For patients with schizophrenia, distressing auditory hallucinations including commands toharm and intent to act on those commands should be the sixth vital sign. Shift report shouldinclude the intensity of a patient’s unpleasant voices on a scale of 0-10 during the previous shift,whether the patient hears commands to harm and if they plan to act on them (i.e., information allavailable from UVS). Just as we include elevated vital signs in end of shift report, informationabout auditory hallucinations, especially commands to harm should be part of the inter and intrashift communication. This is consistent with a sixth vital sign that has been proposed specific toseveral nursing specialties (e.g., emotional distress for oncology patients, dyspnea for COPDpatients