I'm tired of working with professional RNs who don't know what their patients vital signs and I & O's are. We have great staffing and the techs are in charge of keeping track of I&O's, accuchecks and vital signs. But why when I ask an RN what how her patients bp is five hours into her shift she can't tell me?
How come when a daily weight is done the RN doesn't compare it to the pattern of weights.
How can an RN go into shift change report and not realize her patient hasn't voided in 12 hours. (I tried to cath the patient in the middle of my shift report and couldn't get in, a gu doc came in and got 2000 cc's).
Am I wrong or are vitals signs, weights, I&O's, accuchecks part of your assessment and things you need to know???
Sorry, I'm so upset about the 2000 cc's I can't think straight. That is so scarey and incompetent.
One of the first things I do after my beginning of shift assessment is to look at the I&Os, Fingersticks, and vitals from the shift before. Our aides, when we have them are notorious for not letting us know of abnormals, so I make a point of checking at the time they're due to be done.
All the flowsheets are kept in a book that is left at the patient's rooms, so nurses, aides, docs all have easy access to them. If there are abnormals, I jot them down on my worksheet so when I catch the doc I have the numbers at hand. Same with labs.
I haven't seen too much of a problem on our unit who don't watch this stuff, but I'm sure there are a few who don't which is shameful.
Thanks for letting me vent. The aides are awesome and are good at reporting abnormals. There are some nurses that never look at their vitals at all, because they expect to be told the abnormals. I'm sorry, but I feel it's part of your initial assessment to look and know what every single vital sign is for your patients before too much time in your shift passes.
Teshiee, the nurse in question had six patients which is our max ratio for night shift, with two aides on the floor. She had time to do crossword puzzles, so believe me it has nothing to do with the nursing shortage, understaffing or any other issues. What's scarey is that if the doc hadn't come in her and asked about the I&O's she never would have known, never would have passed this information onto the next shift. Very scarey. We do I&O's q8hours, at midnight wonder why she didn't know the patient's output then? Grrrrr.........
What makes me INSANE besides no I & O or not counting the OR and PACU intake/output as part of the floor I&O is:
being told a patient doesn't have a fever because their temp is 94. ANd no one is looking alarmed by this. I have also found that a patient has a temp of 97 orally or TM and when i ask that a thermometer be put in their bum or i do it myself there temp is 100+. If patients are taking PO and someone goes in the room and takes an oral temp after they've had cold fluids it will affect your reading. Dosome people not have common sense ??I have told the nursing if i ask for a temp on a patinet and they are going to give me a reading from hours previous just make a number up and save the time of looking in the record. I am a B***** about this but the way i was trained in nursing this was drilled into us.
To all of you that are so vigilant about I&O and VS come work with me ...please !!!!!!!!!!
Occasionally I will come to work in ICU with a report of no urine output (or another gross abnormal) in 12 hrs too....told to me as an afterthought and left for me to investigate.
What does I & O stand for? As you can tell, I'm not a nurse.
A very important part of the nurses assessment. Fluid intake and urine output. Fluid in should equal fluid out. This includes IV fluids and fluids taken by mouth. Certain patients, to include cardiac, post-op, hepatic failure, renal failure, patients who are not taking anything by mouth, etc. need to have their I&O's monitored carefully. It's simple, but we miss the mark so often. My floor has recently had a complaint from an MD who wrote "Strict I&O" for three days and the staff didn't do it. Very embarrassing and incompetent.
I have a few pet peeves I guess and this is one of them.
I have problems with aides having too much to do, and some nurses who feel the aide(s) are there to help her/him only. I also have had problems where the aide waits too late to get the I/O or VS, for one reason or another.
I also have had aide forget to get a blood sugar, or give me the wrong results!!!! The other thing that really sends me crazy is when I go to document I/O for 24hrs and there is NO I/O from the previous shift!!!! Sends me into a cussing fit (under my breath)!!
So what I do is, I get my VS as I go to each room for assessments, that way I don't have to track down an aide or hope that it is correct. After being given the wrong pt's Bld sugar once, I now get my own, unless it's from an aide I know is responsible.
From pts who are A&O I enlist their help in writing or remembering what they drink, and I explain to them the need to call when they void. I do this and other things because I run into too many problems in the past. It saves me from being pissed, and the pt. from having the wrong or incorrect info documented.
I also hate going to facility, and trying to figure out what # IV is hanging! And one of the biggest pet peeves of all!!! DRY IV BAG hanging!!!!!!!! Depending on what the rate is, if there isn't at least 300 cc or more up I replace or at least hang a new bag on the IV poll!
Well since I have I already started a good rant, no sense wasting it!
Last floor I worked on, came on out of report, to find every single IV going dry, three PCA pumps needing new syringes, and two pts in 10/10 pt post op surg! Also neither with I/O measure containers sor hats in the potty! One with ordered TED hose not on, SCD's not on, and the nurse walks up to me and tells me she was just too busy, and could I do it!!! But that didn't stop her from going home on time!:((!!!!!
I ran the whole figgin nite, but I still left flds up or another bag hanging, and all PCAs syringes changed, and no pt reporting more 3/10 pain! Took my own VS and did my own I/O! But I have had enough!!!
It's our JOB to know these basic aspects of pt care..plain and simple..I guess one good thing about not having a cna most shifts is that we really get to KNOW their condition head to toe.On the rare occasions we do have a cna, I still chart/graph my vs and i/o's..and wonder of all wonders ASK if pt Z has voided or had a bm @ least halfway into the shift. And for goodness sakes..OUCH @ 2000 cc bladder!..that poor pt
You go Mandy, can I work with you? I give a pt. 6hrs from last void. No void >bladder scan, and then cath if I have an order or there is a standing order. If not ...MD called!
As an ICU RN, I can't tell you how many times this happens! It really makes me angry. I have seen patients with bladders the size of basketballs, and no one has cathed them! It is so incredibly wrong!!!! I work days now, but when I used to work nights I worked with a nurse that was like this.
The surgeons come and do rounds at 6 am. The minimum amount that we do vital signs in the unit is q 2 hours. We have monitors in the rooms and at the nurses station. People can pull VS off the monitor without even going in the room! That allows for nurses to be lazy and NEVER assess their patients. Well, this nurse was rounding at 6 am, and the surgeon looks at her flowsheet and says....."Wow.........so-and-so.....one blood pressure for 8 hours....that's pretty impressive!" Can you believe it......all she wrote on her flowsheet was one lousy blood pressure. She couldn't even get it off the monitor!!!! GRRRRRRR This stuff really makes me angry!
Depending on what the rate is, if there isn't at least 300 cc or more up I replace or at least hang a new bag on the IV poll!
SmilingBluEyes
20,964 Posts
I keep a "brain" for all those factoids so I can give these in report. I have to, to stay organized. It has worked well for me all these years.