Falsifying Respiratory Rates

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Falsifying Respiratory Rates

Hello Nurse Beth,

As a nursing tech is it okay if I chart but include in the notes who told me to chart it? Also while orientating at the beginning of starting my job my preceptor would have me chart under her name to learn the system. We would get the vitals and she would have me type them in.

I would stop when I saw the RR portion and ask what number because I knew I wasn't counting and she would usually say "18”…. Even now sometimes I leave that portion blank if I am unable to accurately obtain the RR.  I'm almost positive she weren't counting. Anyway every time it came to the RR portion I'd stop and ask because it WAS under her name after all and she would tell me the number. It became so repetitive I eventually said "what do you want me to put for RR...18?”

I would never make a number up under my name but I didn't submit anything without her approval. Actually there were times (two women trained me and did the same ) I'd literally count the RR and wanted to submit my number and was told "no, that's too high... put 20..” or something that was contrary to what I got. So my question is ... I know a lot of people don't count RR and it's no excuse but since I was the one typing (although under their name and under their guidance ) am I responsible for the lie?

Should I quit my job or confess to my employer? This was months ago and thankfully I no longer am training and I am very anal about my RR and do not submit just any random number. Also, do you have any advice on finding a mental health professional for those in the health field?

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Specializes in Tele, ICU, Staff Development.

Dear Should I Confess,

Do not quit your job based on this alone and do not "confess" to your employer. You could let your manager know about this orientation practice, although it's possible management knows and is turning a blind eye.

This is such a pet peeve of mine- falsifying respiratory rates (RR) for convenience. It indicates a lack of critical thinking and professional indifference. Shame on nurses who do this.

I have worked with nursing assistants who always chart 18, or 16. Once my nursing assistant documented 16 and a pulse ox reading of 89- pretty much incompatible. The patient was in respiratory distress and her actual RR was 24. 

Your gut feelings served you well-what you were being told to do was wrong. Once a physician asked me to document in the progress notes that he visited a patient a half-hour earlier than when he was actually there. I felt immediately confused (gut feeling) when he asked me, and a part of me wanted to comply and please him, but I did not document what he requested. Only years later when this physician was in the news for malpractice suits did I realize I was almost manipulated into doing something wrong.

Respiratory count, quality and regularity are part of a skilled assessment. RR should be counted for 30 seconds and multiplied times 2 if regular. Count for one full minute if irregular.

In your case, as far as documenting false vital signs under another clinician's name- technically you are acting as a scribe and the person who is logged in would be held responsible for the information.

However, documenting under another clinician's login is the first problem here. You should only document under your own login. Making a note while under someone's login further complicates the entry and is not advised. Likewise, never share your own password or allow someone to document under your login.

As far as a mental health professional- check with your insurance and also your Employee Assistance Program (EAP). You may be entitled to free counseling. If you are experiencing any serious mental health symptoms, see your provider for a diagnosis and referral. Symptoms can include anxiety, depression, and sleep irregularities. Don't hesitate- you are not alone and there is treatment.

Best wishes,

Nurse Beth

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