Refusing to change/toilet pts

Anna Flaxis, BSN, RN · Sep 11, 2017

I am not sure if this is in the right topic...
I have been working with an increasing amount of nurses who FLAT OUT REFUSE to change or toilet their patients. Is this a thing? Do your hospitals have policies or guidance on this topic?
I've brought this up to a few people unofficially and one answer I got was (from a VP) "the nurse may be too busy and you just don't know it." My thought is "If you know they are soiled or ask them to toilet them, why are they taking the time to find a CNA and not just doing it?"
Years ago someone was talking to a group and the toileting issue came up (different hospital) and this person asked us rhetorically how WE would feel if our nurse was in the room and we were soiled and they would not change us? Or if we asked to go to the toilet and they walk out and send in a CNA? I know I would feel pretty small.
Suggestions, comments, HELP...? Anything?

Hi, I've been on both ends of this. More than once when I was a CNA did the RN say within my earshot that "The CNA will do that" when they were in the freakin' room. More than once have I changed the soiled bed of a dependent patient *by myself*.

Does that always feel good? Well, I only know how it felt to me when I was a CNA.

As an RN, I've had to pass on assisting with ADLs because of other more pressing issues.

If you let it bother you, it will eat you up. Just do your best to provide the best patient care you are able, and if the RN won't help you, f*** 'em. Just remember what kind of RN *YOU* want to be (if that is a goal of yours).

Take care!

Orion81RN · Sep 12, 2017

Okay, let's take it down a notch. I understand that YOU have had a pt gasping for air, but that is not at all any of the situations I've whitnessed. *Army Medic* here, I know what an emergency/urgency is, like the one you are describing. There is a nurse I am working with tonight who refused to clean her pts up and she's been sitting at the desk playing a candycrush-like game on the hospital computer. Another nurse tonight took a pt to the BSC, found the CNA (doing vitals), asked her to dump it because "its really gross." Then she came back to the nurses station and shot the breeze with another nurse from another floor.
I feel like you have some personal background with CNAs who don't help you. And I am sorry if that is your situation. I came to this forum to get some advice on how to remedy this situation. The need for better pt care and the battle between RNs and CNAs. How have your hospitals, LTCs, rehab facilities tried to conqure this issue?

Again, what are you wanting to hear? Yes, *some* nurses are a-holes who feel toileting patients is beneath them, and that is wrong. There ya go.

Ellie G · Sep 12, 2017

I'm a PICC nurse who did lines on evening and weekends in my facility. I went in to do a PICC and was using the floor RN as my assistant. When we went into the room, I detected the odor of stool, checked and sure enough our patient was dirty. I told the nurse we needed to change her before we got started and then she left the room! She went and got the nurse tech. I was flabbergasted. In the time it took to get the tech in there we could have done it already. I thought it was ridiculous. The patient was pretty out of it and didn't know the difference but I was a bit shocked at the nurse's attitude.

Sour Lemon · Sep 12, 2017

I'm a PICC nurse who did lines on evening and weekends in my facility. I went in to do a PICC and was using the floor RN as my assistant. When we went into the room, I detected the odor of stool, checked and sure enough our patient was dirty. I told the nurse we needed to change her before we got started and then she left the room! She went and got the nurse tech. I was flabbergasted. In the time it took to get the tech in there we could have done it already. I thought it was ridiculous. The patient was pretty out of it and didn't know the difference but I was a bit shocked at the nurse's attitude.

Did she stay while the patient was being changed, or leave to do other things?

Ellie G · Sep 12, 2017

Actually she said "call me when you're ready" and then went to sit at the desk. The patient was a large lady that I believe needed two people to do it safely. She was certainly fine with me doing it.

Sour Lemon · Sep 12, 2017

Actually she said "call me when you're ready" and then went to sit at the desk. The patient was a large lady that I believe needed two people to do it safely. She was certainly fine with me doing it.

In that case, I don't think I could judge. I've gone to assist the PICC nurse more than a few times and it's a pain because I always have 8000 other things to do. When there's a delay, I leave and go back.

And I admit ...the first thing that crossed my mind when I read "PICC nurse" is "This is someone who's had it with being overwhelmed at the bedside and wanted OUT."

It is odd that you cleaned the patient along with the CNA, though ...normally it would be two CNAs or me and the CNA, not the PICC nurse. So, you must be an unusually nice PICC nurse.

There are a lot of things I do while I'm "sitting at the desk".

Ellie G · Sep 12, 2017

In that case, I don't think I could judge. I've gone to assist the PICC nurse more than a few times and it's a pain because I always have 8000 other things to do. When there's a delay, I leave and go back.
And I admit ...the first thing that crossed my mind when I read "PICC nurse" is "This is someone who's had it with being overwhelmed at the bedside and wanted OUT."
It is odd that you cleaned the patient along with the CNA, though ...normally it would be two CNAs or me and the CNA, not the PICC nurse. So, you must be an unusually nice PICC nurse.
There are a lot of things I do while I'm "sitting at the desk".

Well only one CNA on a floor. Scrolling on your phone is not taking care of business. As for being overwhelmed with being at the bedside, PICC lines was but one of my duties. I was Cross trained for PICC lines. I stayed to help the CNA because being expected to clean a patient that large by yourself is ridiculous. I don't think that means that I'm unusually nice but I do believe in being part of a team. Besides, I was an ICU nurse for years. No techs in the unit. It was all CYOP in there.

Sour Lemon · Sep 12, 2017

I stayed to help the CNA because being expected to clean a patient that large by yourself is ridiculous.

Agree 100%!! Still think it was extra nice of you, though. I guess I believe you if you say "desk nurse" was horrible. You seem credible enough.

bikegirl · Sep 13, 2017

Ohhhhhhhhhhh!!! This is a HOT topic for me. When I was a CNA:

1. I was walking a patient when the nurse I was assigned to came out of a patient's room, and told me to put that pt on the bedpan. By the time I got the

walker pt back to bed, guess what? The nurse couldn't put the pt on the bed pan and then tell me 'B6 is on the bed pan." Nooooooo she was "a

professional and didn't do those things". Incidentally, the nurse was a new grad and had 3 pts on a Med/Surg floor. She was off perceptering.

2. I was in an isolation room giving a bariatric patient a bath. I was actually paged to to toilet a patient. My pt was on her side and holding on to a bedrail

so I could clean her back and bottom. Now, what would you do?

3. A pt had soiled herself and was sitting in the shower' while 2 nurses and the nurse manager where debating in the hallway about what to do about the pt.

I was coming out of another pts room, having done a blood draw. It was SNF floor. Hallelujah!!! I can save the day. My heart hurt for the pt: she was

humiliated at having soiled herself, cold, and kept apologizing. I gave her a big hug when we finished.

4. Another bariatric patient. This time it was a physical therapist. PT called me in to get patient up. PT didn't want to help or do it because she "didn't want

to hurt " herself. I leaned out the door and called "Can someone help me in D3? I need to get this patient up and the PT doesn't want to hurt herself".

That PT henceforth became kryptonite.

Moral of the stories: CNAs are expendable at 7 bucks an hour. Also? When I got my RN I vowed NEVER EVER to become THAT NURSE and respect my CNA.

Jory, MSN, APRN, CNM · Sep 13, 2017

If the patient simply needs minimal assistance to the room, I take them. If the patient is sitting on the pot and is a high fall risk (due to more than age, due to weakness, etc)...and a code or emergency is called the nurse HAS TO GO.

That's the only reason I get the CNA.

**emergenceRN17, ASN, BSN, RN** · Sep 14, 2017

Sorry no, you aren't going to play the "get my degree card" as if I don't know what a nurse does. I'm not a teen thanks. I have 10+ yrs experience in a variety of clinical roles, from ER to Critical Care, even ones in working directly with surgeon. That's absolutely incorrect of you to say I don't know what a nurse does. In fact, plenty of people in other careers know exactly what a nurse does. Another card RNs like to play. Actually yes a CNA is a nursing assistant... meaning that they don't have a seperate role that cannot be done by a nurse, it is completely under the RN scope and expected of the RN if a CNA is unavailable. I am not saying you specifically are going ask me to move the pt by myself. Mainly I was saying that if you are RN you must understand that CNA has many pts... Also, it is not other CNAs responsibility to take care of your patients. I'm sorry if you can't get what you need done because workload is high, but it is not other CNAs responsibility to provide care when you are the designated caregiver and there's no way you can argue around that. If you don't understand that a CNA also has other things to do for other nurses, and abuse delegation that is treating them like a slave. I wasn't saying you specifically do this, but you sure got defensive like I was saying that you were. I do think you are quite insensitive however. And starting to dread employment as a nurse if this is the way other nurses expect me to also treat my CNAs, which I won't.
Also, I don't consider RN school "significantly" greater education than a CNA. ADN is a two year degree that doesn't required hard math or sciences. It is very condensed, but I know people with PhDs in stem areas that make less than rn. I would say they are "significantly" educated. Even so, I believe minimum wage for CNAs doesn't reflect the amount or importance of the work they do. As well, part of your RN pay is assuming you are participating in at least some cargiving measures that the CNA is doing and please don't tell me it's not true because I know for a fact it is.

First .....Actually a CNA is NOT a nursing assistant. One is certified and one is not...

Second, ADN/ASN DOES require hard math AND sciences. Unless I imagined the program that I just graduated from?!

Your view on RN's are very askew at best. Especially your last sentence.

tamdmoss2 · Sep 14, 2017

Tuesday morning during my med pass my hospice patient on continuous tube feeding vomited EVERYWHERE. My tech was in the dining room feeding so I cleaned him up, gave him a bed bath, changed the sheets, changed him and went back to my med pass. It took me at least 45mins, but I was NOT going to leave him laying in vomit so I could pass meds, and I had 30 patients. Were meds late? Yes, yet I'd do it again.

If a patient comes by me and I can SMELL that they need to be cleaned up I'll tell the tech. If I'm doing a bolus feed and they need to be cleaned up, I'll tell the tech. Will I ALWAYS do total care during my med pass? Nope. But I will make decisions based on their well-being and if that means cleaning up puke and giving a bed bath I will. The truth is, when I see nurses taking 4-5 smoke breaks before lunch, you can't tell me you're too busy to do any kind of care. What it does tell me is that you DON'T WANT to, and those are the nurses I can't stand.

I was a tech 15 years before becoming a nurse and it has afforded me the privilege of having techs say to me "I'll do whatever you need because you're my favorite nurse." Truth is, passing MOST meds isn't rocket science, THAT'S why med techs exist, so please don't act like you're doing Neuro surgery and can't stop for a moment.

Yes we get HELLA busy and a GOOD tech can see that and doesn't ask us to do things they know take an immense amount of time. But good nurses also know they can get off their asses or miss a smoke break and clean someone up if needed.