cna's obtaining vital signs in a timely manner

[cwgrlup85, ASN, RN]

It seems that in the different places I have worked getting the cna's to obtain vital signs in a timely fashion is near impossible! Their excuses are always "we don't have time" or "why can't the nurses do them all they do is sit anyways". If the cna's are having a rough day the nurses usually get the vitals, but then there are some cna's that would take advantage of that and assume the nurse will do it all the time. I have some very spoiled cna's who truly do not realize how easy they have it in comparison with your typical LTC facility. Our unit has extra staffing due to being a dementia unit, but it seems the more staff we have the less gets done! Any suggestions would be appreciated!

[amoLucia]

If it's their job to get the VS, then they need to get them. But you need to be very clear with the expectation. Write it down on their assignment sheet with the pts each is resp for, the time you expect the VS, and where you exxpect them them to record the results.

Now here's the hard part - SOMEONE hs to be responsible for followup, and I recommend that it be you. At the expected time, approach anybody who missed their VS. Let them know that YOU know they missed them and you expect them to be done. Compliment those staff who did get their VS.

Remember - critiicize in private, compliment in public.!!!!! And reward all for general group improvement (like donuts on payday).

Repeat and repeat again. Keep accurate detailed notes about any delinquet VS.

If a chronic delinquency continues, write out some type of COUNSELLING form; you give them their copy and you keep yours . Do a few informal COUNSELLING forms and the word will get around that you're serious, and the behaviours should improve. If you've got a really problematic employee, then you may have to proceed to a real disciplinary write-up. Remember, your documentation must be specific.

Make sure that your staff has the skill competency to do VS as you may need to get some inservice done first. Ensure that BP equip thermometers and wristwatches are avail. Also, be aware if any of your staff might have a reading/writing deficiency. And ALL CNAs must be accountable.

It seems like all the work falls on you and it pretty much does. But it's the only way delegate and manage. Your licensed staff must be part of the plan also, esp in your absence. If you deal with a union , you'll need to follow something like this.

[MichelleRN32]

I like my CNA's to come up to me as soon as they come on the floor. I don't do walking rounds with them, but I go over new orders for patients (like D/c Hoyer) that pertains to CNA care, I remind them that whenever redsidents come back from dialysis I need to be notified (they come back in the middle of med pass), I remind them I'd like the lap buddies/ bed alarms I want in place etc and the fact that I need VS in by 1600, which is when I will start passing 1700 meds. The vital sign sheet has their names and room #s on the top, together with "Vital signs in by 1600, please:) thanks"

I always tell them "let's not have any falls this shift" and "report any changes please". I also go over new admissions with them and tell them what care they need to provide for patient, diet etc.

You have to be a leader. talk to them exactly how you were taught in school: no open-ended questions; limit use of "you", use: "I would like to have...please" instead. If you ask them three times in a shift to do VS and they don't, it is your choice to write them up or take the VS. Imagine that you have someone with SBP of 180 and you only find out at 1800...by then, you could've treated it with 0.1 Clonidine PO and assessed if effective!!

Of course, there is no one answer. sometimes you'll have to take a BP yourself at 2100 if the resident takes lisinopril at HS....

Hope this helped, good luck!

[cwgrlup85, ASN, RN]

Thanks! I will try these things, great advice!