Vent about toiletting patients

[SleeepyRN]

I will start off with a disclaimer that I am NOT saying that nurses should not have to toilet patients.

I'm pretty new to a sub acute rehab facility. 3 months there now. Many of the patients, specifically being there for PT, are non weight wearing and require total assist. This of course means that it takes a good chunk of time toiletting a patient.

So at the end of shift today while giving report, 4 of us nurses were at the nurse's station when one of our ADONs came to us with an inservice sheet saying they have received a LOT of complaints lately that nurses, particularly one (I'm pretty sure it was me) are answering call lights and saying that a CNA will be with them after they are finished with what they are currently doing.

The sheet we had to sign stated that we are all nurses, and that we all know how to toilet patients and must toilet a patient if that is the reason for the call light.

The majority of call lights I answer are for toiletting.

Well....we were PISSED, and all of us spoke up. However, we had our different reasons for being upset. I was upset because our facility strongly emphasizes never passing a call light un-answered. So I always knock and much of the time, yes, I let them know a CNA will be with them. That is after already having toiletted, say, 3 patients, knowing the CNA is working his/her butt off too.

But I can only spend so much time toiletting patients! A CNA made a good point today that MY work has a legal time limit. I'm always always cutting it extremely close with med pass BECAUSE I'm also answering call lights, or a situation occurs. My facility is NOT LTC. Acuity is higher. Two of my patients both had BPs over 200 at the same time the other day at the exact same time a post op patient spiked a fever. LOTS of time spent contacting the doctor, entering new antihypertensive orders, administering the meds, checking and rechecking the BPs during a good 6 hour period for both patients... I eventually sent one to the ER. When I'm not doing med pass, I'm still:

- answering call lights for pain meds (even though they say no when I'm doing med pass...grrrr,)

- doing dressing changes

- working on my admission, (almost every day there is at LEAST one per nurse)

- trying to chart

- give neb treatments

- change PICC dressings

- change ostomy bags

The list continues. I CANNOT toilet every patient I answer a call light for. I do on average 3 a shift. I have on average 15 patients. The reason I'm pretty sure they were talking about me, was because I notice I'm usually the only nurse who answers call lights. All this is going to do, seriously is make me stop answering as many call lights.

ANYway, the other nurses, as I was, were in an uproar saying that the CNAs were lazy and aren't answering call lights. That irritated me. Yes, there are a few CNAs like that. But that for the most part is not the problem. The problem is ridiculous CNA to patient ratios and unrealistic expectations of patients.

Thoughts? Suggestions? We are starting monthly meetings beginning this Friday. When this happened today, I said to the other nurses, "Fine. If they want monthly meetings, then we all need to address this Friday." Well they addressed it right then. The ADON had walked by again. They told her, in a definitely upset manner, that they need to talk to the CNAs. That they are lazy and not and not answering call lights. That's not what I'm seeing the majority of the time. I'm seeing 4 call lights at the same time during my med pass, each waiting to be toiletted. Each getting angry about the wait. These are rehab patients. They are slow. It takes time. Yes, a patient may wait 45 minutes. All the ADON could say was, "I know. I feel you guys. I'm with you." She's pretty much just the messenger of this. This is coming from the DON and other ADON. I get that. It changes nothing.

I try and help the best I can. But 12 out of 15 patients are going to be irritated with ME, because when I have to tell them a CNA will be with them, they all roll their eyes and say, "no one will come."

This is certainly not a unique problem. But now we had to sign a paper saying we will always toilet a pt. when answering that type of call light. It is extremely unrealistic. But they are HUGE, like everywhere else, on customer satisfaction.

[icuRNmaggie, BSN, RN]

You are in charge of your practice and prioritization. How juvenile to ask you to sign a document that mandates you to answer call lights and perform the CNA duties.

[jadelpn, LPN, EMT-B]

Can you suggest a team of 2 CNA's going "down the line" and a rule that they need to be in rooms q 2 hours and ASK if someone needs the bathroom? Cause I know that the easiest way to dress and wash a patient is while they are on the commode. If there is a 2 person CNA team left, they can float and answer call bells--the other teams have assignments.

No one is "lazy" overwhelmed, yes, lazy is putting an emotional judgment on patient care.

I would at least be present for one toileting--helps with assessment on how patient moves, skin integrity, and if they are urinating and have BM's that are quanity sufficient. And you don't end up in enema city cause someone hasn't had a bm in days, nor with a UTI (hospital acquired) then ya'll will be in the thick of it as far as non-reimbursement issues.

If you are answering call bells, you can assume that someone needs the commode. Use that for your advantage for your assessment, for your report to PT as far as movement.

Do not get caught up in a nurses/CNA's are so lazy stuff. You can only go forward from here. And to create a plan that solves the issue as opposed to name calling is the goal.

And remember, nurses are the delegaters. So if you are delegating a CNA to toilet a resident, and they are not following through, it is still on you.

2 CNA's as a team. They go down the line. PT and OT need to know that the goal is function. Keep on top of it.

[Helori]

I probably would've signed and added the note that "I will toilet pts when I answer the call bell when I do not have other pts requiring a higher level of nursing care at the same time."

[NOADLS]

This is terrible! The standard "the CNA will be in shortly" as an answer to patients requesting to be toileted should be accepted everywhere.

I don't say this just because I believe that we're above toileting patients. Your workload also looks fairly heavy. I really can't believe that you're being asked to toilet patients at such a facility.

[dream'n, BSN, RN]

TPTB see the problem of patients having to wait to be toileted, but don't want to lay out the money for enough CNA or nursing staff to timely accommodate them. That's what the bottom line is. The CNAs are doing all they can and the nurses are doing all that they can, but the problem is still there. So, instead of putting their money where their mouth is they unload more expectations on the staff than can be accomplished and create an environment in which nurses and CNAs are pitted against each other.

If you feel brave enough, tell Management at the meeting that the CNAs and the nurses are working as hard as possible and that the only real solution is more staff. But be ready for management to push back at you hard.

[icuRNmaggie, BSN, RN]

https://petitions.whitehouse.gov/petition/provide-federal-legislation-nurse-patient-ratios

Sign this petition for Safe Staffing in hospitals, LTC and prisons. We need 100,000 signatures by 10/17/2015 to garner a video response from the President.

[dream'n, BSN, RN]

https://petitions.whitehouse.gov/petition/provide-federal-legislation-nurse-patient-ratios

Sign this petition for Safe Staffing in hospitals, LTC and prisons. We need 100,000 signatures by 10/17/2015 to garner a video response from the President.

Signed and shared with friends

[Been there,done that, ASN, RN]

https://petitions.whitehouse.gov/petition/provide-federal-legislation-nurse-patient-ratios

Sign this petition for Safe Staffing in hospitals, LTC and prisons. We need 100,000 signatures by 10/17/2015 to garner a video response from the President.

Signed and shared.

[Been there,done that, ASN, RN]

" All this is going to do, seriously is make me stop answering as many call lights."

You answered your own question.

The corporate masters KNOW you need more help, they are not willing to decrease their profits by doing so. Now you are getting the full whip treatment.

They will not change.... move on.

[calivianya, BSN, RN]

I worked in acute rehab as a CNA, and even though you're subacute, it sounds like the patient population may be similar. The nurses had 5-6 patients, and the CNAs had 6-12, and that was not enough help to get everyone fed and toileted. On really good days they paired a nurse and a CNA together and we both shared the same six patients - but when two of those patients were three person assists and five of those patients were total feeds, even that was insufficient staffing.

Rehab is no joke. I would just get out of there.

[nynursey_]

My philosophy is this: I can do a CNA/PCA's job, but they cannot do mine.

If I have time to help out, I do. I never mind taking vitals, checking F/S, toileting patients, turning/repositioning, and doing bed baths. However, if I have RN responsibilities that have to take precedence, or are a bigger priority, then the CNA/PCA's are just going to have to figure out how to make it work. And that's the bottom line.