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
If the techs at my job aren't given specific list of tasks to do, they won't do them because they'd rather sit around and talk. I've lost track of how many times I've seen them playing with their phones while looking at a call light, and more often than not I have to prod them to get them to do something they're already supposed to do anyway. It's unfortunate but true. So if they're not doing vital signs, they're not doing anything - I don't understand why I'd give myself another thing to do while taking more off their plates. They already take 1.5 hour lunches (for an 8 hour shift) and I have to skip lunch most days just to get charting done.
I don't have anything to add to the above...all good ideas and time management strategies. I would however, like to point out that it is illegal to do patient care or any other "work" while off the clock. So don't start before punching in. Management loves to look at this if they need ammo for anything else!
Coming in an hour before your shift to take vitals on your patients and not get paid is not only ridiculous, it's a liability issue. You're technically not supposed to be there until 630. Find a way to make it work during your shift.
I do make it a habit to come in early at times to review my patient charts in preparation for report, but that's MY time. I don't do any patient care, assessments or even answer the unit phones. It's like I'm not there and I refuse to acknowledge anyone work-wise before 700. That's just me.
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.
I don't see what the big deal is either. During an assessment, we listen to patients' heart and lung sounds. We can certainly count heart rate and respirations during that time and grabbing a temp and BP in addition to it adds on an extra 45 seconds.
I way preferred doing my own vitals when I worked in the hospital to delegating them. Mainly because I didn't trust our aides. Plus if I was working nights, I was waking the patients up q 4hr anyway for neuro assessments and why would I want the aide to disturb them again when I can take the extra min and a half to grab their vitals while I'm in there. We seriously had aides who wouldn't start doing midnight VS until 2am and, on occasion, found aides asleep in the treatment room or, once, a closet.
I had colleagues who would ask the aides to do their q 1 hr VS while the patient was receiving blood or the q 15 min BPs while the patient was receiving high dose IV methylpred but I was just never comfortable doing that. If the patient has a transfusion reaction that goes unnoticed because the aide didn't do the 15 min or 1 hr VS, who's going to ultimately be held responsible? I did them myself because I knew they'd get done and get done correctly that way.
I don't trust my NA's to do my first round of vitals.. I prefer to do vitals myself to ensure accuracy and to detect subtle changes. But I do hate a change in policy that doesn't shift responsibilities around. We have so much to do at the beginning of the shift... we need our ancillary staff to do something!!
I work med/surg night shift and we do our own vitals and other tasks. We don't have any PCTs during that shift currently OR a unit secretary. I almost consider having a tech a luxury so I am used to doing my own vitals and such whether we have on or not.
Our hospital just instituted this policy as well. I get vitals before I give morning meds. I do my assessment at this time as well. I actually don't mind it- I have a baseline and I don't have to chase CNAs down to get my vitals. I can't tell you how many times I went to look at vitals and nearly had an MI over a 200/100 BP that was never reported, etc. I do another set between 2-4pm. Depending on the flow sometimes I will delegate q4h vitals, or ask aides in a pinch to grab a set if they're not busy. A lot of people were resistant to the change, and honestly I think some of them only take 1 set during 12 hours- which, frankly, is scary considering I work on a tele unit with some heavy cardiac meds.
First this is a nursing role anyway, I worked with a HCA who used to do Rader vitals, everyone BP was exactly the same as the previous set.
Ask for extra vitals machines or at least manual BP thermometer and sat probe. There should be at least one per nurse. Vitals machines are truly not that expensive, I bought 2 when I was NM over 2 months, never blew the budget.
Also don't do vitals before your shift, they truly don't take more than a few ticks either manual or automatic,
I tend to use time with a auto to listen to lungs, belly if applicable, pain assessment. Manual is actually often quicker than auto.
Kinda glad I did preceptorship without techs at all (except sitters). Yes, things get behind, but I learned how to prioritize and get things done without others taking over a significant part of my job.
Also, I definitely agree with someone who said not to come early because of liability. Don't open yourself up to that if you can at all avoid it.
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. )
seconddegreebsn
311 Posts
If the techs at my job aren't given specific list of tasks to do, they won't do them because they'd rather sit around and talk. I've lost track of how many times I've seen them playing with their phones while looking at a call light, and more often than not I have to prod them to get them to do something they're already supposed to do anyway. It's unfortunate but true. So if they're not doing vital signs, they're not doing anything - I don't understand why I'd give myself another thing to do while taking more off their plates. They already take 1.5 hour lunches (for an 8 hour shift) and I have to skip lunch most days just to get charting done.