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?

[Esme12, ASN, BSN, RN]

I worked in a facility where, not only were the automatic BP machines broken ( you had to bring in multiple machines b/c the thermometer was working on one, not the other, same with pulse oximeter, ect). There were no working manual BP cuffs. NONE!! I was concerned about getting accurate readings from the automatic BP b/ I it was never calibrated.

IS IT TO MUCH FOR A NURSE TO EXPECT TO HAVE ADEQUATE SUPPLIES TO DO OUR JOBS??

No...you should always have functioning equipment!

[bankssarn]

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

This is how it was when I worked tele. Six patients. No techs. When I started on a med-surg floor at another hospital and we had techs doings VS and BS, I felt spoiled!

[AMD88]

I agree that the support I receive from the majority of UAPs is unreliable for basically all of the same reasons you all posted. We do have some who are amazing. The main difference between the UAPs who are great and who spend their day in an empty patients room watching Netflix is mainly work ethic and education level. Our best UAPs are in nursing school or are trying to get into a PA program. You know what I feel would solve the issue of them not being reliable, is hiring people who have some kind of education and actually show some kind of desire to help people. Our hospital hires to many UAPs that have no desire to do anything else for the rest of their lives than be a UAP. It is basically a paycheck to them. I would not have any problem at all if they would phase the UAPs out, as long as they adjust out patient load to 4 patients. I really enjoy doing some of the basic duties for my patients. My patients typically know I’m busy and when I bathe them or go out of my way to do something for them, they feel special which makes them happy. Happy patients=happy nurse. But unfortunately this is not my hospitals plan. They plan to keep us at 5-6 patients, give us extra work, and then reduce the techs workload….maybe so they can enjoy more Netflix.

In my hospital, we only have the bp cuffs & pulse ox in the rooms on some units, but of course not in mine. So I will be bringing in my manual bp cuff because we only have about 2-3 dynamaps. Majority of the time they are malfunctioning and they take too long, so I figured the manual cuff would be quickest/most accurate. I plan on purchasing a pulse ox off amazon that measures 02 and pulse. We have 2-3 thermometers, but we have some disposables that I can use so that shouldn’t be a problem. As far as accu check machines, we only have 2 so that should be fun.

The reason the hospital is going to this is the same reason that many of you said. The turns are not being done/people are not getting bathed. I do not think taking away the vital signs and accu checks from the techs is going to make any difference on this issue. If they wanted to bathe and turn their patients, they would do it. The good UAPs do this already and have no problem. As for the other UAPs, I find them in empty patient’s rooms looking at pinterest, watching Netflix, on fb, etc. I think we should have roles that are nurse’s roles because legally only a nurse can do it. But the rest of the care should be team work. I have no problem grabbing half of patient patient’s vitals or getting the accu checks as long as I have time. Yesterday I walked in to work, got report, and then my POD #2 craniotomy is having chest pain, crushing headache, and can barely move the left side of his body. Now how was I suppose to call rapid response, get ekgs, stat labs, VS, call surgeon, and take all my VS and accu checks on my other 4 patients? Sometimes everything goes perfect and I can do it, sometimes things go wrong and I can’t. My concern is that when I can’t get the VS & accu checks and I ask the UAP to do it their response is going to be “that’s not my job”. I sure can’t go to admin and complain about it since they are making this rule.

[AMD88]

Quoting Assit. Admin...I have no idea how to do it in the white boxes...

"I went to a ASN/ADN program many, many moons ago so I am hopeful that this was covered on your BSN program...for it was covered in mine."

I also went do an ASN/ADN program and am now working on my last semester in a BSN bridge. And trust me, I got adequate education on how to take a manual BP.

"I know, I know....we are all entitled to breaks. I get it I really do. Maybe negotiate with management to delegate the B/P to licensed staff and have the UAP obtain the temp, pulse, respirations to ease the burden. If you approach it from the standpoint that you understand the importance of the glucose and B/P that you can negotiate the TPR to the UAP. This way your B/P can be included on your initial physical assessment and/or when you give your meds"

This is a great idea, I will run this by them.

"What type of floor do you work that you take vitals, and glucose, every four hours on every patient? UAP's are a vital part of the nursing team but should we be delegating assessment when we base our treatment/intervention on these numbers."

I work on neurosurgical/neuromedical. We only take BS on people who are diabetic, on feeding tubes, steriods...basically everyone. & we take vitals q4.

"I don't think so...if we as nurses insist that we can delegate important assessment skills to non licensed personnel? Are we then saying that we can be removed from the bedside to be replaced by UAP's because it isn't necessary for an educated professinal to perform such menial tasks...just food for thought."

Anyone could take a BP with a automatic cuff...that's why they are in every walgreens. If the VS are out of normal for that patient I take them myself. Or if the patient is critical I take them myself. Otherwise no, I think they should be able to take a BP.

[Irish RN]

I agree with the OP....if my hospital did this, the staff would be in an uproar. I'm surprised at those who feel nurses should do VS and BS checks and UAPs should ONLY be doing ADLs. At my hospital, the UAPs are responsible for VS, BS checks, ADLs, turns, incontinent care/toileting, I/O. They have a TON of duties and are always busy. The RNs are ALSO responsible for these duties in addition to all the crazy stuff we deal with, assessments, med passes, etc etc as you all know. We work as a team. RNs and UAPs have received the same training on how to obtain a blood sugar....the glucometer sends the lab to the computer. I would never give insulin without seeing the lab in the computer even though the UAPs write them on a board. I will check VS if the situation warrants it (abnormal, prior to giving meds...) but the UAPs usually do the routine VS. Interesting to hear different perspectives!

[RN2B123]

Welcome to Canada, where we typically have 4-5 pts on days and 5-6 usually on nights and most hospitals (at least the ones I've been at) don't have UCPs at all - each nurse takes care of their patient load. We do everything... Bathing, all toileting/ADLs along with every other nursing skill and stuff required some places do have UCPs but it might be one for the whole floor and most places don't at least in my province it's not that popular.

[Esme12, ASN, BSN, RN]

Quoting Assit. Admin Emse...I have no idea how to do it in the white boxes...

"I went to a ASN/ADN program many, many moons ago so I am hopeful that this was covered on your BSN program...for it was covered in mine."

I also went do an ASN/ADN program and am now working on my last semester in a BSN bridge. And trust me, I got adequate education on how to take a manual BP.

"I know, I know....we are all entitled to breaks. I get it I really do. Maybe negotiate with management to delegate the B/P to licensed staff and have the UAP obtain the temp, pulse, respirations to ease the burden. If you approach it from the standpoint that you understand the importance of the glucose and B/P that you can negotiate the TPR to the UAP. This way your B/P can be included on your initial physical assessment and/or when you give your meds"

This is a great idea, I will run this by them.

"What type of floor do you work that you take vitals, and glucose, every four hours on every patient? UAP's are a vital part of the nursing team but should we be delegating assessment when we base our treatment/intervention on these numbers."

I work on neurosurgical/neuromedical. We only take BS on people who are diabetic, on feeding tubes, steroids...basically everyone. & we take vitals q4.

"I don't think so...if we as nurses insist that we can delegate important assessment skills to non licensed personnel? Are we then saying that we can be removed from the bedside to be replaced by UAP's because it isn't necessary for an educated professional to perform such menial tasks...just food for thought."

Anyone could take a BP with a automatic cuff...that's why they are in every Walgreens. If the VS are out of normal for that patient I take them myself. Or if the patient is critical I take them myself. Otherwise no, I think they should be able to take a BP.

You can quote by using the "quote" icon on every post you can mutli quote by using the " icon.

I'm not saying that they can't take them...I'm saying that as the nurse you are basing your interventions from a non licensed person. Of course anyone can use a non-invasive B/P cuff the issue is only a nurse (or MD et al) can make an assessment to change medical treatment based on that information . Vitals are considered apart of the assessment...something only nurses should do. Some facilities have changed their policies because something has happened (which they will NEVER admit to) that a glucose was treated ot B/P was treated when the result was not real, inaccurate, or faked....leaving the nurse liable.

I agree that they should be able to take vitals but I always try to see all sides of the conversation and then seek a solution that will benefit everyone.

Administration isn't always trying to beat up the nurses, although these days I'm not so sure, sometimes there is a good reason for making decisions they just don't communicate well anymore...

[KelRN215, BSN, RN]

Quoting Assit. Admin...I have no idea how to do it in the white boxes...

"I went to a ASN/ADN program many, many moons ago so I am hopeful that this was covered on your BSN program...for it was covered in mine."

I also went do an ASN/ADN program and am now working on my last semester in a BSN bridge. And trust me, I got adequate education on how to take a manual BP.

"I know, I know....we are all entitled to breaks. I get it I really do. Maybe negotiate with management to delegate the B/P to licensed staff and have the UAP obtain the temp, pulse, respirations to ease the burden. If you approach it from the standpoint that you understand the importance of the glucose and B/P that you can negotiate the TPR to the UAP. This way your B/P can be included on your initial physical assessment and/or when you give your meds"

This is a great idea, I will run this by them.

"What type of floor do you work that you take vitals, and glucose, every four hours on every patient? UAP's are a vital part of the nursing team but should we be delegating assessment when we base our treatment/intervention on these numbers."

I work on neurosurgical/neuromedical. We only take BS on people who are diabetic, on feeding tubes, steriods...basically everyone. & we take vitals q4.

"I don't think so...if we as nurses insist that we can delegate important assessment skills to non licensed personnel? Are we then saying that we can be removed from the bedside to be replaced by UAP's because it isn't necessary for an educated professinal to perform such menial tasks...just food for thought."

Anyone could take a BP with a automatic cuff...that's why they are in every walgreens. If the VS are out of normal for that patient I take them myself. Or if the patient is critical I take them myself. Otherwise no, I think they should be able to take a BP.

If you're working neuro/neurosurgical, aren't you doing neuro checks at least as often as vitals anyway? That was my original point, if you're already in the room at least q 4hr, the amount of time it takes to add vitals to your neuro assessment is negligible.

They SHOULD be able to take BPs, I'm betting something happened- like someone documented a BP of 100/60 on a patient on antihypertensives so the meds were held when the BP was really something like 180/100 or they documented a BP of 120/80 which wouldn't warrant holding antihypertensives and the person really was hypotensive and bottomed out his BP after getting his meds. Honestly, the career UAPs I worked with were often unreliable. VS were supposed to be done at 8, 4 and 12 and sometimes my midnight vitals were not done by 1:30 am and I'd find one of them sleeping in our treatment room. That's why I just did my own vitals- it was faster and I knew they'd get done. There were times when a BP was documented and then you'd go into the room of a kid who was on the monitor (every bed had automated BP cuffs attached to the monitor) and there were no recent BP results. Or they'd document that the parent refused vitals but the parent would say that they never came in.

[exit96]

Well, I am in ER. We don't have uap's and our Secretaries don't help at all. If the Secretary isn't calling lab or Respiratory, they are online shopping.

[Anna Flaxis, BSN, RN]

We don't have any UAP in my ER either. I really don't see a need.

When I did work on an inpatient unit, I experienced many of the same problems mentioned in this thread, as far as UAP neglecting turning and ADLs, so I can sympathize. I'll never work inpatient again, partly because of this issue.

[Kaltia]

Aides are quite capable of taking vitals signs and blood sugars. And the should be trained in what are appropriate parameters. From my viewpoint the assessment in these tasks comes from evaluating the results, not doing the task. If the results are screwy, or the patients unstable yes I'll check them. And the good aides learn what I want to know and will tell me 13 has 102.3 temp. 5s bp is 200/90 and so on. yes while it is never going to be found on the actual job description I do expect aides to be able to perform a minimal amount of assessments. The patients not breathing for gods sake get some help.

Yes the nurses can get the signs and blood sugars, but it takes a hell of a a lot of time when you have 8 plus patients two of are fresh post-ops, ones getting blood, you're calling a doctor about another, and still another is climbing out of bed thirty seconds. I have done all the work for my patients more than once but it hurts the nursing care enemoursly. Especially when I have patients who are unstable and I'm stuck trying to monitor them at the level I'd like but at the same time provide good care to the rest. Just having baseline set of vitals to assess and blood sugars done is a huge relief. And let's me put my time to work where it can actually help

[dudette10, MSN, RN]

Why is it that when ancillary or support staff don't do their jobs, the answer is always to add the task to the nurse's workload under the guise of safety and accuracy? God forbid if we actually address the root cause.