Refusing to change/toilet pts

Sour Lemon · Sep 2, 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?

Yes, the nurse may be busy. And if it takes as much time to find you as it does to clean and toilet a patient, then communication methods need to be improved. Do patients like waiting to be changed? Maybe not ...but they dislike gasping for air because their blood transfusion hasn't been started yet even more.

If we had time to do these tasks on a regular basis, we wouldn't need CNAs, at all. Nurses are constantly re-prioritizing tasks, and although hygiene and comfort are important, they are rarely at the top of the list.

***And don't assume that your nurses never clean patients just because they don't announce it to you.

ShockMe · Sep 2, 2017

Okay, nobody is gasping for air. That person's comment was far off base. Communication is fine at this hospital, everybody has locators. By refusing I mean, REFUSING. I see nurses REFUSING to help the CNA change their total pt, telling them to go get another CNA. I see nurses calling out from the room for a CNA to toilet that pt they are in the room with.

I am not assuming anything. The nurses I see and hear doing these things are habitually doing this. Sure, we all have rough nights. We all fall behind. But I take issue when I see the same nurses using CNAs to toilet/clean their pts over and over again.

I get it, it ain't glamorous. But pts are here because they are sick. They can't do for themselves so we do for them, we are "nursing them" back to health. Right?

JKL33 · Sep 2, 2017

From what vantage point are you observing this?

I want to be 100% clear: I have ZERO respect for RNs who, even when they find themselves with a bit of downtime (increasingly RARE), do everything they can to avoid these tasks simply because (they say) "it's the CNAs' job." There are some who believe it is beneath them. It is certainly not beneath any RN to provide care of any type to a patient.

That said, as we all know, there are many other aspects of care that an RN must do. It is a sort of "hard to hear" truth that the RN is able to do all CNA tasks, but the CNA is not able to do all RN tasks. Therefore, there WILL come a time when every RN has to delegate X task (that can be done by RN or CNA) so that s/he can perform other aspects of patient care that only an RN can do. My observation and experience has been that, due to a variety of factors, RNs are being increasingly pulled away from many aspects of hands-on care. In my department, CNAs can not triage a patient, complete medication/allergy profiles, document PMH/PSH, assess for suicide risk, smoking, other safety factors (which we are required to document), start IVs, administer medications, perform ECGs, discharge patients, perform any type of assessments (to name just a few of an ED RN's tasks). We are putting people through as quickly as possible (and yep, this is a measured stat: "throughput time"), which means we do all of this ^ multiple times per shift. CNAs do SO much, and don't get enough credit for what they do, and at the same time, there is so much that they are not able to do (just a simple fact, not a judgment or matter of opinion).

My personal rule with regard to the question you pose has been to always do something myself if there was ANY way that I could, since I have always been aware of the fact that the CNAs/techs are trying to help so many nurses and patients, and I appreciate their help very much. My efforts to never abuse them have created a situation where they are usually happy to help if I need to ask them. I've tried to request their help as sparingly as possible. It's getting very difficult to continue on with my usual MO, though.

With regard to your last paragraph, whoever said that was kind of hitting below the belt in my very humble opinion. If I didn't know better I could only guess it came out of the mouth of someone who is in a position to perch far from reality and toss these sorts of guilt-trips in the nurses' direction. As patient, NO, I would not "feel small" so long as care was provided in a timely and compassionate manner by anyone available to do so.

Sour Lemon · Sep 2, 2017

Okay, nobody is gasping for air. That person's comment was far off base. Communication is fine at this hospital, everybody has locators. By refusing I mean, REFUSING. I see nurses REFUSING to help the CNA change their total pt, telling them to go get another CNA. I see nurses calling out from the room for a CNA to toilet that pt they are in the room with.
I am not assuming anything. The nurses I see and hear doing these things are habitually doing this. Sure, we all have rough nights. We all fall behind. But I take issue when I see the same nurses using CNAs to toilet/clean their pts over and over again.
I get it, it ain't glamorous. But pts are here because they are sick. They can't do for themselves so we do for them, we are "nursing them" back to health. Right?

What would you like to hear? I've actually had had a patient with a critical hgb gasping for air and wandering around her room confused while other other patients called for ice water and toileting.

I am also curious about your vantage point. I find it absurd that some nursing assistants come back with, "Why don't you do it yourself?" when asked to assist. What kind of assistant is that?

Beatlefan, BSN · Sep 2, 2017

I became a CNA before entering nursing school to see if healthcare was for me. There were nurses at the small hospital that I worked at who claimed that they didn't go to nursing school to *toilet patients* (not the phrase they used). I also worked with one nurse who insisted on doing everything for all her patients, which included HS peri-cares/bed baths. Forward to now, with the hiring of non-licensed healthcare assistants/techs, who do little more than get vital signs and blood sugars, and have no problem telling nurses that they are too busy to do their jobs.

I remember in nursing school that an instructor threatened to kick a student out of school for not toileting a female patient. I have seen both extremes in the past 20 years.

As a nurse, in my own routine, I always try to establish with my health techs that I expect them to find me if any of my patients need assistance, so I can assess them while assisting. I also tell them never to be afraid to ask me for help with any patient, if they need help. When patients sit waiting for their call lights to be answered, they know what's going on. With the advent of the internet and cellphones that access the internet, there are many who prefer to be checking social media or playing games instead of doing their jobs.

ShockMe · Sep 2, 2017

From what vantage point are you observing this?
I want to be 100% clear: I have ZERO respect for RNs who, even when they find themselves with a bit of downtime (increasingly RARE), do everything they can to avoid these tasks simply because (they say) "it's the CNAs' job." There are some who believe it is beneath them. It is certainly not beneath any RN to provide care of any type to a patient.
That said, as we all know, there are many other aspects of care that an RN must do. It is a sort of "hard to hear" truth that the RN is able to do all CNA tasks, but the CNA is not able to do all RN tasks. Therefore, there WILL come a time when every RN has to delegate X task (that can be done by RN or CNA) so that s/he can perform other aspects of patient care that only an RN can do. My observation and experience has been that, due to a variety of factors, RNs are being increasingly pulled away from many aspects of hands-on care. In my department, CNAs can not triage a patient, complete medication/allergy profiles, document PMH/PSH, assess for suicide risk, smoking, other safety factors (which we are required to document), start IVs, administer medications, perform ECGs, discharge patients, perform any type of assessments (to name just a few of an ED RN's tasks). We are putting people through as quickly as possible (and yep, this is a measured stat: "throughput time"), which means we do all of this ^ multiple times per shift. CNAs do SO much, and don't get enough credit for what they do, and at the same time, there is so much that they are not able to do (just a simple fact, not a judgment or matter of opinion).
My personal rule with regard to the question you pose has been to always do something myself if there was ANY way that I could, since I have always been aware of the fact that the CNAs/techs are trying to help so many nurses and patients, and I appreciate their help very much. My efforts to never abuse them have created a situation where they are usually happy to help if I need to ask them. I've tried to request their help as sparingly as possible. It's getting very difficult to continue on with my usual MO, though.
With regard to your last paragraph, whoever said that was kind of hitting below the belt in my very humble opinion. If I didn't know better I could only guess it came out of the mouth of someone who is in a position to perch far from reality and toss these sorts of guilt-trips in the nurses' direction. As patient, NO, I would not "feel small" so long as care was provided in a timely and compassionate manner by anyone available to do so.

You are correct, the person saying that is a Vice President.

ShockMe · Sep 2, 2017

What would you like to hear? I've actually had had a patient with a critical hgb gasping for air and wandering around her room confused while other other patients called for ice water and toileting.
I am also curious about your vantage point. I find it absurd that some nursing assistants come back with, "Why don't you do it yourself?" when asked to assist. What kind of assistant is that?

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?

Sour Lemon · Sep 2, 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?

I'm genuinely confused. What is your current role at your current facility? Is it your situation to remedy?

ShockMe · Sep 2, 2017

I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.

Been there,done that, ASN, RN · Sep 2, 2017

I certainly have compassion for the patient lying in poop. It's not that I don't want to get my patient comfortable... it's 15 minutes, that I don't have to give. I am charting, passing a gazillion meds and collaborating with physicians.

This is when I direct my CNA to perform the duty. Please do so and realize that I can do YOUR job, but you cannot do mine.

Sour Lemon · Sep 2, 2017

I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.

I'm not sure what an army medic is, but when I look it up it does not appear to be anywhere in the nursing hierarchy- this is why I assumed it might not be your current job. I'm also not sure what there is to report ...or why you're so terribly evasive.

If the only acceptable "solution" to this perceived problem is to find a way to make people act the way you think they should act, you need to move up the chain until you're the boss. It doesn't sound like something you're going to gain control over, otherwise.