when i give my vital sign list to my cnas, sometimes they come back way to fast with them, for the amount that they had to do, and they hand over results like, 171/53, 95.0, 27, 110, (thats just a combination of some of the results i've been givin) and even if they made em up, why would you make up abnormal vs? and i have found that alot of cnas really dont kno how to do vs, where i live, the course is generally 2 weeks, and only a small portion of that is spent on learning how to do them, then they are sent to hosp and nh, and can barely take a bp, unless they have an electronic bp cuff! uhh hello? but aside from pt care, is obtaining vs not a major part of being a cna? especially in a nursing home, my cnas usually have about 10-15 to get on average, and most dont seem to recognize when they are abnormal, why is this area not hit harder during their course? but more time is spent on learning abbrev they really wont use, and how to give a shower (not that thats not important), but i mean come on
My CNA's are busy. I always take all my own vitals because I have to do the assessments anyway. What better way to assess a resident then to get their vitals first anyway? Plus, I only do apical pulses...I like to hear the heart beat, esp. in those with histories of cardiac problems. If you don't trust your CNA's to do them correctly, why don't you just do them yourself?
Blessings, Michelle
well michelle i dont know where you work, but that is alot easier said than done, wouldnt we all like to go do real assessments on our patients, and get our own vital signs, and much more, but when the nurse to pt ratio is 1:45, that becomes a little unrealistic sweetie, when your working 8 hours, have meds, treatments, orders, family, and more than 15 charts to chart on, (including skilled charting), you should be able to at least know that someone who was supposed to be trained in this area could be trusted to get a set of v/s, but best believe, if i do suspect that the v/s were falsified, then i do either ask a cna who i trust, or, i do them myself, i kno my username is "supernurse", but if you work in ltc, and u have a similar workload to what i described, then i retire my name, and give it to you, thanks for your god bless:rolleyes:
I would say the same goes for CNAs.
#1 If it's not a routine VS (monthly/weekly) why even have an aide do it? When a nurse needs a VS an aide can't always get it immediately. If you need it for a med you should take it. Especially since you take the hit and not the aide if it is wrong.
#2 Aide's do know how to take VS's but if you take them few and far in between you get very rusty.
#3 Avoid using the 'trusted' cna. Nurses tend to 'overuse' that same aide. Overuse = abuse. Spread it around. If your aides aren't doing their job then make them.
#4 If you are a nurse with 45 LTC patients then you really need to re-evaluate your job. With ratios like that care is far from 100%. Even with the best nurses. I bet if the nurse ratio is that bad your aides are getting shafted...
When I was a student, I noticed CNAs & RNs charting according to the previous domentation. It was so obvious because vitals were so off from my assessments. For example, a night shift nurse noted duraderm on sacrum. I did my assessment and found no duraderm. The nurse on shift got to the chart before I did and documented duraderm. As a student I documented my findings, and the nurse then asked about it. She shook her head as if it was the night nurse's fault. She was an excellent nurse however.
#4 If you are a nurse with 45 LTC patients then you really need to re-evaluate your job.
IMHO, I do believe that this is a fairly common ratio for an LTC, esp on NOC shift. I had a 1:50 ratio when I worked LTC and I had the smaller of the two units. From the other nurses I know that work LTC, it sounds like the avg ratio for NOC shift is 1:40 - 1:60. Day and PM shift it seems to be split so you have 1:20 - 1:30. At NOC shift I worked with 3 CNA's. Two were on the dementia unit at all times - so about 2 CNA's to 22 pts. The other wing had 1 CNA for 28 pts.
I'm not so sure that the OP needs to re-evaluate her job, but I do think an evaluation of LTC staffing is required that goes much deeper then this post.
#1 If it's not a routine VS (monthly/weekly) why even have an aide do it? When a nurse needs a VS an aide can't always get it immediately. If you need it for a med you should take it. Especially since you take the hit and not the aide if it is wrong.
#2 Aide's do know how to take VS's but if you take them few and far in between you get very rusty.
#3 Avoid using the 'trusted' cna. Nurses tend to 'overuse' that same aide. Overuse = abuse. Spread it around. If your aides aren't doing their job then make them.
#4 If you are a nurse with 45 LTC patients then you really need to re-evaluate your job. With ratios like that care is far from 100%. Even with the best nurses. I bet if the nurse ratio is that bad your aides are getting shafted...
Just some things to consider...
#1 i am speaking about routine v/s, these are vs that are done qshift on a DAILY basis, so this is not something they will get "rusty" at, in an emergency situation, or prior to giving a medication that requires v/s, of course i would do them myself
#2 i have done alot of agency nursing, primarily in ltc, and 95% of the facilities i worked at required v/s qshift, whether it was 5 sets of v/s to get or 10, this is something that is not uncommon, i dont put catheters in every day, or do trach care every day, but if the time came that it needed to be done, and i knew i had gotten "rusty" at it, then i would rather ask for a little help, than simply act like i did it, or do it and do it wrong
#3 no matter where i work, i can usually separate the strong from the weak cnas, as a supervisor, you have to have this ability, because upper management is not out there working side by side with the staff, and i dont demand anyone to do anything, i ask, and if they are busy, then i'll take care of the problem, i have absolutely no problem with handling a cna who i felt was making up v/s...........i was just posting a topic for discussion,
#4 maybe we all need to re-eval our job, but OLTC, doesnt think we need to, apparently, when i was hired at this particular facility, it stated that in addition to my other duties, i was to make assignments for cnas, which includes v/s, showers, etc, i am trying hard to full-fill my part, and i understand things dont always go as planned, but, that is absolutely no excuse to make vital signs up! if we needed to make adjustments to the assignments, then, that can be arranged, so that we can do our best to deliver HONEST care,
:yeah:but thanks for giving me these things to consider:idea:
I always do my own vitals. Just the other day, I looked at a flowsheet in one of my pt's charts and the unit manager had recorded numbers that did not even come close to mine. Not only that, I never saw her go into any of those pts rooms with a stethoscope, let alone a thermometer and BP cuff.
IMHO, I do believe that this is a fairly common ratio for an LTC, esp on NOC shift. I had a 1:50 ratio when I worked LTC and I had the smaller of the two units. From the other nurses I know that work LTC, it sounds like the avg ratio for NOC shift is 1:40 - 1:60. Day and PM shift it seems to be split so you have 1:20 - 1:30. At NOC shift I worked with 3 CNA's. Two were on the dementia unit at all times - so about 2 CNA's to 22 pts. The other wing had 1 CNA for 28 pts.
I'm not so sure that the OP needs to re-evaluate her job, but I do think an evaluation of LTC staffing is required that goes much deeper then this post.
:yeah:and actually, i work 3-11, and i have wondered about that ratio, of the 45, approx 10 are skilled, 4 pegs, and lots of total care residents, the census usually stays at or around 75-80, they have 2 floor nurses on days and evenings, and one on nights, but they actually have a medicare nurse who does that charting m-f on days, but this is the way they have always ran this facility, and if the way they staff was an issue in question, then why doesnt state ever tag them on this? thats why im not sure exactly what the ratio is, i used to think it was 1:40, but i guess its more, i honestly dont know, i tried to look it up but there are so many factors to consider, (skilled, interm. skilled, independent, total) i thought it was just cut and dry, with specific numbers, but i guess its not, but i dont think its fair or right, its next to impossible, but these days who can afford to be picky?
IMHO, I do believe that this is a fairly common ratio for an LTC, esp on NOC shift. I had a 1:50 ratio when I worked LTC and I had the smaller of the two units. From the other nurses I know that work LTC, it sounds like the avg ratio for NOC shift is 1:40 - 1:60. Day and PM shift it seems to be split so you have 1:20 - 1:30. At NOC shift I worked with 3 CNA's. Two were on the dementia unit at all times - so about 2 CNA's to 22 pts. The other wing had 1 CNA for 28 pts.
I'm not so sure that the OP needs to re-evaluate her job, but I do think an evaluation of LTC staffing is required that goes much deeper then this post.
when the CNA gives you the VS, how do you chart it? Do you chart that they were taken by the CNA? If the CNA does them, why arn't they the ones that have to chart them?
I would not chart things I did not do without having a place to state who got the values.
maybe its time that someone caught them in the act. How bad is it going to look when you find a patient that has crashed....with normal VS just minutes before. VS are taken for a reason.
:)i agree 100%, ive worked at other facilities where the cnas were responsible for charting v/s, and outputs in the chart with their signature, but i think that varies from facility to facility, because i mentioned the same thing to one of my co-workers, it is within their scope to document vs, i question things like that alot, and i was informed by my DON, that that is their policy, the cnas get the vs, and we chart them, and thats how its always been done, i guess in other words (dont come in here trying to change nothin)
I'm sorry, I did mean evaluate her job at that facility. Not her skill at doing the job. :)
LTC has been long overdue for an overhaul and don't get me started on state.
I've seen facilities get a perfect survey and I know there is nooo way they did without paying someone. Oh well... That is why I moved to only private pay facilities.
Specializes in LTC, assisted living, med-surg, psych.
I'm suspicious whenever a CNA's numbers are always even, or when they supposedly take BPs on 10 different people and all of them are in the same range. What gets me is that some apparently don't think I'll figure it out and question their readings.....in fact, I've worked with a few who did more to get OUT of a little work than they would have if they'd just gone ahead and done their jobs.
Just a couple of nights ago, I followed an aide who's notorious for being lazy; he'd written down several BPs, all in the 130/60 area, and so I snuck around and watched him "take vitals".......which consisted of going into the residents' rooms, chatting with them for awhile, watching some football, then writing down made-up numbers on his 'cheat sheet'.
That was his third---and final---write-up. I'm SO thankful for the vast majority of CNAs who bust their buns day after day, doing their jobs right and taking responsibility for the frail men and women in their care, but I absolutely hate it when I get one who treats the job no more seriously than as if he/she were flipping burgers.
Supernurse: I've worked long and hard to find as close to a good LTC as I can...and I do drive a bit to get there, but I work in a pretty close to perfect place.. I'm so sorry you apparently don't.
I thought you just said in a previous thread that you are able to run circles around seasoned nurses? If that is indeed the case, why aren't you able to get your own vitals? What are we talking about here, a half hour out of your time?
MarvinMartian
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