CNA Frustrated with Being the Blame

[Kirsten Creator]

I am a CNA inside of a small hospital. Couple of days ago I took vitals. I missed a crucial part with not reporting low 02 to the nurse because I couldn't find her and ultimately forgot. I did chart ontime, but I forgot. I understand that was bad. I am always good with reporting what is questionable. The nurse came to me a couple of hours later upset that I didn't report. I explained I forgot. My question is why don't the nurses check the vitals on the computers? I know for the most part I am documenting every two hours. So how often are nurses checking and documenting. Don't come to me and put the blame on me when I feel it's a simple lookup right after vitals are taking just because of common mistakes like this. Me forgetting. So I just need some input. I know from now on I will be bringing all vitals to nurses before putting them in the computer whether they catch an attitude or not. I have to chase nurses down all the time because they hide or just give you a nasty attitude because you're bothering them when reporting abnormal VS. 

[londonflo]

Kirsten Creator said:

. I said "Oops im sorry I came looking for you, but couldn't find you".

1) This was not in your original response

 

Kirsten Creator said:

she was sitting down in the hallway while I'm running like chicken with my head cut off. 

2) the RNs feel this too. 

Kirsten Creator said:

Yes, my job is to report to you Mrs. Nurse. But check on your patient as well. Two hours went by with the information sitting right there for you

3)  But you did NOT report to MRS. Nurse. anger, rebuttals will get you no where. How do you know the RN was not checking on the patient? being cheeky shows you may need to reconsider your choice of job position. 

[londonflo]

Kirsten Creator said:

I said "Oops im sorry I came looking for you, but couldn't find you".

Did miss you saying this in your first post?

When 

Kirsten Creator said:

So to end this. Yes, my job is to report to you Mrs. Nurse. But check on your patient as well. Two hours went by with the information sitting right there for you.  It's an easy pull up after I have charted

Boy, I have never read someone who is so wriggling to get off the fish hook and blaming someone else as you do. Your CNA training explained what normals versus abnormals mean and what to do. 

So to end this: Your job is report abnormals as you were taught (in a TIMELY Manner)...numbers, patient's physical conditions including shortness of breath, difficulty walking, urinating, eating etc. Don't worry about what Mrs. Nurse is doing. Just do YOUR job.

[Kirsten Creator]

So in my original post I didn't briefly say I couldn't find her? I then came back and quoted what I told her. Getting off the hook? No. My admitting I was wrong from the start is understanding my position. It's unfortunate that you don't see we both me and the nurse share the blame here, but thanks for your input. I'll take what you mentioned into consideration for next time.

[JKL33]

Kirsten Creator said:

It's an easy pull up after I have charted.

How would the nurse know that you've charted it? Just sit there and keep checking and refreshing? A pulse ox in the 80s is something someone should know about within a matter of a few minutes. Should the nurse be able to guess within a few minutes' accuracy that you have charted a particular patient's vital signs?

The nurse did find out about the low SpO2 despite the fact that you did not report a critical vital sign.  The reason that reporting is added to the care sequence when vital signs are abnormal is because they need to be prioritized  ahead of many other routine tasks that we will otherwise stay busy doing.

Kirsten Creator said:

If I was a nurse I'd check my vitals because I can't trust that the techs will come straight to me and report.

That's what you think. But you're here saying that you failed to do something basically because of being busy. Your nurse did review the vital signs--though not on the type of high-priority timeline one would want to use for critical issues. If your belief is that you (if you were a nurse) would be able to intuit that a patient's vital signs were just entered into the computer and that you should prioritize reviewing them right away because they are going to be critically low (despite no one mentioning anything being abnormal), you are wrong. Nurse DO review the vital signs; even yours did. The issue here is using additional means of communication in order to be able to properly prioritize critical issues.

Kirsten Creator said:

Thanks to the ones who made a post understanding both sides and not just looking at it from a nurse stand point because you are a nurse yourself.

 

MANY of us (not all) have been in your shoes working as a CNA/aide/tech. And as far as needing to report critical findings while we are busy running our butts off with a hundred different things at once, RNs are still in those same shoes right along with you.

I will say this in your defense: I hope your unit can figure out another way for CNAs to be able to report things that need to be reported besides having to physically locate an RN. Do you have other means of communication? It's a terrible inconvenience and waste of your valuable time to have to physically locate someone multiple times per shift just to report something; it's no surprise that reporting this slipped your mind after you couldn't find the RN and remained busy with many other tasks.  >>Suggestion: Do you have a charge nurse or shift supervisor? If you can't  locate a particular RN to report a critical value in a timely manner then immediately move on up the chain of command. Document the name of the nurse to whom you reported.

Brainstorm about how specifically to do something different next time. Then...put this behind you so that you can keep taking good care of patients. ??

[londonflo]

after all was said and done, was the patient okay, with regards to their oxygenation issues?

[jadedRN04]

If that patient's nurse was not available what another nurse around that you could have given the reading to? Just let them know "Hey, I can't find this patient's nurse but I wanted to make sure that someone was aware of this O2 sat reading." I'm not sure if that would have helped but I do know if someone comes to me with a critical VS value I will go check on the patient no matter whether they are my patient or not. 

[Been there,done that, ASN, RN]

jadedRN04 said:

If that patient's nurse was not available what another nurse around that you could have given the reading to? Just let them know "Hey, I can't find this patient's nurse but I wanted to make sure that someone was aware of this O2 sat reading." I'm not sure if that would have helped but I do know if someone comes to me with a critical VS value I will go check on the patient no matter whether they are my patient or not. 

This is the best answer. 

[londonflo]

Kirsten Creator said:

Yea from now on everyone gets a copy before I chart.

Normals do not need to be reported to the RN. 

Nurse Beth said:

I hear your POV, and here's the other POV:
 

Busy RNs juggling a dozen issues that demand immediate attention will assume vitals signs are in the normal range because the policy says abnormal vitals are reported immediately to the RN.

 

[Kirsten Creator]

Yea sticky notes will be my best friend from on ?

[Kirsten Creator]

Yes. Londonflo. The patient was OK thank God. Sorry I do not know how respond directly to you.

[lassieSR, ASN]

As an RN I know it's pretty hard to go through and check all VS that have been charted. RN is reviewing orders, doing their own assessments, passing medications, and may be busy doing some of the CNA duties, because CNA's are busy as hell too and patients often have immediate needs.  The RN shouldn't be angry at you, especially if the patient's condition was not compromised. Maybe someone blamed her, and it filtered down to you? Anyone can get busy and not get around to reporting abnormal VS or other findings.  No nursing or other staff should "hide out" or act bothered by getting a report from on their patient.  If they do this, you must ignore their bad behavior and approach them anyway in a matter of fact way, and if staff are hiding out to avoid work or even perceived to be doing so, go to the supervisor and if they are a good leader, the problem can be rectified in a professional way without anyone getting butt hurt.  

[k1p1ssk, BSN, RN]

It sounds like there is a great divide between the CNAs and Nurses on your unit, which is disheartening. Collaboration - and a healthy understanding by nurses that their CNAs are vital (no pun intended) to a smooth shift - is one of the best ways to ensure positive outcomes.

I think it is a great call on your part to start bringing all vitals to your nurses when you take them. Maybe it's once you're done with your rounds, and if there is a concerning value and you want to tell them ASAP, there must be a way to communicate with them while they are "missing" - be it a pager, or their cell phone, an instant message system within the eMAR... and if you do not get a response, find the charge nurse and report to them. And document who you notified and how. Your nurses need to be available to their patients if their vitals are off.