punishment advice.....please......

[Seamless LVN]

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....

[pagandeva2000, LPN]

I think that you should discuss it with the charge nurse (unless you hold that position yourself) or a more senior nurse or nursing supervisor. See if this person has a long history, and also assess how you think these people will support you. Many times, I have seen management turn a blind eye to the mishaps of the CNAs and nurses. If you think that they will not support you, either take the vitals yourself (it is hard to, I know with many people) or make sure you leave there before something happens under YOUR license.

[P_RN, ADN, RN]

Uhhhh I have documented proof positive that MY OWN rr is usually in the 11 range. Maybe your tech did note a slow one and counted a full minute.

[nursemike, ASN, RN]

Kinda looking at the other side of the coin, I've had aides I trust tell me that some nurses will ask them to re-check a BP with a larger cuff, in the hope it will be lower and they won't have to do anything. I can't be sure the nurse was wrong--I'll switch to a larger cuff, myself, if it's a better fit. I'll occassionally ask the aide to get it manually, too--but usually, I'd rather do my own manuals, because it's nice to hear it with my own ears.

For awhile, our aides were using a Dynamap that was highly unreliable, and I said I could get a better BP by standing in the doorway and visually estimating. Didn't actually do that, of course, and it has since been repaired and another one purchased. Still, I feel like if the machine says it's normal, it's probably close enough, but I don't trust the Dynamaps or the telemetry monitors enough to medicate based on them alone.

I did once have an aide report a fingerstick of 152. Sliding scale started at 151. IV metoprolol or hydralazine is one thing (well, two things) but getting 2 units of Insulin is just a huge ordeal, any more, so I asked the aide to get me a manual reading. (She was one of the ones who'd told me about nurses' tricks.)

[sweetmuffin48]

I do a lot of my own vital signs, especially if i am going to give lasix or a pain med where vitals are important...I have learned there are care tecs that are good and you can trust and others who don't even know how to take a manual blood pressure. I once had a tech who floated to our unit who said my dying patient had respirations of...yup, 20...when really it was five a minute...you don't want to anger your techs but you also have to obligation to make sure your patients are safe

[cherokeesummer]

This problem (inability to count, laziness, or whatever) isn't limited to the unlicensed.

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.

I found out (after I left the facility) that she was later fired for issues relating to T & A fraud because she was having someone clock her in before she arrived for work.

Not to be silly or anything but I do occasionally count the full minute for my respirations and for my pulse...especially with my newborn patients but sometimes with adults when I'm having a hard time concentrating or if something seems off I will go and do it a full minute (many times on newborns I've had to do it af ew times b/c their breathing is so funky sometimes!) :):) But hers do sound funny espeically with a history!