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

Specialties Geriatric

Published

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??

This has been a real struggle in every facility that I have ever worked in. At my last facility the nurses were expected to obtain a BP before administering a BP med of any kind to any patient. Collecting VS on so many residents during a med pass substantially increased the time I needed for my med pass. I routinely used a wrist BP cuff and verified abnormal results with a manual cuff that I kept on my cart. There were a few CNAs who would get a set of VS on their residents first thing during their shift without being asked and it was no secret that all of the nurses wanted to work with them. I did try to get some of the CNAs to change their ways but I just ran out of energy to do so when I realized how unreliable the results were due to poor technique. Some days the work seemed impossible but I did my best. I hope that the OP is a able to find a better solution!

Specializes in Psych, Addictions, SOL (Student of Life).

I work in LTC and have a heavy med pass sometimes upwards of 20 patients - We generally have 2 CNA's if our census is above 20. We might get a third if above 30 but no guarantee. With the exception of one or two individuals they do a very good job providing for the "Total" Bedside care each resident requires. They are not required to do Vital sign but will if I ask them too. That being said I would never have a CNA perform vitals for a patient with critical medication with vital sign parameters. It's my license on the line and these patients require assessment before being medicated not just vitals signs. Most of our CNA's have little more than a high school education which means they are not qualified to make judgement calls with regards to vitals. If they have 15 to 20 patients to bath, feed, dress, change bed linen for etc.... don't you consider what adding the responsibility of adding vital signs to their workload does? Most BP and cardiac meds require an apical pulse rate not just one from a BP machine - are your CNA trained to do this assessment? Of not because they aren't qualified to do any assessments. My facility has a vital signs machine that does the reading in 15 seconds but when taking vital signs for medication purposes I like the hand's on old fashioned equipment.

HPPY

Yes, the CNA's are suppose to be busy bathing, feeding, dressing, changing bed linen etc. However, I haven't seen many "busy CNA's" at the nursing homes I have worked at. The CNA's at the places I have worked at are busy all right. They are "busy" playing on their cell phones, laughing and cutting up amongst themselves at the nurses station, sitting at the nurses station doing NOTHING but spreading hateful gossip. They are constantly making remarks such as "I am not going to do this, I am not going to do that". When you tell them they have to float to another station they act like a bunch of 2 year olds and have loud temper tantrums. If you dare to ask them to do something, they become instantly defensive and angry with you. It's unbelievable!!!

Specializes in Psych, Addictions, SOL (Student of Life).
Yes, the CNA's are suppose to be busy bathing, feeding, dressing, changing bed linen etc. However, I haven't seen many "busy CNA's" at the nursing homes I have worked at. The CNA's at the places I have worked at are busy all right. They are "busy" playing on their cell phones, laughing and cutting up amongst themselves at the nurses station, sitting at the nurses station doing NOTHING but spreading hateful gossip. They are constantly making remarks such as "I am not going to do this, I am not going to do that". When you tell them they have to float to another station they act like a bunch of 2 year olds and have loud temper tantrums. If you dare to ask them to do something, they become instantly defensive and angry with you. It's unbelievable!!!

I guess I'm lucky because the CNAs I work with are for the most part really good at what they do and we make a good team. When I first went to work there I was looked at like a space alien because I suggested to the CNA's on my run that they should call me in if they saw any skin issue or needed help moving a patient etc......The notion of teamwork is lost on a lot of nurses but I grew up in the industry as a candy striper, then a CNA, EMT , RN etc...... so I appreciate my CNAs and have their back - in return they have mine. Yes there are bad actors everywhere but I believe most try to do the best they can.

Specializes in LTC.

Can you in-service them? It can be an amazing tool when applied correctly. If I saw a widespread problem I would in-service all CNA's, 1 topic per in-service sheet clearly outlining expectations as well as consequences for not complying. I always ended my in-service teaching with "Failure to comply will result in disciplinary action up to and including termination." (Of course you will need management to back you on that part.) That tends to get their attention.

Keep in mind in-services are only as good as your follow through. There will ALWAYS be someone who will not take it seriously, and you MUST write them up for it. Why? Because the other CNA's are watching you to see if you will enforce it. If you don't, they will simply go back to their former ways and they won't take you seriously. Once you have written a couple people up, the others will fall in line and be more compliant.

3 reasons vitals can be delayed until, say, after dinner (but no later).

1. A resident is in recreation and then goes straight to dinner--I will happily walk there if I am asked to, otherwise I'll wait.

2. There is not enough equipment for all the aides to use, so we have to take turns.

3. A resident refuses and I decide to re-approach later. Again, I will happily let the nurse know this if s/he asks me.

Most nurses ask for vitals by 10:30 on 3-11. If a nurse needs them earlier, I won't know unless they tell me. Make sure you're communicating with your aides.

CNA's can be a tough bunch, believe me, I know. But I find tension between nurse's and aides exists in my facility because the CNA's don't understand the extent of the nurse's roles and responsibilities, and they feel like the nurse doesn't appreciate theirs. It's not an excuse for a crappy attitude, but it is an explanation.

I hope input from "the other side" was not terribly unwelcome and maybe even slightly helpful.

Specializes in Rehab, LTC, Peds, Hospice.

I get my own vitals. Fastest way to do so for me is to put them on an automatic cuff then pour their meds. I keep a manual on my cart for rechecks and only do the most necessary during med pass the rest I do when doing treatments. If I'm running behind, I ask my CNAs to help out - and sometimes even PT or OT will grab them for me. I find it's easier honestly to keep on top of changes in my patients if I do it myself and I know they are accurate.

Specializes in LTC and Pediatrics.

I work 2-10. My first med pass is at 1600. I have a couple I do at 1500. After report and counting narcs, I get the Vitals I need for my med passes. I don't know how day shift does theirs. I also do my skilled nursing vitals and assessments at this time. Then I am ready to go for my 1600 med pass.

Hello all. I do have some input as a RN in a LTC. While getting all you vs in the first 30 minutes of the shift sounds good, for some shifts (especially 1st) this is nearly impossible. When the aides come in on 1st, they have to get 3 people cleaned up and ready for breakfast, and take them to the dining room to eat before the trays come on the hall. Then 1 aide goes to the dining room while the other aide passes trays and helps feed residents. My advice to the OP is to take you bp cuff and stethoscope and leave it on your cart. Just get the BPs and HRs before administering certain meds. The aides can get the rest after breakfast. If you aide says they are too busy, help them with time management, after all that's a huge component of your day. Hope this helps, good luck!!

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...

Can you come and work at my facility :)

Hi! What would you do to make them feel appreciated ? I am a new nurse and just started working in LTC, before becoming a nurse I was a CNA, so it is my goal to make my aides feel appreciated .. I have considered stopping to by them a small treat bag with little goodies and stuff ... Do you think this is a good idea ? What did you do ? I remember how hard it was as a CNA and I want my aides and I to have a good rapport. I think I'm doing a good job so far - I'm nice but I (very firmly) let it be known that certain things must be done. If I need to correct - I do so privately as to not embarrass or belittle the CNA- I believe I gain more respect from them that way - also, they are people, just like us and we're not "better" than them .. I try to keep that in mind. Thanks in advance for any advice !

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