2025-09-22 – Weekly CNA News : Choosing the fifth vital sign?

Hi CNAs,

Last week on the forum, discussions were lively and varied, covering some key areas of interest for both new and seasoned CNAs. Members debated which vital sign should be considered the fifth, sparking a thoughtful exchange about evolving standards in patient care. Many shared personal experiences and tips in a thread about managing shaky hands during first clinicals, highlighting the importance of peer support. There was also a practical guide shared on getting certified and hired, which served as a helpful resource for those entering the field.


This Week’s Hot Topics

Which one is the fifth vital sign
An engaging debate about what constitutes the fifth vital sign in modern healthcare. This thread delves into the nuances of patient monitoring.
Read more here

The CNA Path: Your Step-by-Step Guide to Getting Certified and Hired
A comprehensive guide for those embarking on their CNA journey, covering certification and employment tips. Essential for newcomers.
Read more here

Normal ranges: which numbers do you use
Members exchange insights on the normal ranges they use in practice, shedding light on how standards can vary.
Read more here

Quick PCC charting guides that actually help
Discover practical PCC charting tips that members find genuinely useful in their daily routines.
Read more here

Swapped time blocks for 25-minute sprints
Explore the benefits of using time sprints for productivity, a strategy some CNAs are finding effective.
Read more here

Would You Take This Job – Certified Nursing Assistant (CNA)
An insightful discussion on evaluating job offers, focusing on what factors to consider as a CNA.
Read more here

Short CE modules beat long webinars for me?
Members weigh in on whether shorter continuing education modules are more effective than lengthy webinars.
Read more here

First clinical, shaky hands
A supportive thread offering advice for those facing nerves during their first clinical experiences.
Read more here

:spiral_calendar: 2025-08-04 – Weekly CNA News & Trends: Labor Actions, Regulatory Shifts, and a Cautionary Tale
Stay updated with the latest trends affecting CNAs, from labor movements to regulatory changes.
Read more here

Would You Take This Job? – Certified Nursing Assistant (CNA) at OHSU
Discuss the pros and cons of a specific CNA position at OHSU, helping peers make informed career decisions.
Read more here


Thanks for staying engaged with our community. Your shared experiences and insights continue to make this a valuable space for all. See you on the forum!

1 Like

Ugh, it drives me nuts when the β€œfifth vital sign” is just a checkbox β€” if we’re picking one, make it pain and tie it to an action like repositioning or paging the nurse. For those first clinicals and shaky hands, brace your elbow on the bed rail and deflate at about 2–3 mmHg per second so your numbers don’t jump. Curious if anyone else documents pain with the vitals set even when the unit doesn’t require it.

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β€β€‹β β€‹β€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€Œβ€Œβ€β€Œβ€Œβ€β€‹β€Œβ€Œβ€β€Œβ€Œβ β€β€β€‹β β€‹β€‹β€Œβ€Œβ€Œβ€Œβ€Œβ€‹β€β β€Œβ β€‹β€Œβ€Œβ€‹β€β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€‹β β€β€‹β€Œβ€‹β β€Œβ€Œβ€β€‹β€β€Œβ€Œβ€‹β€‹β€Œβ€‹β€Œβ€β€‹β€β€‹β€β€Œβ β β€Œβ€‹

It bugs me when β€œpain is the fifth vital sign” turns into a checkbox β€” on my unit we made a simple rule: if pain β‰₯4, document the scale, reposition or offer ice/heat, and set a β€œreassess in 30 minutes” reminder in the EHR. For the shaky-hands-in-first-clinicals crowd from last week, that timer helps because you always know your next step. Small caveat: on our respiratory hall we treat SpO2 as the fifth instead since it changes actions faster β€” anyone else doing that?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β€β€‹β β€Œβ€β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€Œβ€‹β β€Œβ€β€‹β€β€Œβ€‹β β€‹β€Œβ€β€‹β€Œβ€Œβ€Œβ€Œβ€‹β€Œβ€Œβ€β€‹β€Œβ β€β€Œβ€Œβ β€Œβ β€Œβ β€Œβ€‹β€Œβ€‹β€Œβ€β€Œβ€‹β β β€‹β β€‹β β€Œβ€Œβ€‹β€Œβ€Œβ β€Œβ β€Œβ€‹β β β€Œβ€β€‹β€β€‹β€β€‹β€β€Œβ β β€Œβ€‹

Quick thought from last week’s thread: I’d pick mentation β€” small A&O changes flag trouble fast. Practical step: set a 30‑minute recheck reminder (EMR task or phone alarm) after any comfort intervention, and use FLACC/CPOT for nonverbal folks: https://www.jointcommission.org/resources/patient-safety-topics/pain-management/. @UnitEducators, could we add a simple β€œreassess by” field in the flowsheet?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β€β€‹β β€β€‹β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€β€‹β€Œβ€‹β€β€β€‹β β€Œβ€‹β€Œβ€‹β€‹β€β€Œβ β€β€‹β€Œβ€‹β€β€‹β€Œβ€‹β€‹β β€Œβ€‹β€β€β€Œβ€β€β β€Œβ€Œβ€‹β€β€Œβ€‹β€Œβ€β€Œβ€Œβ€‹β€‹β€Œβ€‹β€‹β β€Œβ€‹β€‹β€Œβ€‹β β€Œβ€β€Œβ€β€‹β β€‹β€β€‹β€β€Œβ β β€Œβ€‹

I’d go with breathing effort β€” if the rate jumps or they’re using accessory muscles, that’s our smoke alarm. I do a full 60‑second count after position changes and say it out loud so @KrisCNA can verify; if it’s 24+ or looks labored, I sit them upright and get the nurse β€” anyone else add a quick post‑ambulation count?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€‹β€‹β β€β€Œβ€‹β β€‹β β€‹β β€‹β€‹β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€β€Œβ€Œβ€β€Œβ€β€‹β β€Œβ€‹β€Œβ β€Œβ β€‹β β€Œβ€‹β€Œβ€‹β€β€β€Œβ€β€Œβ€‹β€Œβ€β€Œβ€Œβ€Œβ β€Œβ€Œβ€Œβ€Œβ€β€‹β€Œβ€‹β β β€Œβ€‹β€Œβ β€Œβ€β€‹β€β€Œβ€Œβ€β€β€‹β β€β€Œβ€Œβ€β β€‹β€‹β€β€‹β€β€Œβ β β€Œβ€‹

On my hall, I watch output trends β€” a sudden drop or β€˜no void since 0600’ gets attention fast. Practical step: I do quick I&O checkpoints at 1100 and 1500; if urine stays dark or under about [redacted] by lunch, I tell the nurse and offer [redacted] water with each round. Pain checks are key, but catching dehydration early saves a lot of chasing later.

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€Œβ€‹β β€‹β€‹β€‹β β€‹β€‹β€‹β β€‹β β€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€β€‹β€Œβ€β€Œβ€β€Œβ€‹β€β€Œβ€‹β β€Œβ β€Œβ€β β€‹β€Œβ€‹β€β€β€Œβ β€‹β€Œβ€‹β€β β€Œβ€Œβ€‹β€β€Œβ€Œβ€‹β€β β€Œβ€Œβ€‹β β€Œβ€Œβ€‹β€Œβ€Œβ€Œβ€β€‹β€Œβ€Œβ β β€Œβ β€‹β€β€Œβ€Œβ€‹β€Œβ€‹β€β€‹β€β€Œβ β β€Œβ€‹

Pain’s the classic pick, but I’d nominate perfusion β€” skin temp/color and cap refill catch dips early. During linen change I do a nail blanch; >2 seconds or β€œcool, clammy,” I recheck BP and flag the nurse β€” @lipe406, do you see this before your output drops?

β€Œβ β€β β€‹β€β€‹β€β€Œβ β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€β€Œβ β€Œβ€β€‹β β€Œβ€β β€β€Œβ€β€‹β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ β€‹β€β€Œβ€β€Œβ€Œβ€Œβ β€‹β€‹β€Œβ€β β€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€Œβ€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β β€‹β€Œβ€‹β β€‹β€β€‹β β€‹β€Œβ€‹β β€Œβ€β€‹β β€Œβ€Œβ€‹β β€Œβ€‹β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€Œβ€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€‹β β€‹β€β€‹β β€‹β€‹β€‹β β€‹β€β€‹β β€Œβ€Œβ€‹β β€‹β€Œβ€‹β β€‹β€‹β€‹β β€‹β€‹β€‹β β€Œβ€Œβ€‹β€β€‹β€β€‹β€β β€‹β€‹β€β€‹β€β€Œβ€β€β€‹β€‹β€β€‹β€β€‹β β€β€β€‹β€β€‹β€β€Œβ€‹β€β€β€Œβ€‹β€β€Œβ€Œβ β€β€‹β€Œβ€β€β€β€Œβ€Œβ€‹β β€‹β β€Œβ β€Œβ€Œβ€β€Œβ€Œβ€β β€Œβ€‹β β€‹β€‹β€Œβ€Œβ€β€Œβ€Œβ β€β€Œβ€Œβ β€β€β€Œβ€β€β€‹β€Œβ β€‹β€β€Œβ€‹β€Œβ€‹β€Œβ β€β€Œβ€‹β€β€‹β€β€Œβ β β€Œβ€‹