Okay, So I'm a new nurse working on the Rehab unit of a geriatrics based healthcare center...
I noticed the Vital signs sheets were looking a little shady with ALL the residents respirations at 20 and 22 bpm's....I was given the authority to discuss the issue with the Cna's and hand out any write ups if need be....BECAUSE.....they are obviously falsifying some very important information. I approached the first CNA writing down his vitals and what do you know....20, 20, 20, 20 and 18 respirations for his 5 patients. I asked him if he knew what the normal resting respiratory rates were. what did he say? "18 to 20"...I couldnt help but laugh...the charge nurse took over from there and proceeded to lay into him. He stormed off in a RAGE.
20 minutes later i walk into the employee break room and there he was, still yelling about how we accused him of falsifying records. (a new orient cna told me NONE of the cna's were even counting resps !)
i sat down and over-apologized if we had embarrassed him, he interrupted me, insulted me, disrespected me and ACCUSED ME OF HASSLING HIM ON THE BASIS THAT HE WAS PHILIPINO.!!!!!!!!
yep, he pulled the race-card.
NOW................as a new nurse, i dont want to come in and alienate the entire cna staff. I want them to respect me, and i want them to do their jobs...correctly.
I am thinking of bringing the issue to the DON and writing him up...but I'm not sure how to handle this siuation. comes to find out, he has been a behavior problem before, so do I throw him under the bus already or give him another chance??
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
ALL of my patients have RR of 18, whether in actuality 9-40, I don't even pay attention anymore.... this issue has been brought up at work ad naseum.. I just do my own
I worked with an RN that frequently documented the RR as 11. Not 8, not 12, but 11! Now 11 is a prime number, meaning it's not divisible by anything...you can't tell me that she sat there for an entire minute for each patient and counted the respirations.
What's funny is that 18 isn't divisible by 4. If you count for 15 seconds you will either get 16 or 20, but not 18. 18 is kind of a suspect rate.
I'm a new graduate (haven't taken boards yet) and a NA. When I was oriented to my med/surg floor the NA told me just to look at the pt and guess what his/her RR was. :hdvwl: So obviously I didn't take her advise.
In nursing school, we were taught to take the RR while we were taking the pulse, so the pt wouldn't "catch on" to what we were doing. However as a NA you don't take the pulse, the dynamap does. So I get to stand to the side of the room, pretend I'm writing something on my notes, and take the pts RR. :grn:Needless to say, the pts either catch on or think I'm weird looking at their chest! :hehe:
Okay, So I'm a new nurse working on the Rehab unit of a geriatrics based healthcare center...
I noticed the Vital signs sheets were looking a little shady with ALL the residents respirations at 20 and 22 bpm's....I was given the authority to discuss the issue with the Cna's and hand out any write ups if need be....BECAUSE.....they are obviously falsifying some very important information. I approached the first CNA writing down his vitals and what do you know....20, 20, 20, 20 and 18 respirations for his 5 patients. I asked him if he knew what the normal resting respiratory rates were. what did he say? "18 to 20"...I couldnt help but laugh...the charge nurse took over from there and proceeded to lay into him. He stormed off in a RAGE.
20 minutes later i walk into the employee break room and there he was, still yelling about how we accused him of falsifying records. (a new orient cna told me NONE of the cna's were even counting resps !)
i sat down and over-apologized if we had embarrassed him, he interrupted me, insulted me, disrespected me and ACCUSED ME OF HASSLING HIM ON THE BASIS THAT HE WAS PHILIPINO.!!!!!!!!
yep, he pulled the race-card.
NOW................as a new nurse, i dont want to come in and alienate the entire cna staff. I want them to respect me, and i want them to do their jobs...correctly.
I am thinking of bringing the issue to the DON and writing him up...but I'm not sure how to handle this siuation. comes to find out, he has been a behavior problem before, so do I throw him under the bus already or give him another chance??
i need some advice....
First off, I haven't read all of the replies, so if I am being redundant, please forgive me.
I intend no disrespect whatsoever, but I think you guys really flubbed this one. While I don't condone the CNA's reaction, I can understand how he felt singled out and disrespected.
My suggestion would be that you need to have an inservice for the CNAs on vital signs. Include all of the VS, not just RR. Include information on correct BP cuff placement, selecting the correct size of BP cuff for the patient, correct methods for determining HR, etc. For example, if the patient has an irregular heart rate, the automatic BP cuff may give you an inaccurate HR, so it's important for the CNA to palpate the radial pulse even if using an automatic BP cuff. If the HR is irregular, they need to count for a full minute. If it is regular, they can probably go by what the automatic BP cuff tells them. This also gives the opportunity to actually count respirations using the ol' "checking the pulse" trick. Include information on why it is important to count RR, and situations that would warrant notifying the nurse of abnormals.
Make the CNAs feel included as valuable members of the health care team. Have a brief quiz and skills check at the end, that you can put in their personnel file, showing that they were given training in this skill. Give them a little goody for coming to the inservice, like a pen or pad of paper with the company logo; something practical that they can use on their job.
I think the title of your post "punishment advice..." is telling. Again, no disrespect meant, but rather than looking at punishing these CNAs, which will serve only to lower their morale and further alienate them, I think they need some boosting and encouragement, and positive reinforcement. Go out of your way to catch them in the act of doing something right, and give them recognition for it. Even if it's something as general as "You did a good job today.".
In the future, if you observe a CNA doing something incorrectly, stop them if it is a danger to the patient, but otherwise take them aside quietly and privately later on, and start with some positive words like "I notice you treat all the patients so well, and I appreciate that. But, I noticed you didn't count respirations on "Mrs. Smith". You really need to count because "XYZ". I know I can count on you to keep doing the great job that you do.", or something like that.
If, after these types of efforts are made, this continues to be a problem, then disciplinary action in the form of write-ups would be appropriate, but again, these should be handled privately and discreetly.
This is a problem everywhere I guess. I thought it was just my hospital. On the floor I used to work on I actually had 2 CNA's (that I know of) that could not take manual blood pressures or would not tell me if the pt's VS were not WNL (I think they didn't know what WNL VS were). Everyone who is involved in a patients care should be able to at least notify someone that a patient is in distress. VS are a key factor in that.
Specializes in Did the job hop, now in MS. Not Bad!!!!!.
This is a problem everywhere I guess. I thought it was just my hospital. On the floor I used to work on I actually had 2 CNA's (that I know of) that could not take manual blood pressures or would not tell me if the pt's VS were not WNL (I think they didn't know what WNL VS were). Everyone who is involved in a patients care should be able to at least notify someone that a patient is in distress. VS are a key factor in that.
All the more reason for in-services, validation, training...Not punishment. My only disclaimer to this is the loud bullying that this CNA had in immature retaliative fashion to a request from the OP.
And again, I truly believe that CNA's are part of the team towards pt. care. Are they subordinates? I don't believe so, but I'm new. I admit, I haven't memorized all the laws and manuals. Oops! But I do know how to properly treat another human with respect and favor and I don't see that this CNA was capable in duty nor in behavior.
Specializes in ER, ICU, Infusion, peds, informatics.
i'm a new graduate (haven't taken boards yet) and a na. when i was oriented to my med/surg floor the na told me just to look at the pt and guess what his/her rr was. :hdvwl: so obviously i didn't take her advise.
in nursing school, we were taught to take the rr while we were taking the pulse, so the pt wouldn't "catch on" to what we were doing. however as a na you don't take the pulse, the dynamap does. so i get to stand to the side of the room, pretend i'm writing something on my notes, and take the pts rr. :grn:needless to say, the pts either catch on or think i'm weird looking at their chest! :hehe:
when i was a cna, i always did the resp rate when i was taking the temp. the thermometer had the nice little timer feature, and with the temp probe in their mouth, they couldn't talk. the temp was usually done before 30 sec were up, but i would just leave the temp probe in their mouth until i was done counting.
[color=#483d8b](we didn't have dynamaps, so i had to check the pulse, too; but i always tried to do the rr while that probe was in their mouth.)
I, as a student, have noticed gross differences between what the true resp rate is and what is documented in the chart. (saw one lady hyperventilating from across the room at over 40 breaths per minute but she was charted as 16). However, you have to be careful when you accuse someone of something. Unless you personally went directly behind this CNA and counted respirations immediately after he did them and got a very different number, you really can't say that his numbers weren't correct at the time that he did them. I don't think taking an accusatory tone was warranted. I think an inservice stressing the importance of respirations and accurate documentation of them, and letting the staff know that someone is keeping an eye on this situation might be a better way of handling it.
just to cover my rear, I am an all out advocate for the aides. I know they work so hard and do so much we just dont want to....i appreciate them wholeheartedly and have been so good at treating them with respect, as i see the other supervisory staff treating them as disposable commodities.
I think we can do an inservice on the importance of the RR's. I realize this is a problem EVERYWHERE, but I know we can tackle it ! !
Chloe'sinNYNow
562 Posts
:smiletea2:
I have this innate need to be able to remedy things. I think it led to entering nursing!
Chloe