CNA Frustrated with Being the Blame

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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. 

Specializes in Med-Surge.

Hi Kirsten, 

Thank you for sharing on the board! I became an RN 1 year ago and before that was a CNA. As a CNA I definitely had instances when I would try to reach an RN to report something like a sugar or an abnormal vital via phone multiple times and couldn't get a response. Yes, RNs are busy and yes CNAs are also busy. In the future, if there is something quite abnormal like an SPO2 in the 80s and your RN can't be notified right away, let charge know, she/he is there as a resource to the floor and can help you out. This patient can decline quickly if the issue isn't addressed. It sounds like you are making a plan to make it work though! 

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Kirsten Creator said:

It won't get lost. Especially if I'm waiting to chart after their approval ?

As I stated before. If you are M.I.A. I am not about to run around to find you. If you're not in the med room or in any of the patients rooms then I'm assuming you don't want to be found (this is if the charge nurse isn't available). The other nurses are no help. They don't want to be there let alone do someone elses job. I am not about twiddle my thumbs and wait for you. I have bed baths, assisting patients to the restroom, passing out trays, taking vitals, changing sheets, discharging patients to their cars ect.. I. AM. NOT. ABOUT. TO. WAIT ON A NURSE. That nurse was gone! Poof. If it happens again and the charge nurse isn't there YOU GET A STICKYYYY NOTE! I will then come back once you reappear and ask "Hey! Did you see the note on room such n such"? "Is it okay for me to chart it"? If it's somehow lost at this point then we can figure things out from there.. The sticky note idea was wonderful! 

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Specializes in oncology.
k1p1ssk said:

, but the PCTs on that floor always checked in with their nurses after getting vitals, even if it was a quick "417a was normal, 417b has an elevated temp". 

 

Kirsten Creator said:

If they are not there when I come to bring abnormal vitals then a sticky note is there for them. I then go back after I have seen them and ask if it's OK to chart it.

You  are wasting time if you do not chart in the room, if that is your set-up (you mentioned you have computers) .  . If you are waiting to communicate vital signs you were assigned -- such as discriminating between normal versus abnormal  and then find out if you should document as such you are not using your time well for example ( investigating decreasing your running around with being a chicken with their head cut off for,... to you, ..you need valuable time) You keep re-directing this story that the abnormal was not communicable until you told the RN if, & when Mrs. Nurse was available to you. This would be a great course problem-solving case  (a case study) if you were in CNA school.  Oops wait you graduated and got your certification from your authorizing body and accepted a CNA job. 

Okay you made a mistake...accept it as it was, accept the blame, improve your practice, don't dwell in the BLAME GAME. figure out if you want a job where a  somewhat common activity can can be applicable to another human's wellbeing.  Understand your position in the hierarchy of nursing and impacting another person's life. Learn that you have an importance in that hierarchy and have a very important effect on the life of an individual. Your work is IMPORTANT and does need to be performed as your job description and education are described.   

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k1p1ssk said:

Well, it worked well on the inpatient floor I worked on - there was a working relationship between the RNs, LPNs, and PCTs (most of which were CNAs as well). It was standard practice on that unit for the PCTs to be a part of report and for them to work with the nurses, getting vitals at the same time as the assessment process - of course the timing wasn't always perfect, but the PCTs on that floor always checked in with their nurses after getting vitals, even if it was a quick "417a was normal, 417b has an elevated temp". 

Maybe it's a culture thing, but I feel like putting such separation between nurses and aides is going to brew discontent. Why are we promoting passive-aggressiveness???? That seems really unprofessional and catty to me.  

Whoa, hang on. NO ONE is saying not to work together. What you describe above is not at all the same as someone leaving the RN a sticky note with all the vitals that have just been charted in the computer.

I am most certainly not promoting passive-aggressiveness, or some kind of high and mighty type of separation between RNs and nursing assistants. I have to say that what is unprofessional and catty is that VERY frequently these discussions turn into accusations just like the one you just made rather than a discussion of the issues at hand.

As already mentioned, MANY of us have done the nursing assistant role. We are not unsympathetic to the difficulties of that role. I have seen a nurse here and there who truly appears to have forgotten where they came from, so-to-speak, but not the majority. On this very thread we have already offered some useful problem-solving suggestions for what steps can be taken if this happens again. Those do not involve sticky notes and unnecessary reporting, that's all I was saying. If the OP has chronic problems with the RN in question that is a different matter. At the end of the day, abnormal vital signs must be reported for the patient's sake-- not because the NA "owes" the RN some kind of courtesy; it is  simply the job a person signed up to do and it must be done for the sake of the patient and their health.

I'm sorry, I wouldn't usually go on about this to this extent, but the insinuations and accusations with this us-vs-them mentality got old a long time ago.

-Significantly abnormal vital signs need to be reported.

-We all need to treat each other with respect and remember to put ourselves in each other's shoes.

 

 

 

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Kirsten Creator said:

I. AM. NOT. ABOUT. TO. WAIT ON A NURSE.

No one is asking you to. What you are to do is report significantly abnormal vital signs right away FOR THE PATIENT'S SAKE.

Regarding not being able to find an RN, you have received many comments about the proper way to handle that. You need to report to someone, even if you don't like it. That RN, another RN, a charge nurse, your manager, your director, the house supervisor, call the doctor yourself or call a Rapid Response for all I care, this isn't about you and it isn't about the "MIA" RN.  It's about the patient.

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Specializes in Critical Care.

I didn't read through all of the comments. Just wanted to share that us nurses have the same responsibility: if we take vitals, and there is something off, it is our responsibility to communicate it to someone as well. We see our NPs/PAs/RTs/MDs etc on their computers all of the time as well - it doesn't mean they're going to notice anything. Even if they do, they might brush it off as an accidental entry. So that is the kind of mindset that you have to have. 

The person who notices something off cannot just ignore it and "pass the buck" so to say. When there is a concern, it is necessary to vocalize it, ask for help, for another person to double check. Anything that screams "this ain't looking right" should be communicated to somebody.

I do not expect CNAs or Techs to report every little thing on my patient. Nor do I take advantage (ex: if I have time, I can get the IV, or draw labs, or check glucose, or bathe a patient, or walk a patient, take their vitals, etc). I do expect tho that at anytime if they do notice something very out of the ordinary that they prioritize communicating that to me or anyone to ensure the patient is safe.

That doesn't apply to CNAs/Techs alone. It applies to everyone I am working with. I'd be upset with anyone who noticed something that was significantly off with my patient and chose to ignore it. 

Just reinforcing the idea. 

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JKL33 said:

No one is asking you to. What you are to do is report significantly abnormal vital signs right away FOR THE PATIENT'S SAKE.

Regarding not being able to find an RN, you have received many comments about the proper way to handle that. You need to report to someone, even if you don't like it. That RN, another RN, a charge nurse, your manager, your director, the house supervisor, call the doctor yourself or call a Rapid Response for all I care, this isn't about you and it isn't about the "MIA" RN.  It's about the patient.

I'll take rude because I've already made up my mind on what my solution is.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

My concern is whether you're going to potentially miss a crucial intervention point with the sticky note option. I understand you're going with it and that's your choice, as long as it's acceptable in your work environment, however, there's a big difference between leaving a sticky note with a mild elevated BP vs an O2 sat of 82, heart rate of 160 or BP 80/40. If something needs to be acted on IMMEDIATELY, like low oxygen saturation levels, abnormal heart rates, or critically low blood pressures then yes, I would expect a CNA to drop whatever they're doing and find the nurse, or any nurse if not the assigned nurse, because that's going to be a rapid response/critical situation before any of your other stable patients. As the nurse I'm most definitely responsible for reviewing my vital signs, but it might be an hour later. If I'm in a patient's room for an extended time and I don't see your sticky note for another hour, that patient could be in crisis. You need to be able to critically assess which vitals are appropriate to leave in a sticky note and which need immediate attention. No nurse expects their co-assigned CNA to be chasing after them for every little thing, but as a team, communication is the key to patient safety. 

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Specializes in oncology.
Bluepen said:

I remember when I was working as a tech and the nurse blamed me for not reporting a vital. But it was after they were dead. I

A human life is important . it is our basis for being--more so when they are passing from life or death. If someone was delivering a baby and documented vital signs and said "but it was after they were dead).- '' 

It doesn't matter how many people are outside the room (you mentioned nurses sat in in a chair outside the room. Think about it: they were aware of the importance of a human being's life in this world and the respect given to it.) You were breezing through, taking important, measurable information.  Did it mean nothing to you? If it was you who was dying? 

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londonflo said:

A human life is important . it is our basis for being--more so when they are passing from life or death. If someone was delivering a baby and documented vital signs and said "but it was after they were dead).- '' 

It doesn't matter how many people are outside the room (you mentioned nurses sat in in a chair outside the room. Think about it: they were aware of the importance of a human being's life in this world and the respect given to it.) You were breezing through, taking important, measurable information.  Did it mean nothing to you? If it was you who was dying? 

Let's not do that on this post. Okay? 

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Specializes in Critical Care.
Kirsten Creator said:

Let's not do that on this post. Okay? 

I don't think they meant to be offensive or anything. Rather just trying to make a point. It's okay. 

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Specializes in oncology.
Kirsten Creator said:

Let's not do that on this post. Okay? 

You are dismissing someone who lived a life..probably contributed to the community which you may have benefitted from , provided taxes to fund community college nursing programs and state programs, other services that you take for granted. You were dismissing a loved one's dying (the patient was someone's mother/father/sister brother. 

It is NOT OKAY to diss someone's life as you illustrated: "LIKE" Communicated their vitals to the RN, oops they were dead when I got around to reporting them

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