Only Charting "The Good Vitals"? - Page 4

"Cringing" is not the correct response.

Write up the CNA... in order to assure he/she gets the additional training required to perform their JOB.
In the meantime, I would take my own vitals.

I don't know that 'writing up' the aide is always the best choice....maybe some education is in order. Education may make them do it correctly the next time, while a write up might lead to unnecessary angst between aides and nurses. If this is a repeat offender even after education, then a write up is the way to do.

Either way, only charting good VS is a silly policy for the reasons others have already mentioned.

I've had times when the aide/tech informs me of a 'bad' BP, say 72/39 (with the machine). I go in to do a manual BP and I get something reasonable. Makes you wonder that if the machine incorrectly gives 'bad' BPs that it also gives incorrect 'good' BPs (i.e., the real BP is actually either too high or too low, even though the machine tells you it is 118/58).

Now, this is next part is not meant of a criticism of aides/techs--they are trained in how to take VS (usually with a machine). The aides do not have education in how to interpret the VS, assess the pt, and evaluate the VS in the light of the entire clinical picture. For example, take pulse ox. Aides might be aware that sats should be above 90%. Now suppose they take a pulse ox on a COPD pt and the sat comes back at 88%. Likely totally acceptable for this pt, but for someone without education on the subject, this pt needs supplemental O2 (in reality they do not). Point is, the RN must be aware of VS taken by aides, and aides need to be aware that sometimes the VS will be bad--don't feel the need to 'buff up' those VS--notify the RN and the RN goes from there.

I'm an ex PCT. RN as of July.

Kind of the opposite, nurses used to irritate me. They didn't want me to chart that systolic over 160 or under 80. They would come check it themselves and it would magically be 150 or 90 or something.

It was funny how my manual BPs were very similar to the Dinamap's but the nurses were within a range that wouldn't make the system put up a flag.

On the O2 note, nurses let me do cannula but I always told them.

Its quite amusing to read nurses discuss the importance of charting the first vital set when not a single place I have worked at including hospitals and supervisor staff has said anything more than "chart the best vitals you got and monitor". So many nurses do not seem to discuss what is commonly done in real world nursing as compared to textbook nursing. Not saying the above practice is right, but many of you live in a fairytale world were this is not common practice.

Also, if the first set the aide gets is way out of whack and I recheck right after and get a more normal set, it's safe to assume the aide used improper technique. Lots of times they get crazy low BPs because they use an automatic cuff while the pt is laying on his side. Or they get a temp of 95.5 because they only use those stupid tympanic thermometers. Or they write the "magic 20" respers on everyone, whether their respers are 12 or 32. Why would I chart any of those vitals?

I don't get how "charting both sets" would work logistically in a hospital setting. Say the aide gets a BP of 71/39. Obviously, you would go recheck manually. You get 94/52. If you charted the 71/39, and it's there in the computer, don't you have to call the doctor? And if you told the doctor, "well I rechecked manually and it was 94/52" wouldn't the doctor be pi**ed that you wasted his time? The first set was clearly bogus. So why not just disregard it an chart only the good set?

Really hard to trust these CNAs. I'd report this one to management and insist that the CNAs be inserviced on taking vitals. The nurse is ultimately responsible for everything. I'm glad i no longer work in acute care. No more CNAs to deal with in my field. Praise God.

Well, I don't know if that's fair. I need my CNAs, my facility would collapse without them. They're great at the hands on care part of their job. I just wish they would
take the vitals more seriously. They treat it like just another task. Taking even a routine set of vitals takes *some* critical thinking, putting two and two together and whatnot. I just feel more comfortable getting my own vitals.

I really have a hard time getting why a med surg nurse, with six pts, would have a hard time getting her own vitals. It doesn't take that long. And you're in the room *already*, doing your assessment. I will admit, I've never been an acute care nurse, so maybe I just don't know....

Well here is the thing. I think it's important to document ANY intervention, you would chart the vitals but stipulate the patient was uncooperative, asleep, wrong size cuff etc. As far as calling a physician, in terms of critical thinking, you use your judgement. The is no need to automatically call an MD for an off vital unless you are absolutely sure the reading is accurate. I am an acute care nurse and it's baffling to me when I check back on my patients and see vitals recorded that are clearly abnormal with no explanation! If you get a low BP, consider orthostatic vs or a manual. It's also possible there just isn't the time to search for equipment or reassess, and that is unfortunate but true. I'd be lying if I said my hourly assessments didn't drift into the hour and a half or two hour mark. Sometimes it's just impossible.

Stooooopppppppp!!!! These aides are doing this crap because some someone told them to do it! Every single shift, there are a handful of nurses that tell me NOT TO CHART THE "BAD" VITALS. But I do it anyway. If I get wacky vitals then I retake them 2 times, write it all down, and then tell the nurse and give them everything that I have documented. There is a nurse that I work with RIGHT NOW that goes behind my I&O charting and crosses out my "bad vitals" and writes in something different so that she doesn't have to call the doctor. WTH? Ask these aides WHY they are doing this stuff, and explain to them why it's not a good idea. You'll be surprised at some of their answers. If someone doesn't know any better, then how can you expect them to do differently? Especially if someone has probably given them misguided direction.