Only Charting "The Good Vitals"? - page 7
by whitecat5000 | 12,450 Views | 63 Comments
So I have a question for everyone. The scenario: I had a patient the other day who was 88 RA and 78/49 with a HR of 92 at beginning of my shift. Came in for weakness and fever. The CNA put the patient on O2, sat the head... Read More
- 0May 20, '13 by Kris10NoelI am a CNA, I start nursing school for my BSN at the university hospital in which I am currently employed. I always notify the RN of any abnormalities, even if initial vital signs are off and the retake is good/ within range. I have been instructed by all the RNs I have worked with on my unit to chart the better of the two or so readings, or none at all until they take or I take a manual. I always found this strange myself. Like they just want things to look good, when they very well may not be.
- 0May 20, '13 by SadalaI'm a student. In clinicals I immediately report off on vitals and bgs and if I have an abnormal value on vitals, I re-check AND I give both sets of vitals with the exact times. In fact, I immediately write it down with the time, method used to take it, and then both verbally report it and give the paper to the nurse after copying down the values for my own clinical paperwork (it really doesn't take me long to both do this and report it to the nurse btw). Further, at our institution, we also get each set of vitals signed off by the clinical instructor asap.
I am usually guilty of overkill, but I want someone with a license to have ALL of the available info in order to best be able to assess pt status, and I also want to C my own A.
I also really like manual bps. They are actually easier for me than using the myriad different (frequently broken) machines at many facilities. Not always time efficient though so I don't get to do them routinely, more to re-check if something seems wonky.
- 0May 20, '13 by calivianya, BSN, RNHonestly, this sounds more like a problem of your hospitals/facilities and not the CNAs. What does your CNA orientation look like? What does their skills check off look like? At my hospital, all of the techs, even the new ones, know to report abnormal vitals. Why? The HOSPITAL makes sure they know that after they get hired. There are at least a couple days of classroom orientation for new CNAs. It can be longer on a specialty unit. The new CNA also has to shadow an experienced CNA for at least a week and do nothing without that CNA's supervision unless there is some mitigating factor like the new CNA is a nursing student and seems immediately competent on the first day, at which point they only have to shadow for three or four days. I had to shadow before starting work as a CNA and I'd been on the unit for ten weeks doing CNA tasks during my externship, so obviously this is something the hospital takes very seriously. If the CNA does not feel comfortable alone at the week mark, additional shadowing is offered until the CNA is comfortable. Any task beyond the CNA I level has to be checked off by a RN if the task is offered. There is CNA II certification available in my state, but the hospital only lets CNAs perform a few of those skills, so you are a CNA I+4 instead of a CNA II once you have been checked off on those additional skills, which include inserting foleys/intermittent caths, setting up suction, and a few other things. The check off requires that you do the skill perfectly at least three times with RN supervision, after that you are deemed competent to do it on your own.
If the CNAs are not being trained at your facility, your facility is unsafe. Period. There is no standardization of education for a CNA. It is totally a wild card what training a person who has been hired has. If your facility does not train new employees in the correct way of doing things they are providing an unsafe environment for their patients, and I would blame the facility and not the CNA. It's not a CNA's fault if they got hired with no knowledge at all. That's the fault of the HR department and the facility for not following up.Last edit by calivianya on May 20, '13 : Reason: Typo