Only Charting "The Good Vitals"? - Page 3

Well, I was told to. When the pump beeped "distal occlusion" I was told to have the pt straighten out his arm, check for infiltration, and then push 'start'. It wasn't until much later that a nurse told me "well, technically, you're not supposed to do that". I did many things on that floor that the nurses weren't really supposed to delegate. I changed many ostomies. I did all the bladder scans. I was handed suppositories and told to administer them. I did manual removal of feces in pts that were impacted. I'm not saying it was right. But they were they RN and I was the aide, so I did what they told me to.

And I'd like to add that all of this improper delegation that happens all the time in hospitals is a direct result of the abandonment of team nursing and the elevation of UAP to "nurse tech" status. I mean, how do you know where to draw the line? A tech straight cathing a pt doesn't require nursing judgement, but giving a suppository *does*? Its okay for a tech to change a non-sterile dressing, but resarting an occluded pump is going too far? Is it any wonder nobody knew what could be delegated and what couldn't??

Brandon, here, techs used to do in and outs and foleys but then the facility woke up and smelled the coffee and realized that that was not within the tech scope of practice (not here atleast). High risk of UTI if sterile technique not followed. We couldn't touch the IV pumps or give suppositories.

Techs can't do anything with O2 either, not even checking to make sure it is at the right flow rate (that's actually a nursing judgment).

Right, but when you start saying *some* formerly "nursing only" skills are okay for UAPs to do and others aren't, you've opened the floodgates. Why is inserting a foley "okay" but restating an occluded IV "not okay"? Why are clean dressing changes "okay" but giving a fleets enema "not okay"? Heck, I know for a fact that, on our burn unit, the techs did the vast majority of the dressing changes. So who can keep track of where the line is for each and every skill? Hospitals made their own bed when they replaced LPNs with glorified UAPs who seem to do everything short of giving meds or calling the doc. Now they have to sleep in that bed and deal with the consequences....

We can tell the pt to straighten their arm; but we couldn't actually touch the buttons on the pump. I understand what you are saying though. We didn't do dressing changes either.

We could do vitals, baths/change bed linen, at the time we did foleys and such; but when I finished clinical there, I noticed they changed the policy, we could get specimens,empty foleys, d/c foleys, chart, bladder scan, feed pts unless they were speech pathologist's people/swallowing problems, collect trays, calorie counts (unless it's like tube feeding), turns, empty drains and take the pt out when discharged. We could also ambulate them as long as it was not the first time getting up (nursing judgment)

We couldn't give meds, do dressing changes/wound care, start/stop pumps, do anything with oxygen, do blood sugar checks, etc.

I got ya though. I do think they are using techs/UAP/CNAs for too much now. Definitely think they need LPNs and RNs to do that stuff.

Right, I hear what you are saying. How did you find out about the initial VS? We recently laid off RNs and replaced them with RPNs. It's been a very difficult transition and I really preferred an all RN floor. So, I hear your frustration because I have felt it myself.Another question, if a patient was unstable and say desatting in the 70's, can a CNA put O2 on then? I'm from Ontario and we have RPNs (registered practical nurses) who it seems have a much wider scope of practice. If a patient became unstable they would intervene but then a RN would assume care.Was it a positive outcome for the patient?

There are only a handful of CNA's who I trust to check vitals. Even after educating some people, they either don't care or want to learn. So guess what? Those CNA's don't take vitals for me...ever. Sorry, but I need to know if I'm potentially facing a code situation ASAP, not because someone chose not to report abnormal vitals.

Are the "good vitals" the ACCURATE vitals? For instance, if a CNA was taking an automatic b/p on a patient and that patient happened to start thrashing his arm around wildly, I would assume that they would re-take the b/p and not give me the original, wildly hypertensive b/p. Is the CNA placing the saO2 probe on a cold finger or one with an extra long fingernail?

I used to get low b/p's all the time on night shift and when I woule retake them they would be fine. They were using the narrow, long cuff on everyone because they were lazy. I told my manager and she said "yeah it's long, but it wraps all the way around." ?!??!?!?!! Um I seem to remember something about 80% of the bladder encircling the arm, and I figure there's a purty good reason we use different lengths, but okay then, it's your floor.

Our policy is that is a vital is questionable (somebody who is alert and looks well having a B/P of 60/40 when it's been "normal" for days, for example) then it is not charted, but must be checked manually and the manual B/P charted. Most times it turns out to be a machine error. We do not alert the nurse until we have obtained the manual B/P, per policy. Of course, if the manual is still 60/40, we chart it, but if it was manually 105/50, we would chart that one and chalk it up to the machine.

We can place oxygen, as per instructions on the bedside chart which will be written as something like:
Target SPO2: 90%+.
O2 start rate: nasal flow 2L.

We would start the nasal O2 at 2L and then inform the nurse of that and the new spo2. (and we would, in this instance, chart both the air and oxygen levels).