Nurses just want everyone to have a foley!

NurseyBaby'05, BSN, RN · Dec 30, 2006

When we have patients like this, I often bring up the issue of skin breakdown. Sometimes it works, other times it falls on deaf ears. The times where it falls on deaf ears, it takes the pt's skin actually breaking down (unnecessarily, I might add :angryfire: ) before they agree to having one placed.

SuesquatchRN, BSN, RN · Dec 30, 2006

An issue in NYS is legislators managing health care. Urinary continence is help up as something to be restored in many instances. I imagine that there is a law behind this that the administrators are not sharing with the hands-on care providers.

SportyNurse · Dec 30, 2006

There are only two reasons that we will leave in a foley in our facility:

1. Structural abnormality that prevents bladder emptying (e.g. enlarged prostate, or urinary retention problems)

2. Excoriation or wound in the area that would be worsened by urine

Other than that, they come out. Yes, it means a lot of wiping butt, but it's what we do, and it's what is usually best for the patient. Our patients that do have foleys because of one of the above reasons (almost always #1) they have the most horrific chronic UTIs. We have several different versions of a bladder training program. However, my facility's (and my own personally) policy is that a foley does not need to be in place for your own convenience.

PMHNP10 · Dec 30, 2006

At the LTAC that I work at, it has become the trend to DC foleys on everyone, including those patients that should always have foleys. Their reasoning for this is that it has something to do with preventing UTIs. I questioned the reasoning behind taking a foley out of a patient that, because of an unfortunate accident, doesn't have a normal urethra and has no way to ask for a bedpan. This patient is a feed, so really can't hit the call lite nor even feel the urge to urinate so utimately is wet a lot. I had the UTI statement thrown at me, and I made the statement that I thought it was undignified to expect this patient to lay in a wet bed, and reiterrated that both nurses and CNAs are extremely busy and can't possibly keep this patient constantly dry. Course, their reply was "yes you can." Whatever. I would like to see the ones that made that statement work the twelve hour shift that I just put in and see if they had time to change someone in a timely manner. I was so busy running up and down the hall for PRN pain meds that I hardly had time for anything else, let alone fluffing and puffing my patients. I guess I'm whining but the last two days were so tiresome both physically and mentally. So what are the policies in other places and does anyone know the statistics of UTIs vs foleys. (I know, I could look it up, but I'm too tired.) Thanks for letting me vent.
Wishing our facility had our own Narcotics Anonymous,
Pam

can't help you with the female patients, but condom caths should be a reasonable option for the males

muffie, RN · Dec 30, 2006

iv lasix 80 mg bid postop open heart female 350 lbs. 4 ft. 9 in. arthritis

get that foley out

whooppee

Tweety, BSN, RN · Dec 30, 2006

If there were foleys in every incontinent patient, I'd buy stock in the company that made them.

I'm not sure what the research say, but the standard I've always seen is that for incontinence and busy staff is not a reason to put a foley in a patient. :)

RNOTODAY, BSN, RN · Dec 30, 2006

iv lasix 80 mg bid postop open heart female 350 lbs. 4 ft. 9 in. arthritis
get that foley out
whooppee

I cant stop laughing on that one........

meownsmile, BSN, RN · Dec 30, 2006

No foleys in my facility unless needed to prevent a surgical dressing from getting soiled, decubitus dressing, surgical procedure that prevents the patient from getting up at all and then it will be discontinued asap. Im sure there is documentation and research regarding UTI's and foleys in our evidence based practice approach to EVERYTHING.

P_RN, ADN, RN · Dec 30, 2006

When I worked in a State Rehab facility we got a lot of CP and Closed head injury patients for evals. My "favorite" was the 40 year old lady with CP who had had a foley since she was in her teens!!

By the time we got her she was up to like a 24fr. My "director-gak!" decided I needed to bladder train her. It took an act of congress and a very expensive Urologist (at State expense) to tell said "director" that was a dumb ****** decision and to put the lady's foley back and give her back her dignity.

No, all nurses don't want foleys, but some patients need foleys.

StNeotser, ASN, RN · Dec 30, 2006

I think what the OP was getting at is the guidelines concerning LTAC. I have had to document that I have had a patient who q 8 hr shift was retaining all the time for a week, sometimes up to 1000cc retention. Q 8 hr shift for seven days we did a bladder scan then did a straight cath before we were allowed to put a foley in. How much do you think that prevented a UTI?

BTW, he got one that week.

It's not about, oh sure, we have to wipe butts more but it's better for them. Grr.

Home Health Columnist / Guide · Dec 30, 2006

When I worked in a State Rehab facility we got a lot of CP and Closed head injury patients for evals. My "favorite" was the 40 year old lady with CP who had had a foley since she was in her teens!!
By the time we got her she was up to like a 24fr. My "director-gak!" decided I needed to bladder train her. It took an act of congress and a very expensive Urologist (at State expense) to tell said "director" that was a dumb ****** decision and to put the lady's foley back and give her back her dignity.
No, all nurses don't want foleys, but some patients need foleys.

:icon_hug: Can I still count on you being my nurse in next few years??