Inaccurate respiratory rates

[MattNurse]

Do you trust the respiratory rates the CNA's chart?

I notice that some of the CNA's on my unit always chart the same number for respiratory rate. The other day I had 5 patients and all had vitals Q4 and each time their respiratory rate was 18, for 15 sets of vitals that seems astonishing and improbable. When I was doing my assessment some had RR of 11 to 25. It frustrates me since respiratory rate will be one of the first things to indicate a problem.

[HollyGoLightlyRN]

Working as a CNA through nursing school has made me realize that when I'm working as an RN (when I graduate next year) that I will need to take my own vitals. I learned quite quickly that some of the CNAs didn't just make up RR, they would make up ALL the vitals! I couldn't figure out how some of them always were finished SO quickly with end of shift vitals and I'd be struggling to get them done. Ummm they weren't even taking them is how. They would go in the patient's room to make it look like they were doing their job, but I started noticing that they would close the door, or pull the curtain all the time. Jeez. Seriously?

[Burn-Unit-RN]

Honestly as frustrating as it seems, I can understand where some of the CNA/PCTs are coming from. Some of them are assigned to take vital signs q4 for an entire unit, which may include 30+ patients (on top of washing up god knows how many full care patients). As a former PCT while I was in school I can understand how difficult that might be with the constant patient requests. Every patient whom you go in and see needs an extra pillow or glass of water which slows everything down. Any nurse who expects the the CNA to stare at the clock and count respirations for a full minute is being unrealistic. I do however expect at least a 15 second check. As the RN taking care of the patient, it is my job to assess the patient and assure what the CNA wrote is correct.

[MattNurse, MSN, RN]

Working as a CNA through nursing school has made me realize that when I'm working as an RN (when I graduate next year) that I will need to take my own vitals. I learned quite quickly that some of the CNAs didn't just make up RR, they would make up ALL the vitals! I couldn't figure out how some of them always were finished SO quickly with end of shift vitals and I'd be struggling to get them done. Ummm they weren't even taking them is how. They would go in the patient's room to make it look like they were doing their job, but I started noticing that they would close the door, or pull the curtain all the time. Jeez. Seriously?

Wow! That is crazy to read. I was always concerned before we got autocuffs about the quality of every 120/80 BP I got, but assumed now with vitals the only thing a person could really screw up is the RR. I use to always take a manual BP myself but in the last few years have been trusting that the CNA's can use the autocuff easily.

Do you think it is a lack of understanding? Or pure laziness? I don't know how someone could make up vitals in the manner you explain, but believe it to be true (sigh).

[HollyGoLightlyRN]

Honestly I think it's more a matter of WAY too many patients per CNA. In utopia it should take someone only 3-4 minutes to take a set of vitals. But in the real world you know if you go in that patient's room they will need to go to the bathroom, need to be changed, repositioned, etc. If you've got 10 patients and have timed vitals that need to be done within a 30-60 minute window you do the math. That is 3-6 minutes per patient and that is simply impossible! Then throw orthostatic BP's or weights in there and you've created a nightmare for the CNA. Honestly I think vital signs should be the responsibility of the RN. Meds and patient status are based on those numbers. If the RNs are doing them during their assessment anyhow, WHY are two people doing the same assessment?

[Jenni811, RN]

i usually get 14, 16, 18 and 20 alot. I count for 30 seconds and multiply by 2.

[Been there,done that, ASN, RN]

I have noted for YEARS that respiratory rates have been recorded as 16 to 20 across the board!

I gave up trying to get administration to understand the ramifications of this false reporting.

Makes ALL the difference in my prioritization if the respiratory rate is actually 8 or 28!

[CoffeeRTC, BSN, RN]

bwhahahah. Sorry, I needed to laugh. One of the duties of the CNAs in my facility (LTC/ Rehab) is to get vital signs. Half or more of them cannot do them without using a manual cuff, pulse ox for the pulse readings. Temp is the only one I do trust when the thermometer is working and the resps....yeah, totally made up.

How do I know that they are made up.....um, we've "taken" all of the equiptment, but the vital signs magically appear in the book. Interesting. Some shifts it is a matter of staffing etc but if you have time to take a smoke break, sit around etc..you have the 5-10 minutes to to the vitals. Really..it might just be a matter of 5 or so people that need them.

Bevore there are arguments...sometimes it is a learning issue and I've taugh or helped out with teaching how to do it (how do they pass the cert test?) If it is busy, I will do them when I can...I've worked as a CNA before and many a shift pitch in an always help.

[Mikeal]

I work in a teaching hospital and am a nurse tech and have been for 16 years and am now in nursing school, and I see seasoned nurses using "guesstimations" on the patients which in turn teaches nursing students that this is okay. I always count respiration's since this is an indicator to so many different things, i.e. medications, asthma, COPD, anxiety etc. It's disturbing to me that people take this so relaxed.

[Xlorgguss]

I notice this a lot. I see RR 18 all the time. Then when I take them I get like 36....

[DarkEyed]

I generally trust CNAs. In a critical case or a patient I am concerned with I will do respers myself. I have also noticed with certain CNAS that all my patients had RR of 16. What a coincidence!