to assess her and when I checked for edema in her legs and checked for pedal pulses she laughed and said you are the ONLY person who has done that since I've been here.

[fiona1968]

when nurse to pt ratio exceeds the limitation. i believe it should be 6-7 only but some have 8-10.

[Grow_a_Soul]

Its the first step of the nursing process for a reason. The rest of the care depends on it.