discovered and reported falsification of VS

xtxrn, ASN, RN · Sep 11, 2011

To those of you saying you measure your own VS before giving certain meds because you can't trust others/your co-workers to take and document/report accurate VS, which is clearly a VITAL and routine part of their job description/duties in a acute care setting: I'm curious, do you give patient's their coumadin based on the coags that the phlebotomist drew and the lab tech ran, or must you verify those coags for yourself as well? Do you shoot and read your own XRAYs as well? I'm not asking my CNA to do something outside their scope of practice by taking VS. Where does your mistrust end? The majority of my patients are on BP meds and/or some other med that could affect them in some profound way. You must have a lot more time on your hands then we do on my floor if your re-doing everyone's VS...

For me it depended on the time interval between getting the VS, and when I gave meds. I understand what you're saying- but I also understand what the nurses are saying who can't depend on their CNAs/techs to do it right (yet can't get rid of them). :) I think it is very dependent on the specific situation. :)

OhioCCRN, MSN, NP · Sep 11, 2011

Although i don't use this technique; you actually can measure a bp by looking at the dial and usually you can tell what the bp is by seeing where the dial "bumps". If you release the air slowly its usually pretty accurate. I dont actually do this but i have notice this when auscultating BP.

My CI would ROAST you in olive oil and have you for lunch AND dinner if she EVER caught you eyeballing a BP.

MissJulie · Sep 11, 2011

As a CNA and an ADN student, all I can say is "WTH?"

The CNA should be fired, and be reported to the BON, etc. so that s/he doesn't possibly cause death d/t making up VS. It also makes me wonder why someone would take the time to be trained and pass a certification exam, then be hired, only to risk throwing all of that away...

I know that in my job, I make a point to always take VS properly, and re-check any abnormal findings myself, as well as reporting them to the nurse. We've had such bad findings before that I've checked twice, the CMA once, both RNs, and even the MD!

As our lab instructor said, "The VS are windows into your patient." Obviously, the CNA either doesn't get it, or doesn't care; probably both!

Ruby Vee, BSN · Sep 12, 2011

my ci would roast you in olive oil and have you for lunch and dinner if she ever caught you eyeballing a bp.

i've never worked ltc, but i can tell you that in some of our icu patients, doppler or palp is the only way to get a blood pressure.

xtxrn, ASN, RN · Sep 12, 2011

i've never worked ltc, but i can tell you that in some of our icu patients, doppler or palp is the only way to get a blood pressure.

yep- and that's why they're in icu if they get that low on the floor (except in palliative situations- when my mom was dying, they used a doppler to find her 50 sbp) they are no longer welcome in a regular room :)

Jenni811, RN · Sep 12, 2011

WHOOOOOA!

i think you took this a little too far at that exact time

Yes, i would have been upset and annoyed too. however; i would have gone to the CNA and asked for an explanation. I would have asked the CNA to do the VS correctly, and EXPLAINED why it is important to them correctly. You are giving BP medications and rely on these readings to be correct.

If it makes you feel better, do the vital signs yourself.

I just don't see the need to call your manager at home to tattle on the CNA. What is she going to do at home?

given, i would be upset too but i would atleast be rationale enough to get an explanation, explain why it needs to be done correctly and do it myself the rest of the shift until i can speak to my manager.

Also, you as the RN would not be held liable, the CNA would be held liable. By allowing CNA's to do blood pressure readings, and allowing them to chart them, this labels them as "Accurate." Meaning, for example, if a nursing student takes a blood pressure reading, even though it is in the chart i CANNOT use that blood pressure reading for my use of accuracy. It is there for practice for them.

However; this is a HIRED hospital employee, who was given the "ok" to chart, and they gave you the "ok" to use those blood pressure readings for your accuracy. When the CNA falsifies these blood pressure readings, it is by no fault of your own.

IdrilRN, BSN, RN · Sep 12, 2011

I once caught a CNA making up BP's. And called him out on it, and wrote him up, and I got in trouble for it. The DON said I was just the float nurse and he was one our guys...... (the DON was a woman) and I had no busness writing him up. That was a long time ago.

The LNA's in the LTc I work in do not do vital signs nurses do. The hospital unit I am on I trust my LNA's 100%. But then again I am not giving critical meds, expt maybe clonidine and it's for a high cowa/ciwa score so I am right there doing that part and see them doing it.

Katie5 · Sep 12, 2011

To cut a long story short, just try as much as you can to do these vitals yourself while in the room assessing the patients. It saves you a whole load of grief.

morte, LPN, LVN · Sep 12, 2011

WHOOOOOA!
i think you took this a little too far at that exact time
Yes, i would have been upset and annoyed too. however; i would have gone to the CNA and asked for an explanation. I would have asked the CNA to do the VS correctly, and EXPLAINED why it is important to them correctly. You are giving BP medications and rely on these readings to be correct.
If it makes you feel better, do the vital signs yourself.
I just don't see the need to call your manager at home to tattle on the CNA. What is she going to do at home?
given, i would be upset too but i would atleast be rationale enough to get an explanation, explain why it needs to be done correctly and do it myself the rest of the shift until i can speak to my manager.
Also, you as the RN would not be held liable, the CNA would be held liable. By allowing CNA's to do blood pressure readings, and allowing them to chart them, this labels them as "Accurate." Meaning, for example, if a nursing student takes a blood pressure reading, even though it is in the chart i CANNOT use that blood pressure reading for my use of accuracy. It is there for practice for them.
However; this is a HIRED hospital employee, who was given the "ok" to chart, and they gave you the "ok" to use those blood pressure readings for your accuracy. When the CNA falsifies these blood pressure readings, it is by no fault of your own.

please see Ruby's post, a few up from yours, about the dead patient and the nurse was fired and the CNA was kept on...

DusktilDawn · Sep 12, 2011

please see Ruby's post, a few up from yours, about the dead patient and the nurse was fired and the CNA was kept on...

In reading Ruby's post it's also obvious that the nurse did not notice for approximately 6 hours that the patient was dead. Without knowing all the circumstances involved, 6 hours for a nurse not to notice a patient has died seems like a long stretch. For falsifiying VS the CNA should have been fired. There is no reason that someone trained to do a job should not be expected to perform that job properly.

luvazsun, RN · Sep 12, 2011

There are way too many people who are out of work now, and I am sure there is a line of very good, competent and honest CNA's out there who would jump at at chance to work. Jobs are not a "right", they are a privilege for those who want to work, and who earn the "right" to have and keep a job. Your license is at risk for the CNA's incompetence and laziness. If you don't have support from your manager on this, I would suggest looking elsewhere because your manager doesn't have the guts to do the right thing.

JeneraterRN · Sep 12, 2011

On another note, I verify some vital signs when I believe that there may have been an instrumental error. Before I was a nurse, I was an aide on the same floor of the hospital where I am now employed. It was apparent that on both of our vital signs carts that if a person had a HR of 50 or below, it often doubled the HR (I think it was counting systole and diastole separately) and the BP was often lower than a manual BP (it didn't release air slowly enough,

skewing the pressure lower). It's been shown numerous times over the years that the carts do this. I've tried explaining it to the aides, but they don't seem to understand, but when they do manual VS, they marvel at the difference. It's not that I don't trust them, but many of them don't catch this error in the instruments.

As far as falsification of VS, it has occurred at our hospital, and the aide caught doing it was fired immediately. There was overwhelming evidence that she had been doing for about a week when she was finally caught red-handed. There are bad apples everywhere.