CNAs no longer doing vitals on our floor

[new_grad_RN]

I work on a med/surg floor where I guess some CNAs complained that nurses abuse them and our manager has now made it where the RNs will be doing all vitals on top of everything else. Is this normal for other hospitals? I understand that everyone is busy, but CNAs used to be able to do so much more. Now at night, they will only be taking patients to the bathroom and changing patients, which the RNs do as well.

[uRNmyway, ASN, RN]

Question, from CNA to nurse:

Is it because you don't trust techs to report correct vital signs? Because that is the feeling I'm getting from a couple of the posts. Usually, the nurses on my floor look up VS in our system that the techs have posted. Rarely do I see them collecting VS myself, so this is new to me.

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No, my issue is not with techs providing incorrect vitals. My issue has mostly been that the CNAs I have observed did not know the normal ranges. If I am going to doubt if they can let me know when something is abnormal, then I might as well check it on my own. But again, I am only speaking from MY experiences. I have not worked in hospitals where all charting is electronic. If all your information is at the tip of your fingers, all you have to do is log into a computer at bedside, then I can find what I need and interpret it on my own, if I am concerned at all. However, where I worked, paper charts are still the thing. Sometimes, vitals are only put in at the end of the shift.

BTW, even if they arent supposed to, I have been in hectic rounds where one of our CNAs, who was a nursing student, went and took our vitals and BG. And we were fine with that, because we knew what he knew, and trusted that he could tell us if anything was abnormal.

Besides, all of this is not a matter of trust. It is a matter of interpretation. Trust would imply that I know they can do it, but dont. For instance, they know the BG of 250 is abnormal, but dont feel like chasing me down to let me know. My problem, with the CNAs I have worked with, is that sometimes I dont know if THEY know what the normal values are.

[uRNmyway, ASN, RN]

well, again, you quoted me, but....

and i'm sorry that you've come across some crappy cnas. it just seems unreal to me that a cna wouldn't know abnormal values/normal ranges when we are expected to report abnormal values. i agree that vital signs are apart of the nursing process, but imagine having to do all those things you've listed...what would the point be in having a cna?

well like i previously said, where i worked before going on maternity leave, we did all of what you listed. cnas basically were there for hygiene, elimination, and transfers. and up until fairly recently, we didnt even have lpns. so rns had to do all that stuff, for 8-9 patients. and we lived. dont get me wrong, boy do we ever appreciate the help. i am just saying, i did it for years, and thats what im used to.

[jennilynn]

Question, from CNA to nurse:

Is it because you don't trust techs to report correct vital signs? Because that is the feeling I'm getting from a couple of the posts. Usually, the nurses on my floor look up VS in our system that the techs have posted. Rarely do I see them collecting VS myself, so this is new to me.

Yes, there are some I don't trust, with good reason. But mostly because it is MY assessment. I wouldn't rely on previous shift's report to assess my pt, I lay eyes and hands on my pt. I usually will get the initial set of vitals on a shift or new admit ( again, I am already in there assessing, how hard or time consuming is it to slap a BP cuff on?) and I don't rely on the techs to report abnormals to me before I decide to look them up.

Some techs are more than appreciative of nurses doing their vitals. But I also bathe, toilet, feed my patients etc, without trying to hunt down a tech.

I am in no way putting down techs/CNAs, I teched my way through nursing school, I know how hard it can be.

I also understand now, how much a nurse has to be responsible for that is not directly associated with direct patient care (charting, core measures, education, etc)

[forbidden2know]

I am thinking about becoming a CNA but thought perhaps I will volunteer before I make that decision. The stuff I'm reading on here is kind of scaring me though.

[ThePrincessBride, MSN, RN, NP]

Well like I previously said, where I worked before going on maternity leave, we did all of what you listed. CNAs basically were there for hygiene, elimination, and transfers. And up until fairly recently, we didnt even have LPNs. So RNs had to do all that stuff, for 8-9 patients. And we lived. Dont get me wrong, boy do we ever appreciate the help. I am just saying, I did it for years, and thats what Im used to.

It just seems to be a ridiculous amount of work to do on your own, ykwim?

And if you work on a floor with healthier, more independent patients, it seems as though there wouldn't even be a need for a CNA.

[brandy1017, ASN, RN]

The CNA's don't do vitals where I work so you are running around doing vitals, then the patient needs the bathroom and you are doing that, ending up late on your meds. All the while the CNA is sitting at the end of the hall on the internet doing nothing unless the call lights go off, which they don't since you are there doing their job for them already! So you are busy, running around doing your nursing job and their job and they get to sit back and relax on the internet. Oh you can "ask" them to help, beg and maybe they will do one or two vitals or they will make an excuse or say they will and then 30 minutes later they still haven't with another excuse. But you will have to help them turn and clean the patients, but they can't do your job! It is totally ridiculous!

You walk into isolation rooms and find no thermometers, no pulsoxes, sometimes no BP machine! Nothing is stocked and the BP equipment doesn't work because it wasn't plugged in for hours by the previous shift. Same with computers not plugged in. No thermometer probes because stocking is too much work for the CNA's. Don't ever put the paper in the machines to print out the vitals so you have to write on your hand! All the while they are sitting around, gossiping, reading magazines or on their I-pad! You're lucky if they actually pass out water sometimes!

I think this policy of CNA's not doing vitals only makes them lazy and disengaged! They act offended and put upon if you want them to help out with the vitals which we are supposed to feel free to ask but then you get the attitude that it is not their job! I wish management would wake up and realize this policy promotes disengaged CNA's who do the bare minimum! If we had computers and dash BP machines in every room like ICU has it would at least make it easier on us nurses. Instead we have to drag both machines with us from room to room. The CNA's show no initiative they will tell you so and so wants to see his nurse and you are in with another patient. It turns out something simple the CNA could have done themselves but why ask when you can pass the work off. And don't expect them to take the initiative and get the vitals while the patient is awake and waiting for you though you are busy elsewhere! This really steams me! The sad thing is some of our float CNA's are much more hardworking and will help and take the iniative. One time the regular CNA's complained to the supervisor because a float was doing the vitals, making them look bad. Can you believe that! So many will sit at the end of the hall to get as far away from everyone as possible, but the agency CNA will sit right outside the door of a confused patient, ready to keep him safe. Why can't our own staff have half the initiative? Then they wonder why the fall rate is so high!

Sometimes I think I might as well be working by myself! But given the many total patient care patients and the many morbidly obese patients that would make things even more unsafe increasing the chance of back/neck injuries! We literally need all the help, hands we can get to turn and move these patients safely!

[LynnLRN]

I think nurses should get vitals because I find a lot of times NAs do not do it accurately anyway and it is part of the nurses assessment. I think a lot of patient decompensation that happen would actually be prevented or caught earlier if nurses obtained the vitals.

[alovelymother]

Maybe I'm a bit of an optimist but if you want your techs to accurately take vitals and help on the floor than instead of doing it yourself a little reinforcement of your expectations would help. Show them how to properly take vitals. Explain what you expect of them as a part of the team. it just seems that taking on the extra yourself adds to your load and builds resentment amongst the department.

[uRNmyway, ASN, RN]

Ill repeat that some things should be kept within scope of practice. Can CNAs take vitals? Of course! Can they interpret? Sure, some can!

The same way that I know when Tylenol is indicated or contra-indicated, and the same way I am capable of writing a scrip for it.

[OnlybyHisgraceRN, ASN, RN]

This is ludacris. When I was an aide in medsurg it was no issue for me to get vital signs. The nurses had enough on their plate. Nurses can do the job of a CNA but the CNA cannot do the job of a nurse, this is when delegation is key.

[mmc51264, BSN, MSN, RN]

I work in LTC/Rehab and I usually get my BPs myself before giving cardiac meds. We do our own BS too. I have been at hospital where CNAs do VS and BS. As it has been said before, it is a team effort. If I am in a room and a pt wants to get ready for bed, I'll do that. I do what I can, when I can.

[PatMac10,RN, RN]

Well, again, you quoted me, but....

And I'm sorry that you've come across some crappy CNAs. It just seems unreal to me that a CNA wouldn't know abnormal values/normal ranges when we are expected to report abnormal values. I agree that vital signs are apart of the nursing process, but imagine having to do all those things you've listed...what would the point be in having a CNA?

I agree, in my High school CNA course we had to learn what the normal VS measurements/ parameters were so we could notice if something wasn't normal. That's a basic first aid skill, a CNA not knowing or learning thus would make them useless in one sense be a pt could be breathing 6bpm and The CNA wouldn't know to report it. As far as I know all CNA'a trained where in from (Southeast NC) is trained to recognize the normal VS parameters, whether they remember those parameters or implement them is a very different story however. Lolz!

Maybe because I knew since I was young that I wanted to be a nurse and obsessed over medical and nursing books/ information/ documentaries etc.... I kind of learned by second nature. Im also a current nursing student but i became/worked as a CNA a year before i started nursing school. My mother also became a nurse when I was 8 and was always teach me the S/S if various things and what "always" to look out for. Idk. I know for a fact that normal ranges are taught when learning how to take VS in my part of the state. We are all BLA certified here so we have to be able to recognize normal and what veers away from normal, even if you don't know why the pt. status changed.