Just wondering if other hospitals are doing this....

[AMD88]

Starting next month in my hospitals we are changing the roles of the RN and UAP. The RN will have 5-6 patients (not uncommon) and will be responsible for all their normal nursing duties of assessing, medicating, and implementing orders but will now be responsible for taking all of their patients vital signs Q4 hours and blood sugars as ordered. The UAP's used to be responsible for the vitals and blood sugars. The UAPs only duties are to provide ADLs, turn patients, and stock the unit. Many of the nurses including myself feel we are already stretched very thin with our normal nursing responsibilities and that taking our own vitals and blood sugars will only stretch us thinner. My question is, are other hospitals adopting this role change and has this worked well or not?

[KelRN215, BSN, RN]

UAPs were not allowed to do blood sugars when I worked in the hospital. Nurses had to do them all. Technically they were supposed to do vital signs but it was usually faster/more efficient for the nurse to do them herself. I don't really see how doing vital signs on your patients is going to bog you down that much... you have to assess these patients, you're presumably already listening to their heart and lungs- does counting while you're listening really add to your burden? Taking a BP and a temp together take, what, 45 seconds?

[AMD88]

I appreciate u posting. I think it does make a difference because I use to be a uap and I know taking vitals take more then 1 minute. The patient conveniently decides they need to go to the bathroom, wants this/that, patient/family wants to discuss plan of care etc. I can understand having the nurses do the first set during their assessment, but we do them every 4 hours on 5-6 patients. The blood sugars are also every 4 hours. The nurses were I work get about 5-10 minute lunch breaks around 2-3 pm while the uaps get to go when ever they want. The nurses also do not get out of work till after 8 even though their shifts end at 7:15. But the uaps are clocking out at 7:15. I think it's silly to add more to our plates. During the bachelors program all hospitals insist we all have, there is a huge emphasis on delegation. Now that skill seems to be taken away in my hospital.

[Swellz]

I end up doing a lot of vital signs anyway, just because they are so busy. There's a hospital in my area that eliminated CNAs completely, or at least said they were going to. I couldn't find an update since they announced it last year, but I couldn't imagine functioning without ancillary.

[brithoover]

We don't have UAPs at all so we do vitals, BS, full care, bathing ect

[TiffyRN, BSN, PhD]

I'm sorry your hospital it not choosing to decrease your load with an increase in assigned tasks. In my experience, let me emphasize; in my personal experience. . . support from non-licensed staff has generally been unreliable due to many reasons; they get pulled to other units, pulled to clean equipment for hours, pulled to be sitters, have poor work ethic and manage to "disappear" until time to clock out, get cancelled if the numbers fall at all, on and on and on. So years ago, I learned to just do my own stuff and not adjust my time management to exclude this unreliable help.

A few years ago, all the UAPs were taken away from direct patient care and guess what? Only made my job easier as the management did adjust our assignments slightly to compensate. In addition this is not a huge issue for the environment in which I currently work (NICU) where the vast majority of the cares are generally done by RNs.

Please understand (before I get flamed) that the unreliability of which I speak is multi-factoral; many of the causes are not in the control of the direct-care nurse and UAP.

[TiffyRN, BSN, PhD]

I forgot to add that the reason our hospital eliminated so many of the non-licensed positions was back when the down economy first hit our area and the rationale was that they needed to cut positions and they didn't want to cut RN positions. Kind of a rough proposition but overall I guess if they were going to cut positions regardless, it's better for patient care to cut the non-licensed versus licensed positions.

[KelRN215, BSN, RN]

I appreciate u posting. I think it does make a difference because I use to be a uap and I know taking vitals take more then 1 minute. The patient conveniently decides they need to go to the bathroom, wants this/that, patient/family wants to discuss plan of care etc. I can understand having the nurses do the first set during their assessment, but we do them every 4 hours on 5-6 patients. The blood sugars are also every 4 hours. The nurses were I work get about 5-10 minute lunch breaks around 2-3 pm while the uaps get to go when ever they want. The nurses also do not get out of work till after 8 even though their shifts end at 7:15. But the uaps are clocking out at 7:15. I think it's silly to add more to our plates. During the bachelors program all hospitals insist we all have, there is a huge emphasis on delegation. Now that skill seems to be taken away in my hospital.

Well, yes if all you're doing is VS it takes longer than a minute because you have to go into the room, set up, etc. but if you're already in the room assessing the patient, the amount of additional time it takes to get VS is negligible. You're not in your patients' rooms at least q 4hr anyway? I worked Neuro when I worked inpatient so everyone was on neuro checks as frequently as they were on vitals anyway and it was easier and less disruptive to the patient for me to just do their VS while I was already bugging them. It worked out well, putting the BP cuff on their arm would usually wake them up and then I could quickly do their VS and neuro assessment. I don't see why the patient would want to go to the bathroom or discuss the plan of care any more than they already do when you're in the room just because you're also taking their BP.

[tokebi]

Doing my own vitals would not affect me much at all because we have VS monitors in every room. But I can see how time-consuming it will be if nurses have to share a limited number of Dynamaps. Much more efficient for UAP's to make one single round of VS with their machine.

[TU RN, DNP, CRNA]

Checking vitals and doing blood sugars, logically, should be nursing responsibilities because it is solely within our scope to act upon them should they be abnormal. Same goes for the EKGs and phlebotomy, kind of. I'd be fine if the only care our UAP provided was turning, helping with ADLs, bathing, and running to different departments if needed. Maybe if there weren't as many complete assists in our census, which is rare for us, I'd understand expanded workloads for them. However, I find it difficult to get some of them to fulfill their job descriptions regularly.

I work on a monitored unit, so unless the patient removes their BP cuff or chest leads themselves, all our signs are uploaded automatically from the monitor to the EMR q2hr. Our UAP make sure the equipment is applied and the signs are uploaded, they take the temps and monitor blood sugars, perform EKGs and phlebotomy for labs, answer call bells, turn patients, help perform ADLs, bath patients and sometimes act as runners down to the pharmacy/lab/blood bank. In writing it looks like the spirit of Florence is blessing us with these angels that are our UAP to do so much for us, but in reality I'd say about half of it gets done (the easy half at that).

Personally I think on a floor such as the one I work, calling UAP double clicking something in our charting "taking vital signs" is too much. I love our UAP as people, but such a luxury would make anybody a little lazy, and that's what it does. Now even our turns aren't getting done, moves aren't being made to have patients bathed, and requests to go to the lab or draw some blood are met with attitude. They take hour long breaks (while I work through the night only to eat my untouched food in the car ride home) and are constantly gabbing on the floor when there's stuff that needs to be done.

These are grown, sentient beings - not robots - when does the "needs to be delegated" curve meet the "this is your job description so do it" curve? My response? Like somebody above said, just do the care yourself. Cuz in the end that's the only person you can truly trust and rely on. I used to be UAP at my hospital and found the workload challenging at times. I'd see the other UAP effortlessly going about their business and wondered "when will I be that good?" Well now I know it's not like that at all.

[classicdame, MSN, EdD]

I prefer getting my own VS/BS as I have to wait on the UAP's and prefer not to wait. I do believe the UAP's should have more duties than you describe. Evidently they are being phased out. We find that the floors whose aides are doing VS, BS and the rest are not getting proper ADL's done. So maybe there is a need. I would recommend a way of auditing to be sure the intent of this new rule is being fulfilled.

[SwansonRN]

I think that's really sad. I do all my own vital signs, blood sugars, and blood draws, but I only have two patients and they're on cardiac monitors that feed into the computer. I ask the aides for help with turns, baths, and the occasional EKG, but I know that other places don't have the same capability and they rely heavily on delegation. I have no idea how med surg nurses do what they do. I don't see why UAPs shouldn't be getting vitals and blood sugars. That leaves more Time for meds, charting, assessments, procedures, talking with docs/consults/family...I just don't understand why it's necessary to add more to the nurses plate!