CNAs no longer doing vitals on our floor

squatmunkie_RN · Aug 7, 2012

I'm sorry but I don't understand how or why a CNA wouldn't be able to take a vital sign...wrapping a BP cuff on a arm, sticking a thermometer in a mouth, counting respirations, and putting a finger probe on to obtain a sat? How is that beyond their scope?

alovelymother · Aug 7, 2012

Oh but then it looks like you're "too good" to take vitals or do toileting!!! When in reality you have things to do that you cannot delegate to a CNA. A coworker went to one of our patient care techs once and said "The lady in 425's bedside commode is almost overflowing, I need you to go see her please." and when she left the tech said, "I love a nurse who's too good to dump toilets." Meanwhile the nurse had meds in her hand for another patient! I mean really? I'd love to have the CNA pass meds but oh yeah THEY'RE NOT ALLOWED. That doesn't mean I'm too good to dump toilets; it means I don't have enough time to do this!

I understand. I work in a very supportive department. Expectations are clear. I understand my limitations and why it's that much more important to do the things I can so that my nurses spend more time doing the things I can't. A lot of our techs are either planning to or are enrolled in nursing school. My NM and charge nurses do not stand for lazy behavior. If you have a lazy tech with a diva attitude chances are good that they will be the same type of nurse. Being called on the carpet hurts but at least in my department I always know where I stand. I'll never understand why certain techs feel disrespected when asked to help. It seems to me that egos need to be checked at the time clock.

Bringonthenight · Aug 7, 2012

In Australia we do everything for our patients, I can't believe in an acute setting you let someone take vital signs for you! Who is responsible when things go wrong?

uRNmyway, ASN, RN · Aug 7, 2012

I'm sorry but I don't understand how or why a CNA wouldn't be able to take a vital sign...wrapping a BP cuff on a arm, sticking a thermometer in a mouth, counting respirations, and putting a finger probe on to obtain a sat? How is that beyond their scope?

The point we've been trying to make is not so much about whether or not they are able to TAKE the vitals. It is more about whether or not they are adequately trained to be able to recognize abnormalities or anything outside normal limits. And for myself, until I've been proven otherwise for any individual person, I would rather do it myself than spend my time looking over what has been done to make sure nothing was overlooked.

TheCommuter, BSN, RN · Aug 7, 2012

Who is responsible when things go wrong?

The nurse would bear responsibility when things go wrong.

uRNmyway, ASN, RN · Aug 7, 2012

The nurse would bear responsibility when things go wrong.

And that is exactly my concern. CNAs have to be properly trained to know what norms are, what to recognize, what to report. And for myself, not having the experience of having CNAs have so many responsibilities, I would want to make sure for myself that an individual knows all these things before I trust so much to them. Especially after hearing so many horror stories on here :eek: !!

BrandonLPN, LPN · Aug 7, 2012

I just think delegating certain tasks to CNAs is redundant and inefficient. If I need to know a blood sugar before giving insulin, it's easier to just do it myself. If I'm going into a room to assess a patient every 4 hours anyway, why not just get the vitals then? And why bother the poor patient around the clock? When I worked 11-7 as an aide in the hospital I would go in at 11 to check vitals. Then the RN would go do an assessment after she got report at midnight. I go in to check a blood sugar at 2. The nurse comes in thirty minutes later to give insulin. I come in at 3 to check vitals again. The nurse comes in at 4 to do another assessment. It was ridiculous....

gummi bear · Aug 8, 2012

And that is exactly my concern. CNAs have to be properly trained to know what norms are, what to recognize, what to report. And for myself, not having the experience of having CNAs have so many responsibilities, I would want to make sure for myself that an individual knows all these things before I trust so much to them. Especially after hearing so many horror stories on here !!

Part of the CNA certification course includes identifying and learning about normal and abnormal vital signs. My course stressed that the most important job of a CNA is to obtain vitals and report any abnormalities promptly. I think that the issue here is that some RNs have no clue what the CNAs do/are capable of doing, and some CNAs have no clue what the RNs do. There is a constant breakdown of communication, and it's evident in discussions such as this. And if a CNA is failing to report abnormal vitals, it's not because they're incompetent. It's because they choose not to, for whatever reason. I've seen it happen. I have never heard of a CNA course that does not teach students about how to properly obtain and report vital signs.....And since we're on the topic of failing to properly take vitals, I've seen nurses make up vital signs or complete a full assessment without stepping foot into a patient's room. The issue goes across the board and it's not just a "CNA thing". It's about a lack of communication, laziness, and unaccountability. Some people just have no business working in the healthcare field.

PatMac10,RN, RN · Aug 8, 2012

Part of the CNA certification course includes identifying and learning about normal and abnormal vital signs. My course stressed that the most important job of a CNA is to obtain vitals and report any abnormalities promptly. I think that the issue here is that some RNs have no clue what the CNAs do/are capable of doing, and some CNAs have no clue what the RNs do. There is a constant breakdown of communication, and it's evident in discussions such as this. And if a CNA is failing to report abnormal vitals, it's not because they're incompetent. It's because they choose not to, for whatever reason. I've seen it happen. I have never heard of a CNA course that does not teach students about how to properly obtain and report vital signs.....And since we're on the topic of failing to properly take vitals, I've seen nurses make up vital signs or complete a full assessment without stepping foot into a patient's room. The issue goes across the board and it's not just a "CNA thing". It's about a lack of communication, laziness, and unaccountability. Some people just have no business working in the healthcare field.

Couldn't have said it better myself.

uRNmyway, ASN, RN · Aug 8, 2012

Well, I get that I am not familiar with what CNAs can and cannot do here. That is because I am new to the US and its healthcare system. Like I previously posted, where I have worked, CNAs are responsible for no more than hygiene/elimination/transfers. Like others, I see vitals and BG as part of the assessment, and assessment is the job of the RN. Or thats the way I was taught in nursing school. I guess it will just take some getting used to.

Not that I mind some of the load being taken off my shoulders, far from it. I guess, like Ive said, until I have seen for myself how an individual is, I will feel the need to check up, follow up, dot my i's and cross my t's to be extra careful. Same as I would for an MD Ive never worked with, same as RNs on other shifts who have my patients, or anyone else who might be in any way responsible for my patients. It is not just about CNAs, I agree. I have seen very unethical, unprofessional behavior from RNs too, or doctors, or anyone. I in no way meant any kind of personal attacks against CNAs. It is simply due to the fact that Im not used to them having as much responsibilities, some of the CNAs I have seen so far being GROSSLY unprepared and unskilled, and some stories on here frankly terrifying me.

On a side note, I am also kind of bothered by the fact that more and more of the RNs hands-on tasks are being delegated to others now. Soon enough, the RN will be basically a figure-head, a manager, just another pencil pusher filling out forms. And thats not what I signed up for when I enrolled in nursing school!

TheCommuter, BSN, RN · Aug 8, 2012

Like others, I see vitals and BG as part of the assessment, and assessment is the job of the RN. Or thats the way I was taught in nursing school. I guess it will just take some getting used to.

Here in the US, most nurse practice acts legally allow the RN to delegate certain parts of the assessment, such as vital sign collection and finger stick blood sugars, to the LPN, CNA, tech, or any other healthcare worker who is qualified to complete the task.

Delegation is a beautiful art that, when executed properly, frees up plenty of useful time for the RN to do other things.

BTW, I wrote an article about the tasks commonly performed by CNAs. If you wish to read it, click on the link below.

https://allnurses.com/cna-ma-nursing/how-become-certified-748527.html

PatMac10,RN, RN · Aug 8, 2012

Well, I get that I am not familiar with what CNAs can and cannot do here. That is because I am new to the US and its healthcare system. Like I previously posted, where I have worked, CNAs are responsible for no more than hygiene/elimination/transfers. Like others, I see vitals and BG as part of the assessment, and assessment is the job of the RN. Or thats the way I was taught in nursing school. I guess it will just take some getting used to. Not that I mind some of the load being taken off my shoulders, far from it. I guess, like Ive said, until I have seen for myself how an individual is, I will feel the need to check up, follow up, dot my i's and cross my t's to be extra careful. Same as I would for an MD Ive never worked with, same as RNs on other shifts who have my patients, or anyone else who might be in any way responsible for my patients. It is not just about CNAs, I agree. I have seen very unethical, unprofessional behavior from RNs too, or doctors, or anyone. I in no way meant any kind of personal attacks against CNAs. It is simply due to the fact that Im not used to them having as much responsibilities, some of the CNAs I have seen so far being GROSSLY unprepared and unskilled, and some stories on here frankly terrifying me. On a side note, I am also kind of bothered by the fact that more and more of the RNs hands-on tasks are being delegated to others now. Soon enough, the RN will be basically a figure-head, a manager, just another pencil pusher filling out forms. And thats not what I signed up for when I enrolled in nursing school!

You don't have to explain yourself. At least not to me. I wasn't trying to get defensive. I was highlighting how ludicrous it was that CNA's aren't trained to properly take and report vital signs. But, honestly all I can speak for is NC, VS measurement and reporting is apart of the curriculum for certified CNA training. I know it was for my training in High school. I applaud the fact that you feel more comfortable getting your on VS, honestly, so do I. I realize that this may not always be the case, because as a new nurse I will be adjusting and need help from time to time. They way I see it. You are prepared to handle patients even if you only have minimal assistance from a UAP. Good for you!

On amithet note. Being able to do the majority of the patient care yourself is great. If it can be done safely! However I agree with what an earlier poster said, delegation is a beautiful art when used APPROPIATELY! Teamwork is the best model, to me. As a CNA, I personally don't mind getting vitals. Making sure the vitals are charted in an adequate amount of time and making sure abnormal findings are reported immediately helps me with my time management and prioritizing skills.