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?

[ThePrincessBride, MSN, RN, NP]

But you do realize that many aides' livelihoods are dependent on keeping their jobs as well? Quite a few are single parents who don't have the luxury of quitting or losing their job because they have mouths to feed.

I agree that aides need torbe held accountable and that it shouldn't all fall on the nurse. But if you eliminate the uap, chances are, you won't see a decrease in workload or nurse to patient ratios. You will just see more nurses being overworked to the point of being unsafe.

This.

Problem is; in general UAPs don't have any accountability beyond losing a barely above minimum wage paying job; whereas the licensed nurse is looking at losing his/her entire livelihood. The only way to remedy this is to either have UAPs who are internally motivated (not a measurable way to hire for that) or have management that will monitor and follow up; yea; they have bigger fish to fry when in the end someone (read; licensed nurse) will assure all cares are given. Because their license depends on it.

When I spoke earlier how our hospital eliminated most of our UAP positions (or moved them out of patient care), it was probably largely brought on by the observation that many of the UAPs made themselves scarce when it came time to do patient cares; so the nurses had learned how to do without them; so why not eliminate their positions. . . Just saying. . .

I know the UAPs that actually care are the ones that read these boards; I'm sorry I didn't get to work with you guys. All the worthwhile UAPs I've ever worked with have now finished nursing school. Maybe that's a solution, that there should be some internship agreement between nursing schools and hospitals to employ all their students for 4-12hrs a week. I don't know. Very frustrating, but less so when every person in the care of the patient takes personal accountability for how that patient is doing.

[himilayaneyes]

Many hospitals are already doing this. When I get floated to step-down with 4 patients. I have to take vitals and do blood sugars. However, when I used to work tele with 5 or 6 patients, we haid pcas who did our vitals and blood sugars. Hospitals have to save money somehow so they figure they'll just burden the nurses even more.

[sistrmoon, BSN, RN]

Speaking of floating, when I floated to the cardiac floor, the techs not only did vitals, but drew bloods and did EKGs. Some of the PCAs on my floor have requested phlebotomy certification and been denied. I guess I don't understand why something like that would be blocked, except money, of course.

[Esme12, ASN, BSN, RN]

Speaking of floating, when I floated to the cardiac floor, the techs not only did vitals, but drew bloods and did EKGs. Some of the PCAs on my floor have requested phlebotomy certification and been denied. I guess I don't understand why something like that would be blocked, except money, of course.

This is highly variable according to floor and facility. A facility may train their CNA's to be more involved/certified/educated in certain tasks. I can see why a tele floor might need this for thier CNA's but trust they will cut somewhere. it is all about the money.

My expereince has been that when a facility decides to restrict certain task that CNA's can do perfectly well...is because something bad happened or a near miss and as a part of the corrective action to save their behinds is to restrict the activity, like glucose and B/P, to licensed personnel.

Administration will NEVER share if they have their behinds in a sling or something nearly did or did happen to the staff. They quietly behind the scenes make decisions to limit their liability. It isn't that the nurses don't like the CNA's or think they are bad CNA's or are trying to increase their workloads to spite anyone (as a previous poster pointed out) ...it is seldom the nurses choice.

These mandates are from administration for many reasons, liability is a big one, placing these tasks strictly in the laps of nurses which places the liability directly to their licensed personnel....which ultimately releases them (administration) of liability.

End of story

[Anna Flaxis, BSN, RN]

You work in ED so I can see why you don't feel the need to have an aide, but on a busy med-surg floor where some nurses have up to seven patients....

I'm just glad I work at places that don't find my unlicensed self useless!

In my previous ED we had techs, and on the inpatient unit I worked in prior to that, we had CNAs, and back then I would have preferred to have fewer patients and just do everything myself than more patients with CNAs that weren't being held accountable to do their jobs.

[funtimes]

Someone should explain how exactly a tech should be held accountable. I thought it went without saying that this should be done, and given the fact techs/CNAs have always been fired at a much higher rate than RNs at every job Ive worked, I thought this was pretty much the case, but apparently its not how some RNs see it. So how should these techs be judged exactly. Auditing their charting? Having the RNs grade them? Patient satisfaction surveys?

[TiffyRN, BSN, PhD]

So how should these techs be judged exactly. Auditing their charting? Having the RNs grade them? Patient satisfaction surveys?

Satisfaction Survey: Too multi-factoral, I'm afraid this isn't a reliable measure in many ways for many providers.

RNs grade them: Yea, I want another piece of documentation to fill out.

Auditing: That won't be reliable, the licensed person is ultimately responsible

Sorry, it's old frustration, but if the tech is supposed to do an assigned set of tasks; I want them done and if I have to chase after them, I'd rather do it myself.

And I will try to address the "techs get fired more". I don't disagree. Part of that is going to be a reason some don't want to hear. Nurses cost more to hire and train than techs, easier to pull the trigger on that decision. Another reason I believe is because licensed caregivers perhaps police themselves far more thoughtfully because they fear the almighty "Board of Nursing". Back in the day when nursing jobs were a dime a dozen and all you had to do to get a nurse job was show a license and a pulse, licensed nurses still feared the BON and factored that into the quality of their caregiving. You're not just risking losing a job, as a licensed nurse you are risking all your jobs ever.

How to make the tech accountable? I really don't know a simple answer to that one.

[bell1962]

When I worked in the hospital years ago we practiced primary care nursing. You and only you were responsible for your patients. It was a med, surg floor and we would usually have 5 patients each. The only help you got was from another nurse, if you could find one, when it was time to lift,turn a patient.

[PacoUSA, BSN, RN]

UAPs are extremely valuable staff on our unit, provided they actually do work that helps the RNs complete their already overloaded responsibilities. They take vitals, finger sticks and some already trained in phlebotomy. What I hate is when the good ones are pulled to be safety or 1:1 sitters. Call me spoiled, I don't care, but I honestly don't know how I could get my job done without the help of a good UAP.

Sent from my iPad using allnurses.com

[redhead_NURSE98!, ADN, BSN]

If I thought my ADL's would all get done and I would not have to toilet a patient every time I went in the room because the tech has been hanging out in the break room doing word puzzles, I'd fall all over myself to do vitals and blood sugars.

[Esme12, ASN, BSN, RN]

Someone should explain how exactly a tech should be held accountable. I thought it went without saying that this should be done, and given the fact techs/CNAs have always been fired at a much higher rate than RNs at every job Ive worked, I thought this was pretty much the case, but apparently its not how some RNs see it. So how should these techs be judged exactly. Auditing their charting? Having the RNs grade them? Patient satisfaction surveys?

Yes....the same as nurses are audited, patient satisfaction surveys, competency exams and classes, spot checked.

I don't think a unit can be functional without UAP's but like anything else there are good techs and bad techs. It takes time and effort on a manager to ensure the staff are all functioning at an optimal level...unfortunately, I don't think that many managers take that extra effort any more. with a surplus of personnel these days it's easier to fire and hire. Sigh

[UnbrokenRN09, BSN]

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.[/quote']

My thoughts exactly...

I'm surprised so many are under the opinion that taking vital signs is considered "assessment". I mean really is taking a blood pressure and a temp accurately rocket science?? You need little more than maybe an hours worth of education on the proper positioning of pt, cuff, etc for accurate blood pressures, thermometer placement, etc. By this logic, why are you ok with downloading vitals that the machine did automatically.....you think the machine "assessed" anything? It's up to the nurse to look at how the vitals trend and determine if the readings make sense clinically. If there is ever a suspicion that something is not accurate, I will recheck it myself. Unless every nurse has access to a dynamap or there is a monitor in the room, it's not a very efficient use of time for the nurses to be waiting on equipment when an aid can get most of the vitals done while the nurses are finishing up report and getting organized for the shift.