Vital Signs and the Nursing Asst

[mcpkin]

I work on a medical floor. Our usual pt load on nights is 6-8, we are required to take one set of vitals, for all of our Pt's, at some point during our shift. This was initially so the aides could do more baths. Nurses complained because sometimes thats not always possible. Then we were told that the nurse should be taking one set of vitals, just to make sure they are accurate. I do not mind doing vitals, anytime I get a BP that seems out of the ordinary, I do a manual BP. Now the aides have come to expect us to do it, even when sometimes we have 8-9 Pt's. The director has told them, we are to do one set, and they tend to stick with it. Now they are sitting around at the desk, as nurses are trying to do port draws, call critical values, and pass am meds. Does any one else have to do their own vitals? From time to time we do primary care for 4-5 Pt's, when for what ever reason their are not enough aides on that night. i would rather do primary care, Then to have a full pt load, and do their vitals as they sit. and yes the director has been made aware, but seems to go back and forth with her opinion

[sunny261]

If they are just standing around while your running around...they can absolutely do vitals. If there is a question about their results then perhaps an inservice is due.

[mcpkin]

Thank you, thats exactly what I thought,

[RNsRWe, ASN, RN]

Our aides do whatever vitals we need them to do, period. If I question a set of results, I ask them to re-do them, or do them myself for peace of mind.

I do not have time with my patient load (usually 8-9 also) to do basic vitals on each of them, and management understands that--which is why we have the aides in the first place! They do baths, change patients, answer bells, ambulate whoever whenever. The nurses do all of the above, too, but only as time allows.

If I ever had an aide sitting at the desk while I was running and pushing around a Dynamap, I'd have a FIT.

[catnip]

I always love it when they tell me 'i dont know how to do that", be it vital signs or emptying a bag. My usual response is that i was an aide for 7 years, i went through the same certification as you did, and i know for a fact that to be certified that you have to know how to do this so either your lying to me, or you need to go back to school. That usually gets them moving and stops the argument, if not then the threat of a write up with a full explination of what the person "does not know how to do" does.

[caliotter3]

I worked in LTC. Most residents were stable. We had our assistants take vs as part of their start of shift duties for those residents who had a change of condition or required vs for other reasons. The nurse would take vs herself if she didn't trust a particular asst or questioned results. Taking vs and observing the patient is a very important asst task. I always let my assts know how important this duty is and how much the nurses relied on them to do vs properly and promptly. When vs are not done at the start of the shift there can be some mean explaining to do when five hours into the shift it is discovered that the patient has gone for the worse. You get asked "well where were you for 5 hours? why didn't you check on your patient?" I agree with the statement that we have nursing assistants so that they can do these tasks. Nurses can't do everything. If they could, there wouldn't be any need for nursing assistants.

[RNperdiem, RN]

When I worked med-surg, the aides did do vitals. I preferred to do the vitals myself as part of the assessment and leave the aide free to assist patients to the bathroom(0600 Lasix having effect), and to pass breakfast trays.

Surely there should be enough for the aides to do with turning patients and getting the total care ones clean.

[grandee3]

I do agency nursing at various hospitals in the area. One hospital, LTAC, that I work at often, has a new rule that nurses must take their 2000 vitals on each of their pt's. From the time we get report and check charts and get our vitals, the NA's are supposed to be checking rooms, starting baths that are done on nights, making their first rounds for the night. I noticed for the last month that since this was started that the NA's are sitting in the brake room talking. No one answering lights or phone at desk. Honestly, I don't know why Charge nurses put up with this.

Don't get me wrong, I really appreciate the NA's and the part they play as a team member, I just wish they would

at least stay out on the floor. 8pm is a busy time for all team members, meds, families visiting with questions, assessments etc. That facility is the only place I see this going on.

[AprilCNA]

I work on the surgical unit and my first job upon clocking in is vital signs. If I'm the only CNA for 20 patients, I do them all, or if the floor is split with another aide then we each do 10. We get post op vitals, every 15-30mins for 2 hours, vitals on patients again half way through the shift and sometimes if I'm caught up, I'll do half for the night staff.(and all the regualr duties in between,cpm,bladder scans etc.etc...) A RN may do a set if a something comes up critically with the patient and I'm in another room, but other than that, it is the CNA's job to do it. The nurses don't go back and check our work, because we were trained how to take them, and if we need our work checked, we probably shouldnt be a CNA. Keep letting managemt know that the aides are not keeping up with their job responsiblity, sounds like they are taking advantage of you, and nurses have enough to do without doing everyones vitals to boot! I wish you good luck and keep getting on your managers back until they correct the problem.

[HeartsOpenWide, RN]

They usually only have one aid for an entire floor. They recently fired all LVNs. Its not uncommon to see RNs do bedbaths and make beds since there is no one else to do it. Thanks to Arney.

[student-with-no-life]

our STNA's do the VS. We do them before passing a BP med, pre-op, or if anything comes up abnormal and need to recheck it. I really appreciate the aids, they do make our job go a little smoother. Thank you!!!

[mcpkin]

I also appreciate the aides, I try to help out when I can, I don't call them if the Pt's wants coffee, snacks, etc.. I just get it myself as I know they are busy also. I empty urinals, and put Pt's on bedside commodes and bedpans. So it does get aggravating when you are so busy and they wont take the initiative to help out, just because they were told you have do them. We have more problems with the aides that float to our floor from the other med/surg floor. Last week I had one aide that left at the beginning of our shift, she just clocked out and went home, we had a bad night, (seemed to be the weekend for Pt's yelling at staff, anyway that night a new admit started yelling at her and instead of letting someone change her asignment or at least that pt, she just clocked out and went home. We had 6 admits before 1 am, and only 3 nurses one of which had a pediatric pt and could only take 6 pts. Anyway the aide that our supervisor brought out of ICU, she worked med/surg, but had been floated to ICU that night. She was mad and asked me so what set of vitals are you doing. I told her none, I wont be able to to any vs tonight, she said "so I am going to do all vs tonight" I said yes. That next night she was back on our floor, and came to me at 4 am and said she wanted to leave early. I told her as long as she was finished with everything and I was caught up and the super, didn't mind she could leave at 6am.. At 10min to 5 as I was getting prepared to do port draws, she said" I want you to answer the call lights", as I can not be interrupted so I can leave.. I told her (not that I mind answering call lights), it does not make sense for the nurse to be interrupted, to answer call lights, otherwise we could just do primary care. I think some of our nurses spoil our aides, I know that their job isn't easy, as I also was an aide before becoming a nurse. You say you have 20 Pt's, thats alot our aides are not allowed to have over 15, and we are strictly medical, occasionally we have a post op, and they don't take care of any peds either the nurses do primary on them. I wish they would just go back to the way it was before. I think that nurses should use their judgment if something is off to repeat it or do a manual. When I was an aide, the aides did manual bp for the nurses if they data scope seemed way off. Thanks for listening it helps to vent.