Vent!

Marie_LPN, RN, LPN, RN · Oct 21, 2003

This is why even thought entering into the computer the I's and O's and vitals and weights are supposed to be a part of my job that i DON'T enter that in. This way they can review this.

Typically we don't have any problems of someone not paying attention to any of these, but what all you are describing is ridiculous, not to mention NEGLET and ABUSE for letting a pt. sit with a 2000cc bladder.

Ortho_RN · Oct 21, 2003

Alot of times... The nurses never ask me what the vitals I got for "their" patient was. I keep them on a clipboard with me at all times. And I always tell them of the out of normal stuff. But I don't normally "chart" them on the graphics until about 10pm, which is 7hrs into the shift...

Nurse Shark · Oct 21, 2003

You know, I agree with you. I am a tech and I make sure I do my vitals, accuechecks, I & O's prompltly when they need to be done, and I always make copies for the nurses and make a point to say " Here are your vitals, and Blood sugars" as I put it right in front of their face. But I have still had nurses on more than one occasion call me at the end of the shift to ask me why I did not give them the vitals for the shift..... I've even had one wicked nurse call me screaming that I didn't give her the copies. When I told her I put them in front of her face, she called me back screaming that I must have lost them.... And all of this was six hours into her shift(she could have looked in the charts after she lost them, they were there too.)

You would think she would have thought about that before giving her meds., or as she did her assessments. I unfortunately see alot of things that they emphasize NOT TO DO in nursing school.

renerian, BSN, RN · Oct 21, 2003

I always ask anyone taking my numbers to jot it in on my sheet. I agree that information is needed.

renerian

stella123 rn · Oct 21, 2003

We do all computer charting now. I check about an hour into the shift to look at the vitals. If they are not there I hunt the aide down and ask why. Accuchecks I always ask because there is usually insulin that goes along with it.

I will admit that when we switched to computer charting, I definately have to make more of a point of looking for these things. Before I would just grab the aides clipboard and scan everything. Now, they take the computer in the room and it goes directly in. I know computer charting is the thing now but I think it makes it harder to see trends. Escpecially weights and I & Os. At least out system anyway. Just can not flip through a chart anymore.

fcallicoat · Oct 21, 2003

Oh yeah I know how you feel.

I'm so ready to throw in the towel after last weekend. Nursing in general esp after reading this thread.

Nurses in my facility are required to check the books of the CNAs and sign off that it has been done. (time consuming, and tedious).

But why is it weekend staff who notices a trend where some one just stops eating, voiding etc? Especially when the CNAs are basically jumping up and down that something is wrong. I'm so tired of hearing "I told the regular nurse..." Or worse from a group of them "WE told the UNIT MANAGER...!!!!" Since July there have been 2 weekends that I have not sent someone to the hospital for a problem that started during the week. Worst of all I float floors so I really am playing catch-up.

I've gotten to the point where the ER nurses know me by name, and have asked me "why is this emergent onthe weekend?"

I have started asking other nurses for a second opinion because I've gotten paranoid about over reacting.

I'm just venting.

I also work with alot of good nurses and CNAs. I love my residents and I guess thats why it make me so crazy.

nursemary9, BSN, RN · Oct 21, 2003

Hi

Boy, do I know exactly what you mean!!

I see Nurse's like this EVERY Night!! My nurse aides are excellent!!

I work the Night Shift, also. They have the VS's within an hour of the shift;s beginning& they are all charted--all the nurse has to do is look at her charts. If there is a Too High or Too Low Vital sign, the aides will always verbally alert us--& yet, how often do I hear RN's say hours later--oh I didn't know why didn't you tell me!!

These of course, are the same RN's who don't check out put until just before 0700 or don't know other important facts!!

Don't you just love them?? NOT

Teshiee · Oct 21, 2003

That is sad I wonder how many pts this nurse have? She should develop communication with her aids to prevent a major problem with her patients because the RN is ulitmate one responsible. That is why I do my own vitals for at least the first round to get a baseline of my patients. I have some pretty nasty experiences with wrong vital signs!!!!!!!!

mattsmom81 · Oct 21, 2003

I was a charge nurse on a busy stepdown for several years and used to run into this problem too. The nurses were so crazy busy they allowed themselves to get into bad habits of not being aware of vitals and IO.

What helped us was to keep a 'shift record' on each pt's door. Vitals, IO and weights are recorded there.

For everyone's information. It was EVERYONE's job to keep this record accurate. . The docs liked it there too...found their data without chasing down the nurse, so it saved us some time too.

We shared computer documentation...CNA's entered vitals and nurses entered IO. It was night shift's job to play catch up if days didn't get all the data entered.

Personally I like to do my own vitals as I consider it part of my asessment. My staff did not agree...they preferred the CNA took vitals for them...BUT we made sure the nurse knew she was responsible for knowing what they were and acting accordingly. It WAS NOT the CNA's job to hunt the nurse down unless it was very abnormal.

The weights...well my thought is it's best to have a system where everyone weighs the same way on the same scale. Someone may forget to hold a foley bag off the scale or to take off a heavy bathrobe. We chose weights to be done by the CNA...one person who does things the same way...every day while she/he does a set of vitals.

If this stuff is making you crazy it's probably time to (with your director's support) set down stricter expectations with your staff Tweety...time to be the 'hard' charge nurse.

barefootlady, ADN, RN · Oct 21, 2003

Ask my CNA's for a copy of VS, if they are too busy will ask for sheet and make it myself, always look at these asap. Also ask patient themselves if they are having problems w voiding/bm's.

Do this when doing assessments. Do a quick abdominal check for BS and note if distended. Sometimes just getting patient oob and to BR is answer. Or BSC. If CNA does not have VS in approiate time, then ask why. Sometimes they are too busy and need me to pick up the last 2 or 3. I don't mean to sound like I go in and can do it all in 15 minutes, but I do try and keep an eye out for problems. I hate it when doc ignore's me when I report a elevated BP or T. One nurse on floor often gave Tylenol w/o orders. This is dangerous when an infection is brewing and a blood culture is needed. I know plenty of nurses do it but I want to be a safe patient advocate and let doc know so he can decide if further measures are needed. Sorry to be so long winded but I like to feel like I take the extra step to protect my license and the patient.

night owl · Oct 21, 2003

You're absolutely right tweety. It ticks me off to no end that when I report a patient has poor fluid intake, his output was only 100 cc, very dark amber for my 8 hr shift, record and report how much fluid I was able to get into him, temp of 99.8, bp of 100/60 and no one follows up on it, come in the next day and now he has hematuria and is dehydrated and get, "Oh I wasn't aware of his condition." It makes you want to run down the halls screaming, "why am I here, why are any of us here?!?!?!?" Where is the continuity of care???