“You should never give oxygen to a patient with Chronic Obstructive Pulmonary Disease (COPD)”. It’s an age-old myth and more than anything it is wrong and endangering the lives of patients everyday.
When I was a Student Nurse I explicitly remember being told by many, many Nurses, that putting oxygen onto a patient with COPD will cause them to retain carbon dioxide (CO2), remove their hypoxic drive and promptly send them into irreversible type 2 respiratory failure. This is partly true, but it is missing several pieces of information.
Let me start by saying, that not all COPD patients are CO2 retainers and chronic CO2 retention only stands at around 20% of patients with a chronic respiratory disease. Even then only a marginal PC02 increase can be detected with know retainers on 100% O2 for 20 minutes (Wilson, 2012). Acute CO2 retention is a possibility for ALL patients not just those with COPD.
I cannot stress to you enough – If your patient has low saturations – give them oxygen! In an emergency situation when your patient is acutely unwell, and/or their oxygen saturations are below any specified values for that individual patient, start at 15L via a non-rebreathable mask and titrate downwards as able, the saturations you are aiming for should be specified by a medic. You should never withhold oxygen from any patient when they urgently need it, as emergency Patient Group Directives (PGD’s) are in place to implement this treatment, and guide your patient/oxygen management with support from the Resuscitation Council guidelines. You should ensure medics are made aware ASAP and an arterial blood gas (ABG) is completed, this is to assess for adequate oxygen saturation and to monitor for hypercapnia.
Ultimately it falls down to this – low oxygen saturations are going to cause multi-organ damage and cardiac arrest through hypoxic damage much, much faster than CO2 retention. Plus CO2 retention is, in most cases, reversible.
“You can reverse hypercapnia, you can’t reverse death” is something that should be taught to Nurses and Students around the world in order to prevent unnecessary deaths. A fantastic fact sheet about COPD and CO2 retention can be found here.
One in six nursing associates drop out before qualifying, finds report
Despite this trainees showed “high levels of enthusiasm and commitment to the programme”.
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.
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.
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.”
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.
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.”
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.
Mental health and learning disability services are deteriorating, says CQC
Growing pressure on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients.
Nursing vacancies hit record high leaving patient care at risk
It can be "dangerous" when there aren’t enough nurses to provide care.
Healthcare staff have a ‘professional responsibility’ to get the flu vaccine
This seasons flu vaccination target is set “above 90%”.
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