Now, all of us since we read forum boards know better than this (I HOPE!), but I have a little story from my time of working agency as a CNA back when agency was a going thing and a valid way to get work as a CNA.
One CNA I knew was a 5 year veteran of a local area hospital. After years of working the floor on a med surg unit in a hospital, she finally got a decent raise and moved to a prestigous ICU unit. Now, compared to the hustle and bustle of med surg, ICU is much more cilled out at this particular facility. All the nurses are much calmer because they have at most 2 patients. The workload is also much lighter on the CNA as all she had to do was assist the RN with baths, take vitals, and of course poo and pee removal.
One day, the CNA went on her rounds to take vitals. After she was through, she turned in her vitals sheet to all the RNs. As she turned it in, one of the nurses turned to her with a puzzled look. "You got vitals on Mr. J. Mr. J has been dead for 3 hours and they are waiting on the funeral home to pick up his body!".
Needless to say, tha CNA got fired. Probably because there where other issues I did not know about helped. But still, this is a pretty dangerous thing. I think the patient would want someone to know if his pulse rate was 150 resting. Last i heard of our CNA who made up vitals, she had to work for a nursing home well known in that area for being not too good of a place because she was blackballed in that town from working other hospitals.
Anyone else have any stories of gross incompetence like that?
"nurse aware" seems kinda unwarranted. Of course, the nurse is going to be aware. You jumped up to double check and your notes are what they are going to read over what the CNA put.Manual is always the best way to do it. Also, sometimes the blood pressure machine can read a unusually high number if the patient jerks or if, like you said, you use a smaller sized cuff. I always get a manual if I get something messed up from the machine.
When I was an aide in the hospital, high/low BPs turned red when charted in the computer. When a vital turned red, it was policy for the aide to add a note of "notified Sally, RN" or something. You can only note "nurse aware" AFTER actually notifying the nurse. Of course they'll become aware on their own eventually, buts is your job to notify them NOW.
Good for you for rechecking wonky BPs manually. Where I work, this never occurs to the aides.
I know for me, if I get an abnormal vital I let the nurse know right away by calling her pocket phone. And yes then I document "nurse aware" because if I don't and something happens Ive covered my ass. Seems to me if so many cnas are incompetent you would check your own vitals. I have to say when I work med surge and am doing q4 and q8 vitals on 15 patients it's pretty hectic and hard to keep everything straight. Hence why i let the RN know before i leave the room if somethings off because i wont be charting the vitals for a few hours.... I have always wondered why an RN would not check bp herself on someone before giving hypertension meds. If I were me I would not rely on someone else's readings. Same with blood sugars. I wouldn't give 6 units of insulin on someone else's word. I would never falsify vitals or anything else, but there are CNAs (why I don't know) who only want a paycheck and don't seem to remember they are caring for human beings. Sad.
When I work a continous care shift I'm always suspisious when the previous shift has documented Q1hr on a stable patient. Especially when they numbers are very similar and I get nothing like them after rechecking 2x. I think sometimes they feel because there are spaces for 12 sets of vitals that they need to fill them all in for a 8 hour shift.
I have had someone admit to me that she (a nurse) makes vitals up in particular respirations, O2 sats and temperatures. I was like ummmmm okay.
The hospital I work at has a very strict policy for what CNAs can and can't do. We can take VS, bathe, walk, feed and clean pts. We can't even switch O2 from the wall to a portable tank because a tech caused a pt to go into respiratory distress. I work on a renal floor so reporting BP is based on the pts trends- which is why all of our techs are nursing students as well.
Work with nurses who chart only once every four to six weeks (home care). Then, they will chart days in advance. Of course, she gave all that shift's medications for that date, three days prior to the shift. Can only imagine that any of these nurses did the same thing when they worked as CNA's.
I usually check BP again before giving BP medication since it is not too uncomfortable for patient even thought it is better without getting pump again. But for blood sugar, really? Most patient ACHS, Q6, or Q4, if CNA check it and I have to re-check it, you know how many times patient will get poke? I look at patient satisfaction score, and one of the areas that we get low in hospital is frequent blood taken for lab and poking patient. So yes, if I can re-check my blood sugar without having to poke my patient again (which is impossible) I will take my time and do it. And no matter how many units of insulin I give, if I give wrong one, patient will go into hypoglycemia.
I was a CNA equivalent on a trauma surg floor (now work in the NICU as a RN) and it never occurred to me to make up vital signs.
That being said, I feel like CNAs are at a disadvantage and can be made to look dumb because we don't have all the information on a patient since we don't get report. I would always report out-of-range VS and then get responses like, "Well, Patient X is back from surgery, of course he's going to have a temp" or "Mrs A's norm is to have bp that low." I wouldn't have minded it so much if it was done in a here's some more info on why, but it was done more in a why didn't you know this, stop wasting my time. Based on that attitude, I can see the temptation to not tell nurses VS or to make up their own, although I had the additional training in nursing school to understand that abnormal VS can be the first step into crap hitting the ceiling.
We occasionally have techs do VS/feed stable babies at my place when we have 3:1 or at agency when I have 4:1 and I always make sure to tell them why something may be out of range but thanking them very much for telling me. A little bit of appreciation goes a long way (also helps when you're stacked with stuff to do and need them to run labs or feeding babies!)
I would always report out-of-range VS and then get responses like, "Well, Patient X is back from surgery, of course he's going to have a temp" or "Mrs A's norm is to have bp that low." I wouldn't have minded it so much if it was done in a here's some more info on why, but it was done more in a why didn't you know this, stop wasting my time.
That's unfortunate. What I do in situations like that is always follow it up with "thank you for telling me though I do appreciate it." To let them know to keep on doing it
In many cases I think it just makes more sense for the nurse to get the vitals or do the fingerstick. When I worked 3rd shift as an aide in the hospital I always wondered why some of this stuff wasn't combined. First I go in at 11 to check vitals. Then the nurse comes in to do her beginning of shift assessment. Then I check blood sugar at 2am. Then 30 min later the nurse comes in to give the coverage. Then I check vitals again at 3. Oops, low BP so the nurse comes in 20 min to bolus. I know how busy the nurses were, but couldn't they have done the vitals during her assessment or checked the blood sugar and give coverage herself in one trip? Those poor pts never got any sleep....
Patient was in the PACU. The patient's electronic chart shows bathing and peri-care done 30 minutes before by the tech. Really? he was in surgery for the last 3 hours. The charge nurse was notified, but as far as I know nothing happened.
I'm from Australia where the nurses have to do all vital signs. I don't think I could trust a nurse assistant to do that kind of task for me. Especially in an acute care setting.
I know in the US your CNAs are trained to take vitals but if the nurse always has to double check the work to make sure it's been done are you really saving nurses time? Just do the vitals properly yourself the first time around.
I'm not hating on CNAs by any means, I used to be the Australian version of one but if nurses are always complaining about having to double check that it was done correctly, why don't they just do it themselves?
miabia, BSN, RN
43 Posts
I'm an MA and I'm not even allowed to insert Caths or handle IV's! I can't even fathom why a CNA would be allowed near such a machine.