CNA with a question.. ocd on the job.. afraid someone will die because of me

[Anxiousandafraid]

Hi all… sorry to be that annoying ocd CNA but want to ask .. who views the notes in epic ? I have nurses that get annoyed with me for documenting my RRs accurately. I can LEGIT understand their frustrations. I know at my job the joke is “only she counts RRs” someone will have 18 for three days until I come to work. It’s literally dreadful for me to come to work because I’ve noticed the patients that seem perfectly fine in every aspect will be the ones that breathe slow as heck .. so when I document 8 the system will turn red and my nurses are pissed. I really feel they’d be shocked to see that so many “normal “ people have low slow breathing. It doesn’t move anyone if the entire floor were at 18… but it’s a panic when it is 8 and 10… I’ve developed a form of trauma now at work due to the amount of times I’ve counted a pts RR and recounted it was STILL 8-10… I’d break out into a literal sweat DREADING the nurse coming to me and asking why I would document something so low … or saying I must be doing it incorrectly. It feels terrible doing your job accurately and being deemed incompetent. So I’ve found a loophole for myself but feel guilty. I’ll tell the nurse I didn’t document the low rate and will reassess. Generally nurse will have seen a pt already and say “they’re fine .. not in distress “… but instead of charting the low rate I’ll leave a note with what I obtained literally .. just a note in epic .. is this wrong ? I’m sure it is wrong since the system doesn’t recognize my note as a value .. do doctors see the notes in the blank value area ?  My OCD says “someone will die because I didn’t chart my 8… although everyone else somehow got 18”..”my number could’ve saved their life !” Am I being dramatic and giving this too much thought ? Is it possible someone will have died because of me? Say a Tuesday night I didn’t omit that number but next evening they’re discharged … would there have been a deterioration that would’ve occurred during that time if something were brewing ? And yes .. I know I need therapy… and I KNOW it’s my job to document I know. I feel so dumb being judged at work for “counting” and being told by superiors “just put this “ or being laughed at by superiors because they admit “no one counts “ .. I love my pts but this one aspect makes me want to quit. 

[hppygr8ful, ASN, RN, EMT-I]

OCD is treatable with talk therapy, meds or a combination of both. Living under the clouds of your current mental health has to be miserable. You owe it to yourself to seek out a qualified mental health professional.

[CommunityRNBSN, BSN, RN]

On 11/12/2022 at 6:25 PM, mtmkjr said:

And by the way my RR right now is 10 ?

I don't know how 18 got to be the standard RR for everyone. I believe that is too high at rest and especially during sleep. A sick person, especially with fever, metabolic, cardiac or other issues would obviously run higher but as the RR is usually documented it is not a very useful part of the overall assessment (I'm talking about when it's always 18)

Right?  When I was in nursing school and people had to practice on me, my RR was always about 10. The instructor would joke that it was time to turn down my morphine. 18 seems pretty fast for lying in a bed. 
 

Anyway- I love what everyone has said. Yes, chart accurately. But recognize that charting is not a life-saving intervention. You might save a life if you see a patient in obvious distress and you call the nurse!  But you are not jeopardizing lives by charting 8, or 10, or 18 or anything else. Your job is much more important than just writing down a number. Focus on caring for your patients and showing the care for them that you clearly have. You sound like a great CNA! 

[JBMmom, MSN, NP]

On 11/12/2022 at 2:38 PM, avo_921 said:

I am also a lowly CNA

This is a bit off topic, but it's pet peeve of mine. PLEASE, everyone, no matter what your job is, stop putting it down! "Just" a CNA, a med-surg nurse, LTC nurse, LPN, etc. We are ALL playing and important role in the lives of our patients. Your patients need YOU, not a flight nurse, not a CRNA, not a MD or whatever else people are putting up as the high standard that they are somehow not meeting by being themselves. 

We're all doing our jobs to the best of our ability (or at least I hope we are), and that's enough. YOU ARE ENOUGH, in whatever role you're fulfilling, in the lives of your patients. 

[Anxiousandafraid]

On 11/13/2022 at 9:13 AM, hppygr8ful said:

OCD is treatable with talk therapy, meds or a combination of both. Living under the clouds of your current mental health has to be miserable. You owe it to yourself to seek out a qualified mental health professional.

Yes, I've decided to get treatment for ocd recently. The constant guilt im feeling is overwhelming me. I love and appreciate everyones response on this post. My anxiety /ocd is now wondering "what if someone has suffered because I didn't record their respiratory rate…and I was the only one who noticed the low rate…although I refused to document a false number and didn't record anything …its all my fault ..they may have been released from the hospital and in distress and no one knew they breathed slowly …I don't deserve my job "…its terrible how I think and feel.

[CommunityRNBSN, BSN, RN]

6 hours ago, Anxiousandafraid said:

Yes, I've decided to get treatment for ocd recently. The constant guilt im feeling is overwhelming me. I love and appreciate everyones response on this post. My anxiety /ocd is now wondering "what if someone has suffered because I didn't record their respiratory rate…and I was the only one who noticed the low rate…although I refused to document a false number and didn't record anything …its all my fault ..they may have been released from the hospital and in distress and no one knew they breathed slowly …I don't deserve my job "…its terrible how I think and feel.

The International OCD Foundation has some good resources, as well as a provider directory.  If nothing else, reading some other people's stories may give you a little reassurance that you aren't alone in these cyclical thoughts.