New CNA, need help with speedy vital checks.

[keithjones]

I just started a new job in a hospital Transitional Care Unit. It's basically a nursing home in a hospital setting We have 23 beds and get post-op, or post infection patients on their way home or to a nursing home, hips, knees, and people who can't go home yet in order to free up more expensive beds in other areas. There are 3-4 nurses at night and 0-1 aides.

This is my first job as a CNA, or in the nursing field in general. I am working nocs 2 nights a week 7P-7A and will pick up 1-2 more nights a week once I get off orientation until nursing school starts in the fall, it will be my first semester in nursing school.

Getting to the point, My first two nights we had 13 patients, 17 on my third night and 18 on the fourth, nice build up to full load for me to orient with and I am learning my duties pretty well, my only problem is speed. Last shift that I worked the aide who is training me took 10 patients and I had 8, when we did 03:00 vitals she was done and charting by 3:30 It was 04:10 before I got done, granted I had two incontinent patients to change, one of which required a whole bed change, but I still felt I was very slow by comparison.

The night before I was alone, my preceptor was a LPN who had her own duties and was just there in case I needed help. I started at 02:30 and finished at 05:10 with 17 patients. I am supposed to chart my vitals by 05:00 at the latest with a 04:45 time stamp because updated graphs with vitals print at 5:30 and there is no way to redo them after that point, you have to print out your latest vital check seperately which makes updating the charts take twice as long and then the Docs get upset because it takes more work for them to read the graphs since a plot point is missing and on a seperate page. That night the nurses charted half my vitals for me and all my I&Os.

Does anyone have any input for speeding up my vital checks? I can do blood pressure and temps in less than a minute (unless it is a Lying, sitting, standing check), my problem is counting respirations, it often takes me 1-3 additional minutes to get an accurate count, I often feel as though others must be writing down random numbers between 14-20. A few times I have found that I can count respirations during the BP check and do a quick temp scan after, but chatty patients make it difficult and often I feel as though patients are holding their breath during the BP check. Wheezers are a cinch, but shallow and irregular breathers may take me 2-3 minutes and I still feel as though I am guessing. I know a certain degree of speed will come with time, but I feel some tricks of the trade would best help with the particular problem I am having.

Thanks for the assistance.

Oh, by the way during my vital cheks I am responsible to collect I&O sheets, including emptying urinals and foleys and checking water pitcher levels, recording temp., pulse, respirations, and BP, some of which are lying, sitting and standing, and daily weights (which involves clearing the bed of all but one sheet and one pillow).

[DayDreamin ER CRNP]

I'm a tech too but I don't really have any super helpful tips for you. For me, I start my Q4 vitals 30 minutes before they are actually due so I'm usually close to being on time to get the results charted.

When I do my vitals I can do the BP and resps at one time and I only time for 3o minutes then I do the temp. If the patient is really chatty, i put the thermometer in his/her mouth and count while the machine is reading. Of course, the temp reads in a few seconds but the patient doesn't know that so I keep my own time and count. Make sense?

Also, when I'm going around to do my vitals that is all i do. As much as I hate it sometimes, if my patient needs to be changed I tell him I'll have to come back in a sec and I always do. Now, if a patient needs help to the restroom I do that.

If I can't get back to my patient that needs to be changed or he is really bad I do tell the nurse or try to get to it right away.

I carry a little clip board with those mini legal pads on it where I record my vitals for each patient and I can also write down any needs that patient has and I take care of those as soon as my vitals are done. Clear as mud?

It just takes a little time to find your rhythm and get it all working for you. I would definitely ask your charge nurse to see what is expected of you. For me, when we have three techs on the floor (which is preferred) we all have 15 patients each and we assign our pages to all of those rooms. If we only have 2 techs on the floor we each have 24 patients to do and we assign our pagers to 3 rooms per nurse or every other room basically. We won't do Q4s on all of those but we get close some nights.

You and your nurses just need to really work as a team and communicate and sometimes crap just doesn't get done on time. I just try to make sure to prioritize as best as I can.

good luck!

meredith

[keithjones]

We use temporal thermometers so no stopping the talkative ones, unfortunately. I love the patient interaction, just hate to get bogged down with my work.

[fuzzywuzzy, CNA]

Tell them you need them to be quiet so you can count their pulse. Then while you're counting it (or pretending to), count the respirations. I only count those for 30 seconds. If someone is breathing really fast or slow you will notice anyway. I agree with the last poster that said to start them early and don't stop for interruptions.

Did you ask the aide who was training you how she gets it done on time? She's probably the best person to ask. Or ask the nurses if they have any suggestions.

[TampaTech]

It comes with time and experience thats all I have to say. Everyone does something that makes it faster for them.

[macrich84]

Try splitting up what you do when you check the vitals. Refill your water pitchers, empty foleys/urinals and change your inc. patients, etc before you start with your vitals. Make those rounds first, maybe a half hour, or hour before vitals..depending on your speed. It sounds like you are trying to do way too many things during vital checks. As far as your respirations, you'll get use to doing those.. but, if you are having a hard time try asking your nurse to verify your numbers when they pass out AM meds.

[JDZ344]

After we do AM care I do the vitals. I find that if I do the vitals directly after this, there is less interuptions because people have had their needs attended to for the most part.

Before I do the other rounds of vitals, I like to make sure that everyone has water, has used the bathroom, been changed, etc etc. Less interuptions and you can just go around in one go.