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This question is for LTC nurses: I took a summer CNA job at a local nursing home that is chronically understaffed and has no equipment for taking vital signs. Maybe there was once an oximeter but nobody knows where it is. The nurse gave me a list of residents to get vital signs on and no equipment to do so. When I pointed out that there was no equipment, I told "the other aides do it- make it happen". Turns out the other aides just write down numbers and don't actually take vital signs. I've worked in some real crappy SNFs before but never have I been asked to fake vital signs. As a nurse, wouldn't that worry you that your aides are blatantly lying to you? Is this common?? Some of the aides have bought their own equipment but for the pennies they are paying me I can't afford that. I'm told asking management for equipment is a losing battle.
This is honestly scary. High temp can mean infection. A reason to get labs done. Too low a bo and then giving a bp med can cause risk as well. Having a high bp and not knowing it then not taking a prn bp med is a risk. Not having a pulse ox?!? So a person can be walking around for a few days in the 80's and no one cares?? That is so unsafe. I would quit right away. And go to the don and tell them how it's a liability. Make sure your friends and family know, never go there!
You're right. There is a reason they call them "VITAL" signs!
Kooky Korky, I really think you just don't get it. Lack of functional equipment should not become the financial burden of the staff. And I also don't think you understand that staff doesn't have the money to drop on things the facility should provide. With a nurse's salary, I don't have $100 to be spending on equipment to care for patients of the facility I work for. Is there a legal obligation? I bet if you went through all of JC and CMS regulations, you'd find plenty. And that doesn't even touch individual state DOH requirements. Your DON's commending staff for providing their own equipment that is not certified by the facility or properly maintained is mind boggling. Residents and patients deserve accurate assessments- including vitals taken by properly evaluated, calibrated, and maintained equipment.
Staff should not have to buy and use their own equipment, but it is an alternative. And staff will then have the equipment for their own private future use. And they don't have to buy it all at once. Also, my $100 guess was high. As another person said, the BP cuff and a cheap stethoscope can be had for much less at the drug store.
And the truth is we don't know everyone's financial status . They might be wealthy, even have a trust fund! We must not assume. Just because someone doesn't earn much doesn't mean he or she is without assets. Or in your case, just because you are making a nurse's pay does not mean you have an extra $100.
OP has solved her own problem, so no real point for me in discussing her problem any further.
As for regulations, you are very likely right. You must have missed my remarks where I said I'm rethinking the situation.
As for my boss, I'm just telling what she says.
How often are BP cuffs (manual or machine) and thermometers calibrated at your place? At ours, it's annually. And that infrequency doesn't really mean a lot.
One thing that disturbs me about all the "person vital sign" equipment is who ensures they are in working order? Calibrated? Up to industry standards? Not worn down from years of repeated use, which home equipment is not designed for? I get that many people have their own stethoscopes, but an automated blood pressure machine is a different beast.
Staff should not have to buy and use their own equipment, but it is an alternative. And staff will then have the equipment for their own private future use. And they don't have to buy it all at once. Also, my $100 guess was high. As another person said, the BP cuff and a cheap stethoscope can be had for much less at the drug store.
Those blood pressure cuffs you can purchase in a drug store are intended for personal use, not heavy use as would be required in a LTC setting.
And the truth is we don't know everyone's financial status . They might be wealthy, even have a trust fund! We must not assume. Just because someone doesn't earn much doesn't mean he or she is without assets. Or in your case, just because you are making a nurse's pay does not mean you have an extra $100.
Exactly, although I'd be willing to wager that those working in the role of the OP aren't rolling in trust funds.
OP has solved her own problem, so no real point for me in discussing her problem any further.
Actually, as it appears this is a rampant problem in several LTC settings, the discussion should continue until the issue of inadequate functional equipment is resolved.
How often are BP cuffs (manual or machine) and thermometers calibrated at your place? At ours, it's annually. And that infrequency doesn't really mean a lot.
In mine, it's quarterly, as well as the equipment going through a self-test every time it's turned on. But once a year is better than using equipment in a setting where it wasn't intended to be used and that is never given an initial or regularly scheduled maintenance.
One thing that disturbs me about all the "person vital sign" equipment is who ensures they are in working order? Calibrated? Up to industry standards? Not worn down from years of repeated use, which home equipment is not designed for? I get that many people have their own stethoscopes, but an automated blood pressure machine is a different beast.
LOL I was suggesting a manual BP cuff.
I always shake my head with the ease that people toss out the suggestion to quit.
I have been trapped in a job and been asked to do things for which I wasn't qualified. When I sought advice on how to be accomplish the tasks, I was berated for being in that position and had multiple people tell me that I should walk out straight away. I ultimately figured things out on my own well enough to get by but it would have been so nice to have someone offer so guidance beyond "run. now."
While I desperately wanted to leave and was actively seeking new work, simply refusing to do as they asked or walking out the door would have brought with it immediate, serious repercussions for my family which, at the time, included an out-of-work spouse and a kid with serious medical problems.
While I of course agree that the OP should (a) not falsify the medical record and (b) be looking for a new job, I think it's important to recognize the catch-22 in which some people find themselves.
OP, buy yourself a manual BP cuff, stethoscope, and pulse oxymeter and enter real data in the chart.
They have 2 working manual cuffs in this facility for 96 residents (as of last night LOL). If you're a tiny little old woman or a bariatric resident- we have a lot of both- too bad. I talked to the DON and I got a lot of fake concern and promises to do something "when we can" and a big talk about how medicaid doesn't pay enough. Its the corporation that owns the facility that is squeezing it dry, though. We have 4-5 CNAs days and evenings for all 96 residents. I have no idea how they continue to pass their surveys but they do.
"Report...report...report..."
The OP mentions that she lives in a small town, and it seems she does not plan to move until she becomes a RN. She probably cannot afford to be a martyr right now. Though, if she can, she should look for another job.
Side note: There is no such thing as "anonymous" reporting. Though illegal, whistle-blowers and their families face retaliation that can last for years.
They have 2 working manual cuffs in this facility for 96 residents (as of last night LOL). If you're a tiny little old woman or a bariatric resident- we have a lot of both- too bad. I talked to the DON and I got a lot of fake concern and promises to do something "when we can" and a big talk about how medicaid doesn't pay enough. Its the corporation that owns the facility that is squeezing it dry, though. We have 4-5 CNAs days and evenings for all 96 residents. I have no idea how they continue to pass their surveys but they do.
If you would work up the courage to report to CMS and your state regulators the rules you see being broken, the ethics and legalities you see not being upheld, maybe they will not pass their surveys.
Cactus Nurse
165 Posts
This is honestly scary. High temp can mean infection. A reason to get labs done. Too low a bo and then giving a bp med can cause risk as well. Having a high bp and not knowing it then not taking a prn bp med is a risk. Not having a pulse ox?!? So a person can be walking around for a few days in the 80's and no one cares?? That is so unsafe. I would quit right away. And go to the don and tell them how it's a liability. Make sure your friends and family know, never go there!