CNA's not doing vitals & slow to answer lights?

[garnetgirl29, BSN, RN]

In my facility, the the nurses put out a list of what resident's they need vital signs completed for at the very start of their shift. The CNA's are supposed to complete the vitals and return the list to the nurse. We (the nurses) use this as a reference before giving certain medications and for charting. Well, the problem is that the CNA's are not doing the vitals until late into the shift which means nurses have to stop and do the vitals required for specific medications during their very heavy med pass. I am a very nice person and and I absolutely HATE calling someone out and can't stand the thought of writing someone up, but management says that the nurses are "the keepers of the CNA's" and they do not reinforce to the CNA's that they need to return the completed vitals list to the nurse before they begin their med pass. Many of the CNA seem to be taking an attitude about doing the vitals and are deliberately not doing them. Also, I've found some given to me at the end of my shift to be running fevers or having BP's way too high and the CNA did not notify me. (a nurse last week told me her CNA found a resident with A.Fib to have a pulse of 145 and did not notify her!!!)

I overheard a CNA complaining about a nurse not toileting a resident when she was passing meds. Do CNA's not understand the time restraints nurses have?

Is this a problem at other facilities, too?? I have 25 residents that I am *supposed* to medicate within a 2 hour time frame. How could that even remotely be possible if I have to answer call lights and do all those vitals in the midst of a heavy med pass?? I am absolutely willing to answer lights after my med pass is finished, but I cannot spare the time while I'm passing meds. The majority of my 25 residents are difficult to medicate either because they don't want the meds or they have difficulty swallowing or they have a VERY large amount of various medications.

Also, as a nurse, I cannot leave just because my shift is over and if I'm not finished with everything 30 minutes after the end of my shift, management has a melt down about over time, but they also have a melt down if the nurse does not complete their charting.

Last week, I needed vitals for charting and the CNA did not do them. When she announced that her shift was over, I reminded her that I still needed the vitals completed (that she knew about when her shift started 8 hours earlier). She said nothing and left. So, I was chewed out for getting OT because I had to go get those vitals to finish my charting.

I feel like we are all adults and everyone knows their responsibilities. Why can't we all just fulfill the roles we were hired for??

Is this a struggle at other facilities, too?? And if so, how do you handle it??

[Adele_Michal7, ASN, RN]

Oh yes, it is a struggle. You are not alone. It is very frustrating.

Sadly I have found that I can not be the nice and sweet nurse... I have to check in with them constantly.

I think receiving the vital signs within 30 minutes or so of shift start is fair.

If that time period passes and there is no vital signs given to you, go hunt down that CNA. "I'm ready for the list of VS."

I've learned I can't wait for them to come to me. I have to follow up.

[mevsmom]

I work in sub-acute rehab in a LTC facility and I struggle with this as well. Hoping to follow for some good responses.

[capria02]

I had this problem as well at another facility.. However I always got my own vitals on the 22 pts I had.. Needless to say I was 30 mins behind on medpass.. Also it seems the facility needs to do some education with cnas on when to report and what to report.. Currently at my new facility cnas obtain vitals but the nurse can not use them if administering bp meds with parameters... I just always obtain my own BP/pulse of its required for a med..

[Postpartum RN]

Just wanted to say I went through the same thing when I worked in a SNF, you are not alone. It's extremely frustrating, an also frustrating that management does not care! Feels like there is always this "battle" between CNA's and RNs. Thankfully the CNA's I work with now at my acute care job are amazing and sweet, makes the job much more pleasant

[Blackcat99]

When I worked the 2-10pm shift I told the CNA's that vital signs were to be completed and turned into to the nurse by 4pm. Give the CNA's a time when vitals are to be finished and turned in. Most would comply. Of course, there were a few who didn't. I then had them sign a paper called a "Teachable moment" where it was clearly stated that vitals signs were due at 4pm. I had them sign their names to this paper. That usually helped because I had "written proof" that they were aware of the fact that vital signs were due at 4pm. I would hold unto the papers they had signed and kept them in case they still did not comply. My plan was to staple their signed signature to the write-up report if needed. Sadly, with some CNA's the only thing that works is giving them a write-up. I am not going to beg, plead and kiss their butts in order to get them to do their jobs. Write them up.

[Adele_Michal7, ASN, RN]

When I worked the 2-10pm shift I told the CNA's that vital signs were to be completed and turned into to the nurse by 4pm. Give the CNA's a time when vitals are to be finished and turned in. Most would comply. Of course, there were a few who didn't. I then had them sign a paper called a "Teachable moment" where it was clearly stated that vitals signs were due at 4pm. I had them sign their names to this paper. That usually helped because I had "written proof" that they were aware of the fact that vital signs were due at 4pm. I would hold unto the papers they had signed and kept them in case they still did not comply. My plan was to staple their signed signature to the write-up report if needed. Sadly, with some CNA's the only thing that works is giving them a write-up. I am not going to beg, plead and kiss their butts in order to get them to do their jobs. Write them up.

It's sad but the more time that passes, I notice this: most people (this is a generalization including all members of the healthcare team) won't do certain aspect of their job unless held accountable. If they think they can let something slide... They usually will.

[LPNtoRNin2016OH, LPN]

I take my own vitals, no matter what. Especially if it is to see if I need to give a medication or not. I can't trust other people (Even other uses for that matter) to take my vitals correctly because I have seen way too many times people taking BP's incorrectly that are unit supervisors.

edited to say: to save on time during med pass I would only get the vitals for those who needed meds based on it, were critical, had orders to be check at certain times, etc. If none of those scenarios applied I would like the vitals for the rest of my residents after my med pass during the time I usually do treatments. I am currently interviewing for a job where the nurses are not "over" the STNA's. I am SOOO excited about that. They have their own boss, if they do not do something, we merely report it and she does the rest. They are our co workers not our inferiors, it makes things so much more livable.

[Blackcat99]

I knew a nurse who did not feel comfortable at first confronting the CNA's about doing the vital signs so she started doing them all herself. Of course, she had 40 residents and certainly didn't have time to check all the vital signs. Management got upset with the nurse because the nurse was doing so much "overtime" since she was trying to do all of the vital signs for 40 residents. The nurse finally got fed up, started confronting the CNA's and started doing write-ups and the problem was solved.

[ktwlpn, LPN]

I would not feel comfortable giving meds based on parameters of vital signs I did not obtain,that includes fingersticks.....I do expect can's to do their jobs and I'll follow our facility protocol to see it happen...That said if this is LTC you need to get the physicians to review these parameters and make some changes....

[Nurse Molly]

I have this same problem with CNA's at my job. They wait until the end of the shift to get vitals. They will input the information into the computer, but they don't think it's important to tell me! I guess they think it automatically appears someone in MatrixCare. I have to dig up the information. Drives me insane at times.

It's just important to tell them you need the vitals at a certain time. Most CNA's know it's important that you see the vitals, but I see many CNA's that just don't seem to care. The attitude I'm seeing from some of my CNA's is that of indifference and just not really caring why they are there except to get a paycheck. I know I see that from nurses too, but I need the CNA's to just do their job and I will do mine. I refuse to answer a call light when I'm putting in doctors orders, doing a med pass, etc., especially when the CNA's are laughing and cutting up sitting at the nurses station doing nothing. Night time CNA's have more time on their hands and they don't stay busy. I, on the other hand, am always busy. I have 44 residents to take care of. So they know I'm not going to do their job. Best advice is to lay it on the line and make sure they are doing their vitals and other duties. Tell them you need those vitals and how important it is for the resident/patient's well being. Maybe they will understand, maybe not.

Sorry if I'm being a bit whiney, bad night at work.

[sallyrnrrt, ADN, RN]

You are not alone, as DON, I would define the priority of their work, emphasis given what needed to be done first and coordinated with the nurse.

then I as them? Could they do their job.....should they say they could not, I would say, alright you need to go home, I always maintained a supply of prn, desiring full time positions...

it it only took one or two, going home before we would be the team we needed to be for best resident care.....

i I also did my best, to let them know how much they were appreciated and needed...