Just wondering if other hospitals are doing this....

[AMD88]

Starting next month in my hospitals we are changing the roles of the RN and UAP. The RN will have 5-6 patients (not uncommon) and will be responsible for all their normal nursing duties of assessing, medicating, and implementing orders but will now be responsible for taking all of their patients vital signs Q4 hours and blood sugars as ordered. The UAP's used to be responsible for the vitals and blood sugars. The UAPs only duties are to provide ADLs, turn patients, and stock the unit. Many of the nurses including myself feel we are already stretched very thin with our normal nursing responsibilities and that taking our own vitals and blood sugars will only stretch us thinner. My question is, are other hospitals adopting this role change and has this worked well or not?

[hope3456, ASN, RN]

I'm sorry your hospital it not choosing to decrease your load with an increase in assigned tasks. In my experience let me emphasize; in my personal experience. . . support from non-licensed staff has generally been unreliable due to many reasons; they get pulled to other units, pulled to clean equipment for hours, pulled to be sitters, have poor work ethic and manage to "disappear" until time to clock out, get cancelled if the numbers fall at all, on and on and on. So years ago, I learned to just do my own stuff and not adjust my time management to exclude this unreliable help. A few years ago, all the UAPs were taken away from direct patient care and guess what? Only made my job easier as the management did adjust our assignments slightly to compensate. In addition this is not a huge issue for the environment in which I currently work (NICU) where the vast majority of the cares are generally done by RNs. Please understand (before I get flamed) that the unreliability of which I speak is multi-factoral; many of the causes are not in the control of the direct-care nurse and UAP.[/quote']

I agree with you TiffyRN - I know exactly where you are coming from. It depends ALOT on the UAP. I have worked with some who simply seemed to have "issues" with being directed to do something and then others did not seem to have proper training. Then there are the reliable ones that don't get enough credit for what they do, IMO.

[HouTx, BSN, MSN, EdD]

I forgot to add that the reason our hospital eliminated so many of the non-licensed positions was back when the down economy first hit our area and the rationale was that they needed to cut positions and they didn't want to cut RN positions. Kind of a rough proposition but overall I guess if they were going to cut positions regardless, it's better for patient care to cut the non-licensed versus licensed positions.

OK - this is an example of misguided, illogical thinking that is typically found in the "C-Suite" at most hospitals. If they are cutting positions in order to decrease labor costs, it doesn't make any sense to lop off the lowest paid staff. Instead, they should have actually analyzed the work that needs to be done and determined the most effective people (by job roles) to accomplish it.

It has been my experience that RN/UAP dyads are a great model. They can usually handle ~at least 8 patients.. dividing the work so that each one is responsible for individual tasks & they work together to accomplish the stuff that requires 2 people. The end result is much more satisfying. The UAP feels more engaged rather than simply being used as a beast of burden. The RN has time to spend on the 'knowledge work' that is normally trumped by the physical tasks

But, alas.... CEOs & other sage leaders don't ask for input from nurses before making their "strategic" (AKA how can I carve out enough expense off the bottom line so that I can get my optimum executive bonus) decisions.

In my book, this type of decision ranks up there with the ever popular cost-cutting measures of: "eliminate the evening PBX operator & get the ED admitting clerk to answer calls" & "close pharmacy & food services after 7 pm and make the House Supervisor take care of those after-hour requests". But I digress. . .

[rncat2000]

On my unit they have done away with both techs and unit secretaries on my shift 7P-7A. The nurses on the night shift are responsible for every bit of not only patient care but everything else that needs to be done on the unit!! One more attempt by the management at my hospital to "save our budget"!!!

[jrsmrs]

We have no aids at all. As an RN, I have between 4-6 patients on days/evenings and I do every single thing for them on my shift. Vitals, glucs, meds, washing, turning, feeding, assessments, admissions and discharges, calling docs, calling pharmacy, arranging inter-facility transfers, etc. I also happen to work on a cardiac unit where we monitor our own telemetry, so while I'm doing all those things, I have a pager in my pocket going off q2m on a bad day... And of course the alarms are usually nothing more than artifact, but I dread the day an ignored alarm turns out to be a fatal arrhythmia. We're really between a rock and a hard place here in trying to protect our licenses.

[iluvgusgus]

jrsmrs , that sounds awful.

I agree with the OP, they shouldn't be adding more responsibilities onto the RNs. My floor used to have great PCAs that I never had to hunt down or stay on top of, but now a lot of the good aides left and we have a lot of new,lazy ones that rather socialize and hide in the corner looking at facebook on their phone than do anything. Many times I end up getting my VS and blood sugars and it sounds easy enough to do but when you have to then go get everyone's insulin pens, find other busy RNs to verify the insulins, and then give insulin to 3,4,5 pts all before they start to eat is a bit much to do 3 times a day. You pray their BS is less than 150 at that point and get angry when you catch them not adhering to their diet because now you will have to give them insulin next time. I left a floor that had aides that seemed to have a chip on their shoulder about being "told" to do this and that by the new nurse. When I went to the floor I am on now, I never got any attitude from the aides, everyone was professional and there was a lot of teamwork. Now I am starting to see a trend toward slacking off and I have spoken up about it because I have come to have higher expectations of the aides that I think we all should have. We delegate to them, and their actions may reflect on our licenses, I dont know why nurses dont have more authority over aides than we do, we just let them and the hospitals use and abuse the nurse. Even other ancillary staff seems to not care if the ball gets dropped in certain aspects of pt care because the nurse will pick up their slack too. On a more positive note, at least now you wont have abnormal VS go unreported to you because you would have taken them, and you also wont have a mix up with BS results and give insulin to the wrong pt... you know what they say, if you want something done right you have to do it yourself.

[cassie77775]

I love having a UAP! I have 8 patients(4 moms and 4 babies) and if I had to do all vials, empty all catheters, help bathe, pass all the snacks(and these mamas are starving all night long), I'm not sure how I would accomplish everything! Now, if they decreased our load to help make up, it may be possible. For the most part, our UAP do all vitals, empty all catheters, ambulated patients for the first time after delivery, do i&os, and then provide ice and snacks for the patients. The biggest time killer is the constant calling for drinks and snacks which can take a ton of time when you have pt after pt calling for more stuff and you can't get our nursing tasks done. The UAP aren't ale to do blood sugars at ,ymhospital though, nurses only but thamkfully we really don't do many of those aside on the initial one on newborns. My UAP always takes a patients vitals and calls me with the results so I can assess that individuals results. And at my unit, our UAP are awesome and just as busy as the RNs are.

[mmc51264, BSN, MSN, RN]

They better buy us some more Dynamaps if they are going to do that LOL we have 3 with 7 nurses. We'd all be fighting over them LOL.

I wouldn't mind doing them if we had enough equipment. Trying to find glucose strips is always a challenge, too.

[HHN2472]

Its been a while since I've been on the floor, but anyone who says vital signs are not time consuming must not have worked on the kind of floor I did with 5 patients at a time. NO WAY would I have time to make rounds to do vitals and blood sugars and do all of the other tasks. I did a full assessment at the beginning of the shift and at the end and if any problems presented of course, but sometimes patients are right beside each other while you are running 10 doors down to the next patient to get vitals, call lights going off, charting, med pass, chit chatty patients. In the perfect world maybe but in real life, UAPs are worth their weight in gold.

[0.adamantite]

They are doing this at my hospital too (phasing out the UAP role). You'd think that this wouldn't be time consuming, but half of our equipment is broken and we don't have enough machines. They are never stocked, so not only will I find that the thermometer doesn't work, but when I grab the next one it is out of probes and so forth; then the machine doesn't have an oximeter probe, or the oximetry function doesn't work; and then the patient needs a pain pill, fresh ice, needs to go to the bathroom ... and your phone is ringing, Mrs. Smith's niece wants to speak to you immediately...

Some of our UAP's are fabulous. Others need constant direction and will sit on their butts at the nursing station or disappear. I will often do some of my vital signs to help them out. I will tell them that the patient in room 7 is incontinent and needs to be checked every 2 hours and turned. A good UAP will help with turns, and if I'm not around, will get the turn done herself. A lazy UAP will make the patient lay in filth if I'm running around too busy to help at the moment. If told that the patient in room 7 needs to ambulate twice a shift, a good UAP will have the patient up in the hall without my direction (I will do one walk, she another). A lazy UAP will sit at the desk, and I will need to get both walks in myself. A good UAP will help with tidying the room, make sure the patient is clean and presentable, etc.

[BrandonLPN, LPN]

I've always said licensed nurses should be the only ones checking vitals and obtaining glucoscans. Both of these tasks can be integrated into the regular assessments the nurse is already doing in acute care. Whoever made the call back when that it was okay to delegate these tasks made a huge mistake.

The UAP in hospitals need to focus solely on ADLs. So many of my NH residents come back from the hospital with bedsores. They come back unkempt, unshaven and underfed. I realize they're in the hospital because they're sick, but there's no excuse on a med/surg floor for not getting patients up out of bed everyday, except in the most extreme cases.

And how many times do the UAP in hospitals just plop a tray in front of a elderly resident without sitting down to feed and/or prompt them? Many of my NH residents need someone to sit with them to help them eat.

I don't blame the UAP, they're likely too busy running around checking vitals and blood sugars, to the point that basic care falls to the wayside. I was an aide in the hospital. I know that the focus is on vitals, blood sugars and intake/outputs. These tasks need to be taken away from them so they can focus exclusively on feeding, toileting, turning, ambulating, etc.

[Esme12, ASN, BSN, RN]

I appreciate u posting. I think it does make a difference because I use to be a uap and I know taking vitals take more then 1 minute. The patient conveniently decides they need to go to the bathroom, wants this/that, patient/family wants to discuss plan of care etc. I can understand having the nurses do the first set during their assessment, but we do them every 4 hours on 5-6 patients. The blood sugars are also every 4 hours. The nurses were I work get about 5-10 minute lunch breaks around 2-3 pm while the uaps get to go when ever they want. The nurses also do not get out of work till after 8 even though their shifts end at 7:15. But the uaps are clocking out at 7:15. I think it's silly to add more to our plates. During the bachelors program all hospitals insist we all have, there is a huge emphasis on delegation. Now that skill seems to be taken away in my hospital.

You had me empathizing with you until you said this....

During the bachelors program all hospitals insist we all have, there is a huge emphasis on delegation. Now that skill seems to be taken away in my hospital.

Delegation is not a skill...it is a legal responsibility/ability to delegate non nursing responsibilities and that having a BSN somehow negates that, as a nurse, you are still responsible for that assessment whether you perform it or not...your BSN does not relieve you of that responsibility. It is, and always has been, apart of the assessment process which only nurses can do.

If you are basing what meds you give of a set of vitals shouldn't you be the one taking the pressure or glucose? Many facilities have decided to change the process...usually because something has happened, like a glucose covered for an inaccurate glucose, due to a part of the assessment being done by UAP's and not the nurse.

Complaining about breaks and the lack of monitoring equipment like automatic B/P cuffs makes nurses sound petulant and spoiled. There was a time when we had to listen and take all of our vitals because we had no automatic B/P cuffs. There actually is a ton of information that can be obtained in taking a B/P with your stethoscope...

The five Korotkoff sounds

Korotkoff actually described five types of sounds:

1. The first Korotkoff sound is the snapping sound first heard at the systolic pressure. Clear tapping, repetitive sounds for at least two consecutive beats is considered the systolic pressure.
   
2. The second sounds are the murmurs heard for most of the area between the systolic and diastolic pressures.
   
3. The third sound was described as a loud, crisp tapping sound.
   
4. The fourth sound, at pressures within 10 mmHg above the diastolic blood pressure, was described as "thumping" and "muting".
   
5. The fifth Korotkoff sound is silent as the cuff pressure drops below the diastolic blood pressure. The disappearance of sound is considered diastolic blood pressure – 2 mmHg below the last sound heard.
   

I went to a ASN/ADN program many, many moons ago so I am hopeful that this was covered on your BSN program...for it was covered in mine.

I know, I know....we are all entitled to breaks. I get it I really do. Maybe negotiate with management to delegate the B/P to licensed staff and have the UAP obtain the temp, pulse, respirations to ease the burden. If you approach it from the standpoint that you understand the importance of the glucose and B/P that you can negotiate the TPR to the UAP. This way your B/P can be included on your initial physical assessment and/or when you give your meds

What type of floor do you work that you take vitals, and glucose, every four hours on every patient? UAP's are a vital part of the nursing team but should we be delegating assessment when we base our treatment/intervention on these numbers.

I don't think so...if we as nurses insist that we can delegate important assessment skills to non licensed personnel? Are we then saying that we can be removed from the bedside to be replaced by UAP's because it isn't necessary for an educated professinal to perform such menial tasks...just food for thought.

[hope3456, ASN, RN]

I worked in a facility where, not only were the automatic BP machines broken ( you had to bring in multiple machines b/c the thermometer was working on one, not the other, same with pulse oximeter, ect). There were no working manual BP cuffs. NONE!! I was concerned about getting accurate readings from the automatic BP b/ I it was never calibrated.

IS IT TO MUCH FOR A NURSE TO EXPECT TO HAVE ADEQUATE SUPPLIES TO DO OUR JOBS??