Anxiousandafraid

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.

I guess my problem is I’m very very literal. So for instance I can be in a room with a patient that is VERY calm , watching TV and not in distress at all … but all I can count for them is 8 RR … I get stressed KNOWING the system will turn red for them and the nurses will be annoyed BUT then I’m also annoyed with myself because I know it looks bad and there’s no one in distress

Thank you so much ...my ocd has had me STRESSED for the past two days obsessing and feeling so much guilt. It's funny I went to the Dr yesterday...literally held my breath and they charted 18...anyway I love your response the problem I'm having is that I DIDN'T chart the 8 ...I only left a note and explained patient not in distress. I was a coward and didn't chart the value allowing it to turn red (in out system an 8 is a possible sepsis)...so I put a note in the value field ..later I went and recounted when patient was sleeping and obtained a 10 and charted that value ...other than leaving a note to possibly assuage my guilt of leaving a trail of the numbers I honestly obtained but also NOT frustrate the nurses with vitals in the system for patients obviously not in distress I haven't found a solution ...I ALWAYS aim to be honest...I have black and white thinking ...and my ocd has been saying "im sure that patient is fine ...they've been discharged ...BUT then again ,you left a note instead of charting that 8 ...maybe they're suffering now and you could've prevented that”…. I know a RR is one of the first indications of something “brewing” … how long usually between the time of noting abnormal vitals or RR does those other signs appear ? If I saw patient Thursday night … and close to 24 hours later they were being discharged would something else like other signs had presented themselves by then before they left ?

Thank you. And this is the part causing me mental torment. I have tried to find a way to be truthful but also not annoy the nurses. I can understand their frustrations honestly. I wasn’t trying to lie in my charting but left a note instead of a value because I know the nurses treat patients and it numbers and the nurse had already send the patient and determined he wasn’t in distress but my Literal thinking is always “did you see this number … chart that “ and the nurses are freaking out like “nooooo. They would be in ICU with that “

Thank you. I’m going to just step down and leave my job. I again LOVE what I do. And can totally understand the frustration the nurses share. I would too be annoyed with someone charting 8 and having an alert next to it for someone who is other wise fine … I thought leaving the note would still give me some peace as to not try to totally omit the RR… now I feel guilty. I feel so much responsibility whenever someone is discharged and think “they will die because you didn’t chart 8 although while they were watching tv, on the phone … alert and awake all night “

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.

So I’ve decided to go PRN. I’m such a thorough black and white thinker … meaning I can see a patient walking , talking doing everything perfectly and I feel compelled to still document if their respirations are 8… I literally can not write a RR I haven’t literally counted. I have ocd. My nurses get annoyed with me due to documenting accurately. I’ve LITERALLY had nurses day .. “no don’t document that … put something normal … just put 18” . I legit spend my days off dreading going back to work out of fear that I’ll have abnormal vitals to report or the nurse will think I’m stupid. I get how people can have trauma from the workplace. It’s a joke at my job that I’m the only one counting RRs. Someone will have 18 for days UNTIL income to work and now it’ll be “12,10,14” because I’ll literally count. NOW we have Epic and I love that in a sense I still can cover myself by leaving a note but may not chart the low rate in the value field alerting the system but still leaving a note. I told nurse patient with perfectly other fine vitals had low RR .. (didn’t tell how many I counted .. just said low ) … nurse had literally just come out of the room talking to patient when I told this. I said I’d reasses when patient slept. Nurse said “oh he’s fine , not in distress. RR will be 20” … later when patient slept I DID reassess and it was 10… patient seemed to just have a baseline of breathing slow .. and actually breathed slower while awake. Anyway … is this unethical to leave a note in the system instead of charting the value especially if nurse had spoken to patient and didn’t seem concerned ? I know sooo many nurses that admit to not counting at ALL and I genuinely think they’d be surprised the one day they did count because for ME the patients that have low RR are usually the ones that have normal vitals , walking and talking just fine. I admit I can see the frustration that they feel for me when I document low numbers that the system will flag. IDK at this point what to do to not have a bad working relationship with all my nurses …I genuinely feel a HUGE responsibility like the one time I omit a low RR someone will die because of me. I literally feel that kind of pressure over a respiration. Even now I’m feeling heavy guilt ALTHOUGH I left a note but my anxiety is like “well people think you’re silly for documenting low numbers so they wouldn’t have taken it that serious … but maybe if you documented the 8 while patient was awake someone could’ve intervened or something “.. patient was discharged the next day and again seemed fine… am I overthinking to think “patient may go home and die because maybe the low breathing rate was an indicator of something bad about to happen and I could’ve been the one to possibly trigger the indication for them to assess more … or am I being dramatic ? And yes , I agree I need therapy (figured I’d say it before anyone else says it. )

Can the person still be reported or no since it was so long ago ?

Care comes natural… me even posting this I hope would show the care I feel for my patients as I wouldn’t take my time outside of work expressing my anxiety about work and reporting to the nurse LOL

I apologize for my defensive response. All in all … I’m just going to document what I get and move on. If they(nurses) get mad ,oh well. I come to do a job and I’ll do it. It’s not (their attitudes ) worth the stress I feel later hoping no one “suffered or died because of me “ by trying to appease them with my answers I obtained . Thank you for your response.

I put “ “ because I was NEVER labeling myself as a nurse. I was saying that’s what the nurse would possibly think when they are charting and notice there’s nothing there … the nurse checks the chart all thru out the night. So I was saying when they notice nothing is there they will say to themselves. So thanks but again I wasn’t labeling myself a nurse. It’s interesting it’s universally almost accepted for everyone to just document 18 but me leaving it blank or telling my nurse that I’m getting a low rate and allowing them to check it instead of putting the low rate is considered terrible. And the patient was awake I was referring to. I mentioned that in my initial post that at times I believe the patient holds their breath while I’m obtaining their full set of vitals. And you’re absolutely correct. I do NOT want to be a nurse. Never have wanted to. I love my job and again as I said I always do the right thing even when I’ve been told by my boss they know people lie and just chart 18. And again I DID notify the RN. I also said that in my initial post. I notified my charge and asked her to assess. Did I chart the low rate .. no. Did I also say I stood outside the door and saw the patient breathing at a decent rate yes. But thanks. Maybe I’ll go flip a burger.

If the nurse “roused” then is not a form of manipulating the numbers ? I’ve even decided to not take respirations while the patient is sleeping and wait until they’re awake. Still sometimes the same result. I’ve had a nurse say “get the respirations now “ after A patient was startled out of their sleep. I totally agree with you. But I ALWAYS do the right thing and put the accurate numbers just for the nurse to chart next to mine “18” or question me like I’m stupid. Leaving it blank in my opinion outside of me notifying the nurse also says “okay it’s blank …there’s nothing there .. I (nurse) need to ask why or assess and enter a number “ … it’s affecting my mental health. At first I pretended and thought maybe I’m not sure in my numbers if everyone else is getting 18. But I knew I was discounting myself. Now it’s offensive and causing me stress to do the right thing and then be told “it makes us look like we don’t know what we are doing “…. This isn’t an everyday occurrence but I had to choose my sanity and walk away. I know my job is to report and document. I have been told by my charge to maybe let the nurse assess before documenting an abnormal rate.

I USUALLY chart EVERYTHING. I'm learning to step back and stop putting unnecessary stress on myself. At work a few nights ago my nurse questioned my ability to do my job because out of ALL my patients she didn't like that this patients vitals were high. I don't lie or add fake numbers. I'm actually one of the only staff who doesn't just chart 18. I just count ?‍♀️ there are times I struggle because I'm doing my job correct but the patient has low breathing rate. Sometimes patients hold their breath while getting their vitals. I had a patient that I didn't record any breathing for all night HOPING I'd get one good number. I did watch from outside of their room and I think I got a good number..didn't record it but was comfortable knowing in my heart they were not in distress. Eventually told my charge nurse that I had no number recorded because it all looked so low. Admitted their sleep rate was extremely low but asked could she assess. I am done carrying a burden of shame for being honest so now I’ll give the burden back to the nurse to assess themself. Honesty has caused me major anxiety at work and insecurity. My bestfried who is a nurse basically agrees that I should just put a “normal number” if they don't appear to be in distress. I'll leave it blank before I falsify a number. My anxiety is trying to make this a huge issue and it's trying to guilt me into feeling undeserving of a job. I always think “if I don’t record MY number and everyone else is lying … someone could die because of me”. Is it wrong to allow the nurses to assess themselves and me not put anything for a number that is deemed too high or too low ? I’m tired of being treated like I’m dumb when they see the answers I submitted. I’ll put the right and they’ll still chart next to mine “18”. I can’t win.

Has anyone ever self reported themselves for violating HIPAA ? Whether it be sharing a story with family , viewing a record anything ? I feel so terrible. So the backstory is I’m a CNA. My nurse basically was upset with me for writing true accurate low RR. That has triggered me to be fearful and insecure at work. I was told that I can possibly hold off and go back to check the RR again if abnormal or enlist the help of a nurse to verify before submitting. Anyway I had a patient with a low RR while sleeping. Eventually it rose a little. I have severe anxiety. I panicked thinking Omgggg what if I’m the only person that knows truthfully this patient has the low RR because almost everyone submits the lucky number “18”. Anyway came back to work and the patient was discharged. My heart sank and my anxiety was doing flips. “What if they died. What if it’s my fault. What if this what if that. “ Then I thought “well they’re discharged but their chart is still attached to your user id… just check to see if maybe sleep apnea is in their file so you can move on and not obsess over this patient “..(I also deal with an inflated sense of responsibility “. So I scanned the now discharged patients file and I knew better. I feel so guilty. I haven’t heard anything from my employer but I feel ethically wrong. Would you tell ? Should I tell ? I just didn’t want to obsess only to find out “okay this patient had sleep apnea … they knew / know about it. Move on with your life “

Hello I’m struggling with doing respirations. At times I would do 30 seconds and if the timer stopped as a person finished inhaling but NOT exhaling I would still count that by 2. Meaning if they had 8 FULL respirations and that last inhale I would end up with 17 as a RR. Someone told me this is wrong. Then I would have my timer end as someone was MID exhale (their tummy would still be decreasing as the timer stops ) … I was told this is also wrong and can’t be counted because they were still exhaling. Please help me in what I can and can NOT count as a respiration. It’s simple I know but seriously stressing me out.