Nurses just want everyone to have a foley!

  1. 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
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  2. 24 Comments

  3. by   NurseyBaby'05
    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.
  4. by   SuesquatchRN
    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.
  5. by   SportyNurse
    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.
  6. by   PMHNP10
    Quote from Traumamama59
    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
  7. by   muffie
    iv lasix 80 mg bid postop open heart female 350 lbs. 4 ft. 9 in. arthritis

    get that foley out
    whooppee
  8. by   Tweety
    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.
  9. by   RNOTODAY
    Quote from muffie
    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........
  10. by   meownsmile
    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.
  11. by   P_RN
    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.
  12. by   StNeotser
    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.
  13. by   NRSKarenRN
    Quote from P_RN
    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??
  14. by   RN34TX
    Quote from SportyNurse
    However, my facility's (and my own personally) policy is that a foley does not need to be in place for your own convenience.
    I've had that rhetoric thrown in my face by MD's and supervisors alike as a former LTC and med/surg nurse.

    For my own convenience?

    As if I'd normally be reading a book or talking on the phone during my shift had that foley been in place but darn, it's not, so now I have to get off my butt and go change the bed linens.

    The UTI excuse is weak and gets weaker by the year. It's long worn out.

    It goes up there with not placing a central line in a patient due to the risk of infection.........

    Yet the MD goes on to order Vanc and other potentially harmful drugs if a peripheral line becomes infiltrated/extravasated and in addition orders labs every 4-6 hours like for patients on heparin gtt's.

    He/she somehow thinks that IV's and labs will somehow magically get done on their blown up elderly renal patients who's veins are long worn out by getting stuck over and over again.

    Just like they think that a nurse is standing over their incontinent patients 24/7 with nothing else to do, eagerly awaiting the next flow of urine to clean up and that their patients would never sit in a puddle of urine for more than 5 seconds.

    No skin breakdown potential here, right?
    And if there is skin breakdown, it must be because the nurses are negligent and/or lazy spending their time filing their nails or talking on the phone throughout their shift.

    That all works fine in "Dreamland Perfect World Hospital" but few, if any of us work there.

    Let's pull all the foleys, then start pointing fingers of blame if the patients start to experience skin breakdown and/or other problems.

    Now that makes perfect sense.

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