I have been a CNA for about two years. I have never really gotten into it with any nurse before tonight. I got into it with the night nurse and the evening nurse. It was about 10:40 PM. I was doing my last rounds and I was going to put my late-night patient to bed.
So I walk into his room and start taking off his clothes, and his colostomy bag leaked out everywhere. (He always picks at it, he has heavy dementia and always forgets what it is). So this is a very common occurrence (it already happened once during the day before I gave him a shower). Now, I go to the nurse and I tell her. She is filling out her documentation and she said she would be there in about five minutes. So I went and cleaned him up really good and got him all dressed and had him hold some wipes over the stoma. She still wasn't there, so I went with another CNA and finished my rounds on my patients. Then 10:50 came around and she still was sitting at the desk doing paperwork and talking to the night nurse.
I went up to her and asked her again, she said she forgot and would be there soon. So I went and did some re-checking on some of my patients. I changed someone and came back and SHE WAS STILL AT THE DESK GIVING A REPORT NOW.
I walked up to her and she said she was busy doing the report at the moment and would do it when she is done. This was about 11:00... The end of my shift... SO at this time I figured I would completely get him ready for bed by changing the leg catheter bag with the foley bag. I did that and had to re-clean him and change his gown because he "forgot" to hold the wipes on the stoma and feces got all over the gown. Now, I was angry. I walked out there and told them he is sitting there and I'm going home, the night CNA could put the patient to bed, he's all ready, he just needed the colostomy bag replaced. They said that was fine.
I even told the night CNA and she said it was okay. So now, I was doing my documentation and it was 11:20 and the night nurse was sitting at the desk and said that he needs him in bed so that the skin can stretch properly and he can place it in. I said, "well, you can have you night CNA do that because I waited for you guys for 30 mins and you kept telling me to hold on" and he said, "you were waiting for (evening nurse's name) not me". I said, " sorry, but if you would have told me at 10:50 when you heard me talking about it I would have done it." So it got quiet and I finished my paperwork.
I was leaving and I said bye as I walked away, both the nurses said to me, "Did you put the patient to bed?" I obviously said no. They then went on that it was my job to put the patient to bed, and I could have just put a towel over the patient's stoma and covered him up and if he made a mess in the bed they would have cleaned it. I told them firstly, "you should have told me from the beginning when I told you he was sitting and waiting for the new bag to put him into bed and I would have. Secondly, it is un-ethical and un-moral that you guys had him wait for 45 mins almost an hour (it was 11:35 at this time) to have a bag put on, while you did paperwork and reporting that could have been halted for five minutes." They then went on to explain that it was still my job to put my patient into bed, no matter what.
I then brought up that I was not going to put my patient to bed and have him soil the entire bed and roll around in it because I knew he wouldn't hold the towel there for very long. Why would I risk soiling an entire bed?
In my mind, I see that as a huge contamination risk and a HUGE waste of material/supplies... Nurse's are suppose to advocate for the patient and use supplies and materials in moderation. These two nurse's did neither I feel and I was made to believe that I was completely doing something against what I should have been.
I feel I advocated for my patient and refused to do something that no human would want. Yes, he was still going to have a soiled gown (even after I changed it, because he forgets why he is holding the wipes on the stoma and it gets the gown dirty), but that must be better than having your stoma squirt out feces while your laying down and the possibility of you rolling around in it... (because with his condition, even if I placed a towel over it, he would most likely move it). Plus exposing the patient to even more contaminated than sitting up in a chair... This just happened 2 hours ago.
What are your thoughts and what should my course of action be? Should I follow up with the DON or confront the nurse/nurses about the topic.
Thanks guys, and sorry for the long novel. I am extremely flustered I walked out saying, " okay you guys are right, goodnight" and walked out the door, I did not want to argue against two people that obviously are teaming up against me for no reason... If the nurse would have said, come with me and put him in bed so I can put it on I would have done it, but he was just sitting at the desk, with no rush to get it on. So I have no idea at what time he would have actually done it....
I would speak with the DON of the facility. I have been working as a CNA for 10 years, and as a student nurse for 3 years. I understand both roles, as I have been working in the nursing system and also have observed the nurses role throughout my 10 years as a CNA. I understand the duties, and have practiced the duties in the capacity as a nurse. Sure it gets busy, sure things get hectic, but at the end of the day we do our best. It sounds as if both sides- yours and the nurse, could have done things a little differently. However, almost one hour to address that situation is inappropriate. I have also worked with many dementia patients, and also patients with stomas. He could have tried to eat his feces, or gotten it into his eyes. It does appear that her course of action was inappropriate, and perhaps the situation can be prevented from happening in the future if it is brought to the attention of hopefully a skilled-leader- the DON. She should have a good perspective on both sides of the situation. If your shift ended at 11:00, you are off shift. It sounds as if you were already assisting the patient off the clock, and staying even later to catch up on your paperwork, that this preventable incident clearly took you away from. As a future reference, perhaps if it occurs again, I would think about putting him to bed before it is time for you to punch out. It is annoying for the other nurses to clean him up, but it is safer for the patient as cleaning up a dirty bed is not as critical to the patient as a decubutis ulcer would be from staying in the chair. Just food for thought. On another note, as for the new night shifts ganging up on you, you spoke to the night CNA, it actually was the night CNA's duty to put him to bed, and the RN/LVN's should have asked the night CNA- the CNA who is on the clock. You were not on the clock, and if an injury occurs, the hospital may not be liable for your injuries. As RN's Im a little surprised that they were not on top of it- it is part of our job as nurse leaders... I am wondering if they did not know the situation at first, and then became defensive after you told them what happened (you were angry by that point, and anger causes the person hearing it to become defensive). If you think that this is what may have happened, perhaps in the future you can keep that in mind when you respond to a person outside of the incident, and keep that perspective that they are completely fresh. You seemed to be understandably upset, but just try to practice not taking your frustration out on the new nurses as a result of the previous nurse- if thats what happened. It is REALLY frustrating, but if you practice that it will actually help to keep you from getting too angry for your own health. All in all, I would definitely speak with the DON. The DON should be aware of the situation, and clarify the appropriate response on both sides. This situation could happen again, and I do not think what the nurse did was appropriate. She definitely will think twice in the future before brushing you off. But that is not the only reason why too. It affects your patient, and if she would do that so "easily", she most likely will do it again. If I was a busy nurse who really had no time to change a stoma bag, I would NOT be laughing with another nurse. It sounds like she wasn't focused or very concerned about the patient... Talk to the DON. As a side note, and as a CNA who does the heavy physical and mental work- therapeutic communication is exhausting for a good CNA- I think that it is important we all respect one another- Nurses and CNAs- for the duties which we do, and work together for the good of our patient. Both roles are CRITICAL to our patients, and we cannot have one without the other to properly care for our patients! What if it was us who was the patient?!
Last edit by Mrs. Sunshine Lily on Feb 16, '13