Only Charting "The Good Vitals"? - pg.5 | allnurses

Only Charting "The Good Vitals"? - page 7

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... Read More

  1. Visit  whitecat5000 profile page
    1
    Quote from BrandonLPN
    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?
    It's the same with the Accu-chek machine. You get a sugar of 482 and then recheck it and get 246. Both numbers will populate in the computer. But if you look it's obvious. "What?! 482?!. . . oh a recheck five seconds later with a 246."

    Just because you chart both sets of vitals doesn't mean you have to call the doctor on the crappy set. If the aide had charted both sets, it might have alerted me that this is someone that I need to keep my eye on more, or recheck their vitals myself.

    I guess my main pet peeve was that they set the patient all the way up to high Fowlers, then retook the blood pressure, and set the head of the bed back down. Wow, way to elevate those vital signs there.
    kaliRN likes this.
  2. Visit  roma4204 profile page
    0
    Reason 6495 why I work in the ICU - I know my patient's vital trends by heart
  3. Visit  turnforthenurseRN profile page
    0
    CNAs getting vitals are a great help but at the same time it does you no good when the abnormals aren't reported promptly. 99% of the time my CNAs report abnormals promptly. There have been a few times where I didn't know about a patient's 103F temperature until 2 hours later when they were being charted in the computer...

    As for blood pressures, they're great for letting me know ASAP if it is too low or too high. Abnormals are charted by both the CNAs and me, but of course you need to chart what was done about it.
  4. Visit  Hygiene Queen profile page
    3
    Quote from jewelspassion
    I still think to this day that there needs to be a CNA advocacy!
    Absolutely!
    I also believe we should raise the bar on their education and what is expected of them, as far as knowledge.
    There is no reason, in my mind, why individuals who are in such a position of responsibility, should be allowed to remain ignorant and/or irresponsible.
    Our first response may be one of frustration at their poor knowledge base, but we need to move beyond that and teach... and hold them to a standard.
    If a CNA can't learn and meet expectations, they need to go.
    joanna73, turnforthenurseRN, and kaliRN like this.
  5. Visit  duskyjewel profile page
    1
    WOW. Just wow. The attitude of some of the nurses on this thread, is, frankly, REALLY ******* me off. Do you think I wanted to be that crappy CNA? I took my training seriously (during which, BTW, I was trained in manual BP and pulse) and tried to be a really good one. And then I got a job in a hospital surrounded by nurses who would do ANYTHING to keep that sepsis alert from firing in the computer from us charting our vitals. Well, anything except take vitals themselves, usually. We were expected to do them Q4 along with accucheks, input/output, and all the care and housekeeping tasks we had to perform on our constantly short-staffed floor. Plus we were expected to manually chart all of it into the EMR. Supposed to have 3 CNAs, nearly always only have two, so what get it all done anyway! And oh, by the way, come put this patient whose bed I am standing right next to on the commode, because I am an RN and I don't do that. Sure, there are great nurses out there who are not like that, but in my experience with hospital employment, they are the minority! Most of them wanted us to chart vitals that would not cause a sepsis alert, and thus put them on a time limit to call the doctor. This was on a tele unit in a major hospital chain whose name you would all recognize. Patient's sat is below 90? Have them take deep breaths until it comes up and chart that. I even watched RNs do that themselves, so where do you think we CNAs learned it? BP seems off? Retake it until it looks better, even if the cuff reinflates on the same site 3 or 4 times. I watched RNs do that too, usually when they finally got exasperated enough with me reporting abnormals that they finally went and did vitals themselves. When I did report abnormals to the nurses, they would tell me DO NOT CHART THAT go take it again, even if I had rechecked it already. When I tried to mention these and other patient safety issues, it was made clear that I was the problem, and I learned to keep my head down and shut up so I could keep my job.

    Before I knew better, I had the job of doing the first set of vitals on a patient after a blood transfusion was started delegated to me. I was less than six months certified. You tell me whose fault that was? Jeez.

    So, seriously, get off your high horses about writing us up. How about you write up your colleagues who demand we do this crap? Nice how you want to try and destroy someone else's career instead of admitting where this attitude actually comes from.

    I am so glad I work in hospice now. I hardly ever take vitals. I actually CARE FOR my patients, instead of just doing tasks TO them.
    Last edit by JustBeachyNurse on Sep 17, '12 : Reason: tos-language
    sidroc likes this.
  6. Visit  sidroc profile page
    1
    Quote from duskyjewel
    WOW. Just wow. The attitude of some of the nurses on this thread, is, frankly, REALLY ****** me off. Do you think I wanted to be that crappy CNA? I took my training seriously (during which, BTW, I was trained in manual BP and pulse) and tried to be a really good one. And then I got a job in a hospital surrounded by nurses who would do ANYTHING to keep that sepsis alert from firing in the computer from us charting our vitals. Well, anything except take vitals themselves, usually. We were expected to do them Q4 along with accucheks, input/output, and all the care and housekeeping tasks we had to perform on our constantly short-staffed floor. Plus we were expected to manually chart all of it into the EMR. Supposed to have 3 CNAs, nearly always only have two, so what get it all done anyway! And oh, by the way, come put this patient whose bed I am standing right next to on the commode, because I am an RN and I don't do that. Sure, there are great nurses out there who are not like that, but in my experience with hospital employment, they are the minority! Most of them wanted us to chart vitals that would not cause a sepsis alert, and thus put them on a time limit to call the doctor. This was on a tele unit in a major hospital chain whose name you would all recognize. Patient's sat is below 90? Have them take deep breaths until it comes up and chart that. I even watched RNs do that themselves, so where do you think we CNAs learned it? BP seems off? Retake it until it looks better, even if the cuff reinflates on the same site 3 or 4 times. I watched RNs do that too, usually when they finally got exasperated enough with me reporting abnormals that they finally went and did vitals themselves. When I did report abnormals to the nurses, they would tell me DO NOT CHART THAT go take it again, even if I had rechecked it already. When I tried to mention these and other patient safety issues, it was made clear that I was the problem, and I learned to keep my head down and shut up so I could keep my job.

    Before I knew better, I had the job of doing the first set of vitals on a patient after a blood transfusion was started delegated to me. I was less than six months certified. You tell me whose fault that was? Jeez.

    So, seriously, get off your high horses about writing us up. How about you write up your colleagues who demand we do this crap? Nice how you want to try and destroy someone else's career instead of admitting where this attitude actually comes from.

    I am so glad I work in hospice now. I hardly ever take vitals. I actually CARE FOR my patients, instead of just doing tasks TO them.
    I was working on a response that was eerily similar to this one but you beat me to the punch, this is exactly how it works and even if the nurses in this thread are not like this, they need to recognise were this problem originates from. To the nurse who said CNA's are not qualified to do vitals, I suppose she also wants a return to a nurse also having less responsibilities. Remember, at one point, only Docters could take vitals and I know many nurses are scared that CNA's might just eventually be allowed to do more as that could cut their salary and comfy position in the future.
    Last edit by JustBeachyNurse on Sep 17, '12 : Reason: edit quote for tos
    duskyjewel likes this.
  7. Visit  joanna73 profile page
    1
    There are good and bad workers in every profession. We aren't implying that ALL CNA's aren't doing their job. I work with some outstanding CNA's, and some who should be fired. The same is true of nurses, doctors, etc.... And I wholeheartedly agree that all CNA's require additional education, as a general rule, so that you can understand and accurately interpret the whole picture, not just the set of vitals taken. The clinical picture of each patient is related to their vitals.
    Hygiene Queen likes this.
  8. Visit  HyperSaurus, RN profile page
    1
    And suddenly, I'm really happy that my floor utilizes team nursing (at night it's two teams of an RN and LPN with 8-12 patients and one or two aides for the floor). Our LPNs do the vitals and meds while the aides do the accuchecks, I/Os, turns, lights, incontinence care, ect (they're quite busy). Usually the LPN is very good with notification of wonky vitals and initiating whatever intervention is in her scope. There is one LPN though who we have to watch and ask for any unusual vitals or if she's done them at all (just because vitals are qshift and they are sleeping does not necessarily mean wait until 0630 to see them).
    I haven't seen too much evidence of just charting the 'good' vitals except for temps--if they are post-surgical and the temp is 99, they are often encouraged to cough/deep breathe and recheck.
    BrandonLPN likes this.
  9. Visit  HyperSaurus, RN profile page
    0
    I don't necessarily think CNA's are unqualified to take vitals--I just know on our floor they aren't certified and already have a lot on their plate. Duskyjewel that sounds pretty nerve-wracking
  10. Visit  Kris10Noel profile page
    0
    I 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.
  11. Visit  Sadala profile page
    0
    I'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.
  12. Visit  calivianya profile page
    0
    Honestly, 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


Visit Our Sponsors
Top
close
close