CNAs no longer doing vitals on our floor

Elladora · Aug 6, 2012

I think they are crazy! Nursing is a team effort. Are they going to tell RNs they can't do what the CNAs do? (Toileting, ADLs, etc) It sounds like a dangerous division. I hope they change their mind!

new_grad_RN · Aug 6, 2012

Yeah, I did not want to sound offensive, but I feel like they are putting a lot on our shoulders. I feel like I run around the entire shift and this just adds to the endless list of things I have to do. I heard CNAs used to be able to take blood sugars, which sounds so nice to me. I don't know this just seems over the top to me.

Piglet08 · Aug 6, 2012

Sigh. I worked on a frantically busy PCU many moons ago, and the same sort of thing happened. I remember one tech who was really bad. Some said she was lazy; it could have been her health issues. I also think she wasn't especially bright. Our manager cut back more and more on what we could ask her to do (so she wouldn't quit), saying "It's so hard to find a tech".... to which we'd say "We don't have one now, but you're paying for one".

I no longer work there, btw.

I have no solution to offer, only sympathy. Whether it's normal or not, it's not right. It seems it's easier for management to have NO grey areas, no areas of shared responsibility/blame, rather than to find a way to cultivate a professional respect and cooperation between employees.

I do make it a point to ASK a tech for help, and to ask WHEN would be a good time for a planned activity like a bath, and to spring as few surprises as possible. No one likes to feel jerked every which way with demands.

BrandonLPN, LPN · Aug 6, 2012

In LTC I think it's appropriate for the nurse to get the vitals. I never heard of this in acute care. To play the devil's advocate, I always wondered, when I was an aide in the hospital, why the nurses didn't sometimes get the vitals when doing their assessments? Sometimes I was the only aide for 30 pts and it seemed unfair that the RN couldn't get vitals on SOME their 5 pts.

sauconyrunner · Aug 6, 2012

I always got my own vitals on my patients. Why? Because it was easier than trying to get someone else to do it, and chart it, and actually remember to tell me that there was an issue with the vitals.

While I really don't work with techs or CNAs anymore (I am now not in a clinical role), I find that ours are happy to do vitals etc, but they are also treated with a lot of respect from the nursing staff, which is rare.

Kasandra · Aug 6, 2012

I am not sure what to think about this.

On one hand: you know your vitals and if they need to be followed up on. There have been instances in the past where the NA did not tell me if a b/p was too high (although they always told me when someone was too low...strange, huh?). You could always slap on the AUTO b/p cuff in the room while you are doing a quick assessment. This is much easier, of course, if you have equipement readily available. However, if there are a limited number of vitals machines.......

Then it will not be efficient and work well. With limited vitals machines, a CNA would be most efficient at going from room to room to take vitals. You see how equipment availability plays a role in this.

One lesson that I have learned: Choose your battles. After a certain amount of time, if you and your nursing colleagues feel that this is not working, bring it up as a group at the next meeting. Change may or may not happen. Either way, continue to deliver the best care that you can at the patient's bedside.

TheCommuter, BSN, RN · Aug 6, 2012

When I worked in long term care for five years, the nurse was expected to obtain vital signs on all 20+ patients, medicate them all, perform all finger stick blood sugars, complete all wound care, do all respiratory treatments, and so forth. The CNAs did not do vitals. There was no respiratory therapist for breathing treatments. There was no wound care nurse to dress wounds. You get the picture.

Now that I am out of the nursing home setting, I realize how spoiled I am. The CNAs at the rehab hospital where I work do all vitals, obtain all finger stick blood sugars, and so forth. In addition, the nurse/patient ratio is lower here than it would be in LTC.

uRNmyway, ASN, RN · Aug 6, 2012

CNAs taking vitals and blood sugars was honestly a big shocker to me when I got to the USA. In Canada, CNAs are ABSOLUTELY not allowed to do any of that. CNAs are basically there for mobility and transfers, hygiene, and running errands. Some of our CNAs would definitely be more than able to do the vitals and all, but it is not allowed. I personally have always functioned where I do my evaluations from A to Z on my own, and that is fine with me. When you have too many people conducting different parts of the evaluation, you risk someone not passing on information, assuming that you knew/noticed it, not thinking it was important or out of the ordinary, anyways, you get my drift. If you do everything on your own, you know nothing will be missed.

Not to play devil's advocate or anything, but I think in some ways you American RNs have been kind of spoiled in this. Try working in a Canadian hospital with ridiculous RN to patient ratios, insufficient equipment, non-functional equipment, and more responsibilities...Oh, add to that all the mandatory overtime and low pay, and you've got a winning health care system! lol.

Anna Flaxis, BSN, RN · Aug 6, 2012

I worked on a busy PCU floor, and this happened there as well. In addition to no longer doing vitals, the CNAs were pushing for the nurses to assist with passing meal trays and take turns with repositioning and toileting. That was right before I got out.

I worked on this floor as a CNA prior to becoming a nurse, and though it was busy, the patient to CNA ratio was very doable. We had mostly walkie-talkies, and for those heavier patients, you could buddy up.

I think the culture on the floor was such that the CNAs didn't realize how busy the nurses really were, and there was a divide among the nurses about what the CNAs should and shouldn't help with, where nurses who asked for more assistance than others were labeled as "needy" or "lazy", and the nurses who just did everything themselves and let the CNAs pick and choose what they would do were the "good" nurses. There was no unity, the CNAs got mixed messages about what was expected of them, and the NM was totally ineffective.

PatMac10,RN, RN · Aug 6, 2012

It's according to the facility I guess, im a second year nursing student and I with in my local hospitals float pool as a CNA II. We still get vitals q4hrs and PRN. We do blood sugars, I/Os, enema's etc...We report abnormal or out of range VS to the primary nurse. We do patient care and ensure pt gave help eating if they need it. We give the baths, and keep rooms tidy, help to the br/ bed pan or urinal. We chart our own vitals and asks and our every other hour rounding and safety measures. We are often understaffed and many times it's one CNA for 17 patients , 10 of which may be total care, 7 isolation, and 4 who need assistance. We certainly stay busy on such shifts, but it runs smoother when there are at least 3 CNAs for A 34 bed Unit. Sometimes it's hard getting vitals when you've got multiple Iso/ total care pt beefing you at one time, but usually If the nursing staff see we're tied up the initiative to get what they need themselves or ask another coworker. Teamwork is really vital in such situation but putting all the VS doesn't seem to be an even distribution of work. Neither is it to expect the CNA to have them when working under such conditions.

PatMac10,RN, RN · Aug 6, 2012

I always got my own vitals on my patients. Why? Because it was easier than trying to get someone else to do it, and chart it, and actually remember to tell me that there was an issue with the vitals.
While I really don't work with techs or CNAs anymore (I am now not in a clinical role), I find that ours are happy to do vitals etc, but they are also treated with a lot of respect from the nursing staff, which is rare.

I agree with your post! I like getting then myself, especially after observing that some staff may use revering eisenhower bP cuff, etc.... Which can give inaccurate readings.

At my school my director stared from the beginning that during our clinical rotations, except ominous fire cases or preceptorship, we are not to ask the staff CNAs to do anything for us. She said that many nurses she trained when she was an ICU director etc.. Were trained to think that a CNA would always be there to assist you," when that's absolutely not true". She says that she and the director of other nearby nursing programs have been really trying to instill the philosophy of total pt care in their nursing students in the past few years.

She drills us with time management and critical thinking so that when the time comes where you don't have an assistant we won't freak out. Of course she says that we all need help, and we should know our limitations and when to ask for help, but do as much as you can, for yourself, within reason. I am thankful for her installing this in us.