What should I have done? Is it even a big deal?

[SolaireSolstice, BSN, RN]

On Monday I had clinical, and as usual I got the patient's 15:00 vitals for the oncoming CNA. I gave her the vitals, all WNL, RR was *12*. We, as nursing students, do not chart in the computers except for medication administration.

Tuesday I went in early to check the chart and computer and I happened across where the CNA input the vitals in the computer, and the CNA I had reported the vitals to had inputed the Monday 15:00 RR as 16, not the 12 I had gotten and reported.

Well, that's sort of stupid. 12 is a perfectly acceptable RR rate. This is a relatively healthy, active man without resp problems. We are taught "normal" RR is between 12-20, but even if it WAS abnormal, the CNAs should chart what is collected. If she didn't like my vitals, she could recheck them, but I know she didn't because I was with my patient, or near his room until 19:00 that day, and certainly in his room until about 15:45 when I had finished hanging his antibiotic and doing his dressing change and assessment. The rest of the vitals she had inputed were the ones I had given her. She said nothing at the time.

Tuesday's CNA happened to be a CNA I had worked with down in the ER last week, so we got to talking and I asked her about the difference between the RR and why the other (Monday) CNA had changed the rate. Tuesday's CNA told me that she was taught normal RR was between 16-20, probably Monday's CNA had changed it so it was WNL, and then Tuesday's CNA asked me "Do you really count it anyway?" :icon_roll

So, whatever. I wasn't going to argue policy with her, and either rate is "normal". And I know this stuff happens. But should I have said anything to someone? Does it matter? For reference, this is a med-surg floor, mostly post-op patients who are stable.

[XB9S, BSN, MSN, EdD, RN, APN]

normal rates will differ on what ever book you read, I usually go 16 - 20 but if I have a pateint with a resp rate of 14 who looks well and is not distressed or sleepy I wouldn't worry about it

As far as not charting what has been recorded this is not good practice, on a post op patient it could have been a downward trend due to opiates and needed to be monitored, yes you need to count respiratory rates, these are so important in post op patients

I think this is something that you should discuss with your mentor / clinical instructor

[nuwbee25]

I agree. RR is extremely important especially with post op patients. The CNA should not have changed the value you gave to her unless she went in and rechecked the vitals herself because whatever she was writing in the patient's chart she wanted to be sure of it herself. Usually someone will recheck vitals if they are abnormal and want to make sure they were accurate and will then notify the nurse who may or may not notify the doctor depending on the severity of the decline in stability. I personally consider 16-20 the norm and 14 if the patient is in no obvious distress as Sharrie posted earlier. I would reccommend speaking with your clinical instructor, you can choose to keep the person annomyous if you do not want to get anyone in trouble but I am sure the clinical instructor will want to know if a CNA is changing values because that is just not safe practice. I think it is good that you are so determined to get to the bottom of the this situation, it shows you care very much!

[NurseLoveJoy88, ASN, RN]

We are taught that RR should be 12-20, thats the norm. I'm tested on in my nursing program. I'm worried about Mondays CNA. Even if she noticed that you got 12 she should of came to you or rechecked and reported it to you. If 12 isn't normal to her , shouldn't she have reported it to the nurse or the student nurse ?

Shame on her !

[caliotter3]

Perhaps it would be best that you let the CNA take her own vitals. And I agree, discuss this with your instructor/preceptor.

[motyandproudofit]

I started recently as a nurse tech on a med surg unit. My first day I told the tech training me the vitals on a pt she was entering in the computer, she laughed when I said 12. She said she had never heard of such a thing. I told her the norm was 12-20 but she laughed and said "No, I counted and they are 16." Maybe so, but I counted again for a full minute and they certainly were 12 with no distress.

I talked to a nurse later about it and she told me that while 12 is normal by most standards our computer system flags it and a nurse needs to be notified etc. so it is easier to just put 14 (which is within the computer systems normal).

On another end of it, while feeding a CHF patient I noticed his resp's increase. He was at 32. I told the nurse and she brushed me off like I was making it up. She went in and said he was about 24. I swear I count these right. Granted he wasn't in any distress, but he was not 24. He was 32. His resp slowed down when I gave him a rest.