Is this a big deal?

Nursing Students CNA/MA

Published

I work days on a Tele floor and have a few questions about work issues that have come up lately.

This occurred the other day... I came in for shift and got report from the night cna. Before he left he told me that he would help me change a total care patient who needed two people to change her because she would not roll and it was too difficult to do by yourself. He had changed her multiple times throughout the night and I know this to be true because it was documented and a nurse I trust was the second person assisting him. I began to change the boards in that patient's room and he went to check on another patient who was wearing pull ups. This was a youngish guy who was completely alert and oriented. The CNA told me that he was asleep and asked me to check on him when I did morning vitals. He had not changed him during night shift because when asked if he needed it around 2 am the patient reported he was dry (the patient checked himself) and the CNA went to do morning labs and by the time had another moment to ask him again he was asleep (around 6). I do not know if the nurse changed him during the night. I got him changed that morning. So I guess my question is is this something that should/would be reported? I know that there are times I get caught up as well; it doesn't mean I'm trying to cut corners. I always get along with that cna and all of the other patients were repositioned and changed, etc.

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I'm confused.

What would you be reporting? Did he or did he not help you change the total care patient? Did he or did he not check on the AxO patient?

Your narrative isn't clear.

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Sorry! I meant that he had not changed that particular patient that night. I am a new CNA working at a hospital so I do not always know the expectation. I would think it would be a bigger deal if it were a patient who could not communicate and was very elderly but this was a patient in his 50s capable of using his call bell. He can be unpleasant so I think that he didn't want to wake him up just to ask him if he needed to be changed.

And yes he helped with the total patient before he went to check on the sleeping one.

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I suppose it is reportable, technically, if he's incontinent and a Q2 or Q4 check. But I doubt your report would go anywhere. That's a quick way to make some enemies with your coworkers. Was the patient in danger? Did the patient have a bad rash or irritation? Was the patient harmed because he wasn't checked? Plus, you're not even certain if the nurse checked on him during the night. I personally wouldn't think of reporting it.

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I work as a night shift PCA at a pediatric hospital - lots of diaper changes. Overnight, I will go into the room and do a quick check of their diaper or Pull-Up about every 2 hours and if they're dry, I leave them alone. I prefer to let my kiddos sleep undisturbed if I can, and I would give adult patients the same courtesy. Changing patients every 2 hours regardless of if they're wet or not seems a little much to me. Now, in terms of charting, I go into my I/O flow sheet and write a little comment next to output that says "patient dry" or something to that extent. That way, other people know they were at least checked instead of nothing being charted for I/O for like 8 hours. Perhaps you could suggest that to your coworker to prevent confusion in the future.

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if the guy is alert and oriented, and told him that he was fine..what is there to report? myself, i will do the same..if someone tells me they are fine and dont want to be bothered, i wont bother them again until my last round..if they are asleep and not obviously wet, i just let them be. its bad enough waking them up for vitals every 4 hours. if you go and nark on someone for something this petty, you will quickly end up with enemies, and even the nurses can end up not trusting you, if you run and tell on people for every minor wrongdoing.

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On the tele floor where I work, it does need to be brought to the RN's attention if a patient is not voiding. Except in certain cases where low/no output is expected, we report anything less than 240 mL/8 hrs because our patients are often diuresed/at risk for fluid overload.

As far as the brief situation goes, if the guy is A&O and capable of checking himself and will report when he voids or needs a new pull-up, I wouldn't worry about that. Offer him a fresh pull-up at the beginning of the shift (they get kinda stanky even if they are dry) and don't dwell on it.

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Sorry! I meant that he had not changed that particular patient that night. I am a new CNA working at a hospital so I do not always know the expectation. I would think it would be a bigger deal if it were a patient who could not communicate and was very elderly but this was a patient in his 50s capable of using his call bell. He can be unpleasant so I think that he didn't want to wake him up just to ask him if he needed to be changed.

And yes he helped with the total patient before he went to check on the sleeping one.

Ugh???

If the person is alert and orientated, what's to report? He would apparently let y'all know whatever he needs OR don't want.

I don't get why this is a question. was he even soiled?

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