My whole floor is changing in one day, apparently according to our last meeting. It seemed to go down like a lead balloon. Everyone, including those who didn't voice their opinions went out with solemn/scared faces.
Our techs are NOT going to be doing their first 0700/1900 rounds, or shift report. They will get report from the nurses. Instead, they will be responsible for ADL's like going to the bathroom, walking, and ambulation. The nurses will be responsible for vitals and blood sugars from EVERY patient. (1900 and 0400 for MY shift, unless the physician specifies q4 vitals. which most do anyways We HAVE to follow the orders if they do that... (I think I will call them in the middle of the night to change that if I must for a patient with stable vitals. )
This all seems great, except that, as a MS nurse... usually during/after report, I get several requests for pain meds, where I give all scheduled meds at the same time. Sometimes during that, I get calls from PCT's who are tasked with taking vitals... and they get critical ones, so I must shift my focus from pain to the basic ABC's.
I will not have these quick vitals now, and I'm kind of worried. Maybe, before med-pass I should do a quick sweep through of vitals. The patients who need the MOST help are the ones who WON'T push the button and I'm so scared that I won't notice because I have 5 other patients who need emergent ADL's or pain meds to deal with. The blood pressure or quickly dropping O2 sat could EASILY go overlooked if they have not called and have to wait until 2200 to be assessed.
6 is our max, but I've had 2-3 crash on me at once, and I don't want that to happen again. I know we're med-surg and NOT acute care, but more often than not, Critical Care patients end up on Med-Surg floors.
We're not LOSING our techs, but... gosh darn it, we NEEDED them, and worked closely with them before this change.
I know that we cannot change others (management) but we can change our own practice. I usually work 3 days in a row, SMT. I plan on showing up at 1730 on Sunday (even though I don't get paid until I clock in at 1838) and checking vitals. If ANYONE shows any question of crashing, then I will view and assess and medicate them first.
What kills me is that MOST of my patient's in MS will have to, during report, ask to SLOWLY ambulate to the bathroom each time you see them. That takes OVER 20 minutes. And, usually, I've got 1-2-3 (6 total) patient's waiting while they're crawling to the bathroom needing pain meds for 9/10 pain every time. I slowly take them to relieve themselves. In the meantime, my 2100 (9:00) meds are LATE for all other patients. So... my scheduled heart/blood pressure meds for my other 5/6 patients get pushed back, my rounding just DOESN'T happen. My 2100 meds tend to happen at 2200 sometimes already even though I try to mitigate it the best that I can. Gah... I'm so stressed about this change, and I can't even imagine how my manager thought that it was a GOOD thing
Specializes in Management, Med/Surg, Clinical Trainer.
Our techs are NOT going to be doing their first 0700/1900 rounds, or shift report. They will get report from the nurses. Instead, they will be responsible for ADL's like going to the bathroom, walking, and ambulation. The nurses will be responsible for vitals and blood sugars from EVERY patient. .....
This all seems great, except that, as a MS nurse... usually during/after report, I get several requests for pain meds, where I give all scheduled meds at the same time. Sometimes during that, I get calls from PCT's who are tasked with taking vitals... and they get critical ones, so I must shift my focus from pain to the basic ABC's.
I worked nights on M/S and we also had a tech, who was supposed to take all of the vitals. But I would take my own first set of the night. This allowed me to do a quick visual assessment for stability, take the vitals, introduce myself and let them know that I would be back soon for med pass etc. You have the opportunity to set the stage for the night this way, make them feel confident that they are in good hands which will help calm down.
You mentioned the techs are no longer attending report, or doing the first round of vitals. What are they doing? If you can I would grab one and let them know that you would appreciate if they would do a quick lap on your folks for comfort care ie. potty break, water pitcher fills etc. Then while you are doing the first pass let them know a tech will be in shortly then you will be back later for a full assessment and med pass.
What kills me is that MOST of my patient's in MS will have to, during report, ask to SLOWLY ambulate to the bathroom each time you see them. That takes OVER 20 minutes. And, usually, I've got 1-2-3 (6 total) patient's waiting while they're crawling to the bathroom needing pain meds for 9/10 pain every time. I slowly take them to relieve themselves. In the meantime, my 2100 (9:00) meds are LATE for all other patients. So... my scheduled heart/blood pressure meds for my other 5/6 patients get pushed back, my rounding just DOESN'T happen. My 2100 meds tend to happen at 2200 sometimes already even though I try to mitigate it the best that I can. Gah... I'm so stressed about this change, and I can't even imagine how my manager thought that it was a GOOD thing
This will improve over time. You may find by doing that quick vitals and assessment pass first thing you can catch the patients who are closer to being on the edge with their pain relief. You can then adjust your med pass to get to the your pain people first and then the others next.
Our tech don't do the first vitals on our units and it works out just fine. I think its just feels scary because its new, but we don't any problems with this. You need to have some more faith in yourself that you can adjust.
I don't know why people think nurses doing vitals is such a big deal. Is this not part of our job? I do all my own. Always have.
Agree; however the OP had taken advantage of the added comfort of delegating a very integral part of the nurses assessment.
As a former tech who worked on a Tele floor, a lot of the nurses got the first set of vitals while they did their assessment; then I did the last two; some did theirs throughout the night because I was responsible for 28 patients, turn and help to the bathroom; it would take me and hour to get vitals; even on a good night when people were sleeping; for the last rounds, which included getting people ready for pre-OP, dialysis and accu checks; I would start at 4 am to get everyone squared away, and be done by 6:30.
Due to my background of being a tech; I did most of my own VS when I worked in acute rehab; my ratio was between 5-6 during the day/evening and up to 8 at night.
I have worked in LTC/Sub-Acute, Critical Care, and now ER-In the past and currently do all my VS.
OP, cluster your assessment with the vitals; vitals take up to 20-50 seconds to complete; which should be halfway through your initial assessment. Once you have your assessments, you can effectively plan who to keep your eye on, as well as plan what needs each of you patients want; use a brain sheet to help with keeping things in order-there are plenty here on AN that you can search for and tailor to fit your needs.
7-8 patients and only two vitals machines for the whole floor, meaning I have to jockey to get one (or wait up to 30 minutes if there's an RRT or code). Not to mention these things frequently have issues and need troubleshooting or repair. Yeah, I don't have time for that. We have nurse techs, not CNAs, and most of them have 10+ years of experience and know the patients very well and what their baseline is. They're great about alerting me to abnormal values and I always go back and confirm it for myself if they tell me something is off.
Specializes in Certified Med/Surg tele, and other stuff.
7-8 patients and only two vitals machines for the whole floor, meaning I have to jockey to get one (or wait up to 30 minutes if there's an RRT or code). Not to mention these things frequently have issues and need troubleshooting or repair. Yeah, I don't have time for that. We have nurse techs, not CNAs, and most of them have 10+ years of experience and know the patients very well and what their baseline is. They're great about alerting me to abnormal values and I always go back and confirm it for myself if they tell me something is off.
And that isn't adequate if you have to do your own vitals. There should be as many machines as nurses, imo.
^^ What should be, and what usually is, varies in almost every environment :)
I don't have a problem getting vitals, I just don't like waking up the patient. And the charting, mang. Nurses usually chart their ADL's every other hour, and the techs in between. Primary care? Charting every hour, vitals, cleaning patients, toileting, feeding, meds, I think we get the point. It's a lot.
Now, if it were only vitals + nursing care, then yeah, that's a great deal easier.
We also have very limited Dynamaps, but we're good about sharing. I work with an excellent crew of nurses.
Honestly, it wasn't as bad for me as I thought it would be. I was actually done with my med pass early. It didn't go so well for other nurses. We were told that we could still delegate vitals to our techs if we needed to, and some of them did. I was VERY aware that I had a mild group of patient's compared to the rest of the nurses and did my best to NOT monopolize my techs time and help out with my patient's ADL's. I do think that this strategy has potential to work if everyone does this and works as a team.
Another thing that I think helped was that the first thing that I reviewed when reviewing charts was vitals trends, so I was able to prioritize my patient's seen based on their potential for BP/temp to rise, etc, Also... who had timed antibiotics due. I've always done the latter, but shamefully, not the former even though I probably should have been. Even if we change back to how things were, I think I've learned something from this
In fact, during the last vitals round, I had a low-grade almost fever that I reassessed and was able to notify the MD and medicate as SOON as it went over 101 instead of letting it get out of hand. The tech probably wouldn't have alerted me with a temp of 100.
It really wasn't as bad as I thought, and in fact... I might actually like this method better.
I think you'll find that once the aides are freed up from doing vs and getting report at the same time as the nurses, shift change(and the first few hours) will go much more smoothly. In my experience, the tasks that take the time in Medsurg are answering call lights, taking pts to the bathroom, and cleaning up incontinence.
Another tip to make your first couple hours go more smoothly is to have a round during the hour before shift change. Make sure each pt is toileted, has snacks, something to drink, and pain relief. Explain to them the need for uninterrupted shift report.
We HAVE to follow the orders if they do that... (I think I will call them in the middle of the night to change that if I must for a patient with stable vitals. )
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THELIVINGWORST, ASN, RN
1,381 Posts
It's more annoying than impossible to do vitals yourself. Do it while you're getting bedside report.