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Do I really need to count a patients respiratory rate for a minute?

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

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Some staff feel that sixty seconds can be better spent.

It is well documented that the respiratory rate is the least accurately recorded vital sign but yet it can be the most important.

Reseach suggests that many students and registered nurses believe they are enhancing patients’ outcomes by performing tasks other than counting a patient’s respiratory rate for the full sixty seconds.

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The research, completed by Flenady et al, suggests that this debate isn’t rooted in laziness but instead staff believe they are enhancing patients’ outcomes by performing tasks other than counting a patient’s respiratory rate.

Do I really need to count for a whole minute?

Yes! It is vitally important you count a patients respiratory rate for the full sixty seconds rather than counting for a shorter period and multiplying, or worse, estimating.

Respiration has differing patterns and without observing these for a whole sixty seconds you are unlikely to obtain an accurate measurement.

The critically unwell patient also sometimes tend to have apneic episodes and counting for a short period may not reveal these until a patient is in full respiratory arrest.

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

Finally, documenting an inaccurate respiratory rate could, potentially, have legal implications.

How should I count a respiratory rate?

You should count each full cycle of inspiration and expiration for a full sixty seconds.

Anecdotally, it is better to count a patients respiratory rate when a patient when they are not aware you are doing so – this ensures a patient is less conscious about their breathing and thus their respiratory rate is more natural.

Why is respiratory rate important?

Haemostasis and the bodies compensatory mechanisms mean that a change in respiratory rate could be one of the first indicators of deterioration in physiological condition.

Changes to a patients respiratory rate can indicate a number of things such as hypoxia, neurological or metabolic changes.

Picking up on these changes early should lead to earlier medical intervention and therefore better patient outcomes.

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Education

One in six nursing associates drop out before qualifying, finds report

Despite this trainees showed “high levels of enthusiasm and commitment to the programme”.

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Only 65% of trainee nursing associates said they planned to work as a nursing associate once qualified.

An independent evaluation of the nursing associate role commissioned by Health Education England (HEE) has found that while there are “high levels of enthusiasm and commitment to the programme”, one in six nursing associates are dropping out before completing the course.

Attrition rates for trainee nursing associates fell slightly below that of student nurses, with 18% leaving before completing the course.

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While ill health and personal issues were some of the most common reasons for leaving the programme, nearly a quarter (23%) withdrew because they failed to meet the academic requirements of the programme – with numeracy skills cited as a key issue.

One trainee said they found the “attitudes towards the role and the negative feedback about Nursing Associates” challenging.

Only 65% of trainees said they intend to continue working as a nursing associate once qualified as the programme is often seen as a stepping stone to becoming a registered nursing.

Highlighting challenges.

Mark Radford, Chief Nursing Officer, Health Education England said the report “highlights some challenges that we must address to ensure that students such as ensuring the quality and oversight of placements, attrition and numeracy support.”

“We also recognise that further work and research is required to ensure that the profession is supported and utilised in the workforce of health and social care as part of the MDT. I am pleased to be able to report that we are in the process of identifying candidates to be considered as NA ambassadors across England.

Commenting on the report, Andrea Sutcliffe, Chief Executive and Registrar for the Nursing and Midwifery Council (NMC), said; “Having had the pleasure of meeting many nursing associates across the country, I am continually inspired by their enthusiasm and dedication for providing care and they should be very proud of the difference they make for the people they support.”

“I look forward to seeing how nursing associates continue to develop and be supported in their work, long into the future.”

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UCAS accused of having an ‘outdated’ view on nurses

They describe the nursing role to prospective students as looking after people when they are sick or injured.

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UCAS describes nurses as providing “support to doctors and other medical staff”.

The Universities and Colleges Admissions Service (UCAS) has been accused of having an “outdated” view on nurses after it described the profession as providing “support to doctors and other medical staff”.

UCAS describes the nursing role to prospective students as looking after people when they are sick or injured. Adding; “You’ll provide support to doctors and other medical staff, take blood and urine samples, and in some cases, you may carry out minor surgical procedures.”

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Nurses, alongside a multitude of other healthcare professionals, have taken to social media calling for the description to be amended so it “adequately reflects nursing in the 21st century”. They also criticised the article for failing to highlight a large number of health promotion and research roles frequently undertaken by the profession.

BJ Walto, a senior member of the Royal College of Nursing (RCN) commented that the description is “inaccurate, demeaning and totally misleading portrayal of nursing.”

Tom Wavlin, a Lecturer in Adult Nursing & Admissions Tutor at the University of Plymouth, suggested the description could instead read; “an autonomous practitioner of nursing who works closely with other healthcare professionals”.

In comparison, the Nursing and Midwifery Council (NMC) website reads; “Registered nurses play a vital role in providing, leading and coordinating care that is compassionate, evidence-based, and person-centred. They are accountable for their own actions and must be able to work autonomously, or as an equal partner with a range of other professionals, and in interdisciplinary teams.”

A spokesperson for UCAS said; “It’s clear that our current role profile for nurses doesn’t reflect the amazing work that nurses across the country do each day, and we welcome the feedback we’ve recently received.

“We want to make sure that students considering their future options have up-to date information about all different careers available to them.

“We’re currently updating all of our job profiles and are in touch with nursing experts to help us make sure that we better reflect the roles and responsibilities of nurses today.”

UPDATE (17/10/19 09:55): This article was updated to include a comment from UCAS.

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