Staffing by Tonnage - page 2

We decided this weekend that staffing should be done according to average tonnage on the unit. The first three rooms in ICU: Bed 1: 252 pounds, new Guillian-Barre pt. Bed 2: 284 pounds, intubated,... Read More

  1. by   caroladybelle
    Originally posted by passing thru
    So true of ICU. Most people outside of ICU , nurses and administration AND doctors don't have a clue as to how much lifting takes place in ICU. Everyone is on tube feeds and is incontinent of stools, in one end--out the other. I remember one nite there was 7 female nurses and one male nurse working. About halfway through the shift, the male nurse reminded us he was getting exhausted as each female came to get him to help with lifting their patients, "cause he was a man"...so we were wearing the poor guy down.
    I would try to get administration to listen. In our hospital, on the big ones, and as you say, a 170 # dead weight is heavy, anyhow, we get the R.T.'s and lab guys to assist. And with the big ones, we do not begin until there are 3 lifters on one side and 3 on the other.
    It's nice that your ICU has 8 nurses to work together to do the lifting and that RT and lab will assist.

    Us non-ICU people frequently have that same pt with two, maybe three nurses for the entire floor and no RT/lab to help.

    Not to flame anyone but WE ALL LIFT, TOTE, and CARRY a lot of weight. And when that humongous pt gets transferred to the Floor - where s/he will spend alot more time - as no rehab or nursing home wants to take them , d/t size - who do you think will be moving them, but the floor nurses - day in and out for monthes. And if tests are ordered and transport is busy - it will be the floor nurse hauling them all over the hospital.

    I'm for the plan of staffing for tonnage with some allowances for number of times that the call light was hit on previous shift, number of "concerned" SOs at bedside and calling the nurse for "updates" on phone, and times pt requests a stat laxative/enema/bath exactly at shift change.
  2. by   RN-PA
    Originally posted by caroladybelle
    I'm for the plan of staffing for tonnage with some allowances for number of times that the call light was hit on previous shift, number of "concerned" SOs at bedside and calling the nurse for "updates" on phone, and times pt requests a stat laxative/enema/bath exactly at shift change.
    LOL-- My sentiments exactly!

    As far as staffing by tonnage, we frequently get gastric bypass patients who can be at least 200 lbs. with continuous epidurals post-op. And we recently had a patient who weighed close to 700 lbs. When it was time to do wound care on her legs, it would take two PCT's to hold up a leg while the nurse did the care. We'd be minus the two aides and the nurse for sometimes 30 minutes.
  3. by   VivaLasViejas
    We had a 650# frequent flyer named Phil whose abdomen was so massive it took 3 of us just to hold up the folds to clean under them. One night we got him up on the commode (7 staff members involved), but couldn't get him back into bed even with several more people, so we had to call the fire department!! That was when the rectal tube went in..........

    Seriously, I feel so bad for these massively obese patients, because health care workers tend to be so judgmental toward them. I myself have weighed as much as 336#, and when I had surgery a couple of years ago I found myself apologizing to the staff for having to lift me from the operating table back onto the gurney. I've lost almost 30# since December, but I still secretly fear the prejudice I've seen directed towards others of my size, and I try to advocate for morbidly obese pts. because we are the last group in America against whom it is still OK to discriminate. (I mean, look at what some of the airlines are doing, forcing large people to buy 2 seats instead of accommodating the growing population of overweight and obese customers by making the seats wider.) I personally don't claim victim status, as I have NEVER let the weight get in the way of anything I really wanted to do, and I've never given in to it---I refuse to let myself vegetate in a dark corner someplace, and I do pretty much everything thin people do, except maybe wear a bathing suit. But there's an awful lot of folks out there who can't cope with the social opprobrium they face, and it's a shame that so many in the health professions aren't a little more compassionate. After all, one can beat almost any addiction by abstaining from the problem substance, but you can't stop eating; there are also a few who can't help it because they have to take steroids, or they have a glandular problem. So please, let's take it a little easier on the obese, and instead make our administrators and nurse managers aware that we need the right equipment and enough staff to take care of them and meet their needs---especially when it comes to lifting and transferring them.
  4. by   gwenith
    just found this thread and i want to ask[

    color=crimson]don't any of you have a "no-lift" policy? don't you use "slide sheets/move tubes"?


    we have a no-lift policy driven by workcover the insurer for workplace injuries. this policy encourages the facility to get mechanical lifters and "slide sheets" to help moving patients.
    slide sheets are made from nylon sail cloth very slippery. you have to roll the patient but once they are underneath you can move even the heaviest patient around the bed by sliding rather than lifting. they do have a downside - more fiddling around so it takes a little longer and they are noisy but they are better than doing it by hand.
  5. by   Zee_RN
    Notice the wording in that: "Encourages the facility to provide..." Does not say REQUIRES the facility to provide. And policy or not...when radiology is saying "we're ready NOW" for you to take that patient to CT, no one is going to wait for 5 more staff members to magically appear (from where?!) to help you move that patient. And the doc doesn't want to hear..."he couldn't get his CT scan because we couldn't move him." Heck, he/she doesn't even want to hear that your little bitty self couldn't get that 600-pounder out of bed. "He HAS to get out" they tell you. "HAS to...just do it."

    Yes, I do feel bad for these patients on an emotional/mental level. But no one is feeling bad on us who have to deal with the multiple problems involved in caring for these people. Getting specialty beds and lift devices is like pulling teeth! And try to get someone to put in a central line...Oh, I just better shut up now.
  6. by   passing thru
    You're exactly right, Zee.
    I've noticed 300 and > pounders are being ignored by some of the nurses at my hospital, especially by the small stature nurses.

    That is something new over the past five years that I am noticing.
    I think the "fat prejudice" is really firming up.
    But, personally, I am not going to injure myself....pull my spinal column out of alignment at any point.................to lift a huge patient.
    When we get so big we cannot move ourselves well when we are healthy, we have to ask ourselves, "what is going to happen to me if I get sick?? Who is going to be able to turn me, lift me, help me to the shower/toilet??

    If you are struggling to do any of these things while you are in good health,,,,,,,,,,,, go on a diet!
  7. by   lucianne
    I doubt that you see many overweight and morbidly obese patients who haven't been on multiple diets. Healthy diets, dangerous diets, fad diets, doctor supervised diets. The latest statistics I read were that only about 5% of people who diet manage to lose the weight and keep it off and that didn't differentiate between people who had 20 pounds to lose and 200. How would you feel if you went into a situation where you knew you only had a 5% chance of success?

    I've often thought about the point mjrln made. If someone wants to quit drinking, smoking, or doing drugs they don't do it by cutting back. They may taper off at first, but eventually (if they're successful) they quit completely. We'd never expect an alchoholic to just take an occassional drink and be able to stay sober that way.

    luci
  8. by   Hardknox
    No lifting in Post partum and L&D? Fat people deliver!!! You can injure your back holding someone's hundred pound leg when she pushes or pulling back on them for shoulder dystocia. Helping them out of bed and lifting them after a c/sec can hurt your back, too. Largest patient I had was over 400lbs. and we don't have hoyer lifts on our unit.
  9. by   mother/babyRN
    Now THAT is a great idea, especially in labor and delivery! ( I mean, think about it...) When I used to work in a progressive care unit, it was my idea to take the two healthiest, mobile patients, and recruit them into nursing assistants. I used to kid around with this until I had patients who were bored, actually volunteer! So, I had them do things like fold bags...In maternity, if they are that bored ( and this usually applies to antepartum or gyn patients), I show them how to make baby hats...Your thread and idea is hilarious ( and a little scary cause it makes perfect sense!)
  10. by   mother/babyRN
    Oh gosh! There is PLENTY of lifting, turning , avoiding of punches, pinches, grabs in sensitive areas when it comes to labor and delivery...Since being a delivery nurse, I have been punched, kicked, scratched, beaten up AND stabbed...Those ladies are MAD! (recall, I am from the era BEFORE epidurals..) Oh, forgot to mention the one who nearly strangled me......
  11. by   gwenith
    no lift policy

    it is a method of moving patients using simple cheap equipment. most facilities here are falling over themselves to implement it as it cuts down on workers compensation claims and thereofor premiums - it pays for itself as well as saving our backs!


    this is a commercial site but it does give an overview of what a no lift policy is about.

    http://www.tuohy-main-systems.com.au/pages/refs.html
    http://www.qnu.org.au

    the second site is the union site and it outlines how they are supporting the "no lift policy"

    instead of putting up with bad backs - get onto your unions/organisations to put pressure on the hospitals to introduce these simple practices,

    slide sheets are cheap well, relatively, compared to virtually any other equipment in the hospital. it is simply slippery nylon material and at first it sounds like a lot more effort but believe me it is not.
    Last edit by gwenith on Apr 30, '03
  12. by   funnygirl_rn
    originally posted by gwenith
    just found this thread and i want to ask[

    color=crimson]don't any of you have a "no-lift" policy? don't you use "slide sheets/move tubes"?


    we have a no-lift policy driven by workcover the insurer for workplace injuries. this policy encourages the facility to get mechanical lifters and "slide sheets" to help moving patients.
    slide sheets are made from nylon sail cloth very slippery. you have to roll the patient but once they are underneath you can move even the heaviest patient around the bed by sliding rather than lifting. they do have a downside - more fiddling around so it takes a little longer and they are noisy but they are better than doing it by hand.
    gwenith...when i lived abroad we used something called a "slip & slide"....sounds like what you are referring to. it was wonderful. unfortunately...back in the states...hoyer lifts are broken or they cannot support the weight of 400 lbs & above on our unit. we tend to get a lot of gastric bypass patients (often 500 lbs & up)...and believe me my lower back & forearm's really take a toll. also, i am 5'4 & weigh 118 lbs, petite. i do try to work out & keep myself in shape...but, these patients, lack of staff, lack of proper equipment & not having a "no lift policy" implemented is causing me chronic pain & trips to the doctor. i want my body back to "normal"....so, i have been looking to get out of bedside nursing....since the hospital(s) in my area don't seem to care if someone injures their back, tears a rotator cuff or has chronic tendonitis.
  13. by   gwenith
    And they wonder why there is a shortage of bediside nurses?

    The push of a lot of this did come form "workcover " which is the goverment workers compensation insurer.

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