Clinical Tips

virtruvian man

When you have 10 patients each day (yes, I said 10!), you start brainstorming how to make the most out of every minute you have and every assessment you make. As you can imagine, I don’t have a lot of extra time to dawdle. But the head-to-toe assessment is something I don’t want to miss out on, and here’s why.

The Initial Head-to-Toe Assessment Saves Time in the Long Run.

I know that it’s hard to believe that it’ll save time in the long run when you are rushing to get through your morning med pass on time, but assessing your patients within the first hour of your shift will make the rest of your shift more manageable.

At the facility I work at, we have certain assessments that we need to complete on patients, including a bowel and bladder, pain, range of motion, skin, and hydration assessments. Some of these assessments are rather lengthy. Instead of taking time out of my afternoon to go back into the patient’s room to ask a bunch of additional questions, I can complete the assessment form based off my initial head-to-toe from the morning. Bing. Bang. Boom. Done.

It Allows You to Do a Better Focused Assessment.

Once you have a baseline assessment of your patient, you are able to hone in on one or two potential problem areas to reassess as the day progresses. For example, if your patient is recovering from hip replacement surgery, a focused assessment may involve asking the patient about pain and looking at or even replacing the wound dressing.

If you are in a healthcare setting where you see the same patients every day (such as long-term care), you might be able to forgo the full head-to-toe on subsequent days with the patient. I would limit the full head-to-toe to once a week unless they were recently admitted to your facility or had a recent change in condition. If you are in an acute care setting, complete a head-to-toe every single shift.

It May Just Save Your Patient’s Life.

I know that sounds dramatic, but we have to remember that there is a reason the patient is in our care. I have been a nurse for less than a year, and I have already sent two patients to the hospital based on findings in my initial head-to-toe assessment. If our patients were well, they would not be in our care. We need to keep a close eye on any potential complications that might be popping up, and this starts with the initial head-to-toe!

And knowing the results from initial and focused assessments as well as admitting and secondary diagnoses will make you a better nurse. You’ll be able to pick up on subtle changes in your patient’s condition that may prevent a major complication from occurring in the first place!

In what ways have you found the head-to-toe assessment to be helpful for you and your patients? Leave your stories in the comment section below!

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I had my precious baby Patrick on November 20th of last year, and was on maternity leave until the beginning of February. That is a looooooooong time to go without practicing my new nursing skills. I was no longer changing central line dressings, inserting catheters, caring for wounds, maintaining G/J-tubes, and giving medications around the clock. I was, however, becoming rather proficient in swaddling, diaper changing, laundry doing, tip-toeing, and lullabying.

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As the end of my maternity leave was approaching, the anxiety about going back and remembering how to do my job was increasing exponentially. I only had five months from the time I became a nurse until Patrick was born to perform the skills I learned in nursing school. Was it going to come back to me? Or was I going to embarrass myself in front of the patient by sticking the urinary catheter in the wrong hole? Believe me, I had plenty of nightmares where things went horribly wrong.

Whenever I experience anxiety about something that is under my control, I always make a plan. Once I have a plan, my anxiety seems to subside. Here’s what I did and what you can do if you are in need of a little skills refresher.

1. Make a list of all of the skills you need to freshen up on. My list included central line dressing change, PICC removal, TPN administration, urinary catheter insertion, G/J-tube management, and wound care. I work in a transitional care facility and see patients recovering from knee and hip fractures and surgeries, COPD exacerbations, strokes, and things of that nature. If you are in the hospital, nursing home, or working in home care, your list might look different from mine.

I've been using Google Keep on my phone and laptop for all of my to-do lists.

I’ve been using Google Keep on my phone and laptop for all of my to-do lists.

2. Gather all of your resources. I used YouTube A LOT! Click here for a playlist of nursing skills videos. Videos are not always 100% by the book, so check your nursing fundamentals book to make sure you’re following the proper procedure.

3. Practice like you did in nursing school…on your friends and family! I saved my lab kit from nursing school, so I took out my supplies and walked through each of the skills I needed to practice. I didn’t have central line dressing change kit anymore, so I just followed along with the YouTube video and put my hands through the motions so I could gain some muscle memory.

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Alright my friends, tell me about the skill you are going to brush up on today! Trach care anyone?!

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My great grandma Ada turned 97 today. Happy birthday to the lefse queen!

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It’s been a busy week! I had my first test on Monday, clinical on Tuesday and Wednesday, and class and clinical paperwork to complete on Thursday. Needless to say, I spent the majority of today watching Gilmore Girls reruns and trying not to let me eyes shut for too long.

I have accomplished a lot and have faced a number of challenges in my first three weeks of clinical. I inserted my first Foley, called a rapid response, suctioned a few trachs, and gave meds through every route imaginable.

With so much going on, I needed to go into each day with a game plan. This is how I manage my time before, during, and after clinical:

1. I try to complete the readings and assignments for class before my clinical. I have class on Mondays and Thursdays and clinical on Tuesdays and Wednesdays. There is hardly any time on Tuesday or Wednesday to read for Thursday’s class because I am busy with clinical and the massive amount of paperwork it involves. So, completing the readings on Sunday or Monday is really helpful.

2. I print all of the clinical paperwork for the entire rotation during the first week. We have 5 weeks of clinical, so I printed 5 weeks of paperwork and organized it so I could just grab and go on clinical day.

3. Michael Linares’ (Simple Nursing) “Most Common Meds Guide” and “Patho Bible” have been enormously helpful in completing my paperwork and knowing what my patient is dealing with before I even enter the room. In order to access these documents, you need to pay $34.99 for a “cancel anytime month-to-month” subscription. With this subscription, I have access to 17 PDFs and 900+ videos. My recommendation:  Save the 17 PDFs to your computer, skip the videos, and cancel after one month. Many of his videos are on YouTube or the content is explained elsewhere on YouTube and other websites.

4. During my prep time at the hospital, I get my patient’s info as fast as possible. I check the important stuff first just in case I get hung up on something. Important data includes:  code status, allergies, reason for admittance, other active diagnoses (look them up if unfamiliar), recent labs, MD orders (unfortunately, I do not have access to these at my clinical site), and current medications.

5. My clinical instructor has us write out the top three things that could go wrong with our patient during our shift based on the data we collected. Even if your instructor doesn’t make you do this, I think it would be a great thing to start doing. It’ll give you an idea of what to focus on and look for in your patient.

6. I try to go into my patient’s room with confidence. The initial assessment is crucial. It guides you in the direction you should take during the rest of the day. Be thorough, build trust, and be kind! You’ll do great!

7. When my first patient’s blood pressure was low and she stopped responding to me, I knew it was time to call in my nurse. If something doesn’t seem right with your patient (even if it is a little change in status), do not hesitate to call for help. It might be nothing, but wouldn’t you rather it be nothing and feel stupid than it be something and you didn’t tell anyone?

8. Find a way to relax after clinical. Take a bath, have a beer, watch reruns of your favorite non-medical TV show, …whatever floats your boat!

Clinical can be rough, so please share your tips on making it go as smoothly as possible!

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