New Policies

I don't know if there are any laws about what time you can give a patient a bath. It seems to me that if you took a patient that was not confused and got them up at 4 am and gave them a bath and put them back to bed that a daily routime of this would make them confused. To do this to a confused patient would certainly not make them more oriented. If this was done to a family member of mine I would be looking for other places to send them to.
This does nothing to benefit the patient and could actually cause more confussion than help it. This is only for the convenience of the facility who should be hiring more help in the day time to maintain a normal day/night routine for their patients.

We aren't allowed to get anyone out of bed before 0600 unless they specifically request to be up...we don't even get our residents dressed and leave them in bed on 0400 rounds like most other LTCs I have worked in. I would check with your state ombudsman and see what they think...

No, that doesn't make it right! I think I would like to have an official clarification on this policy from the agency that regulates Indiana nursing homes. If they approve of this warehousing type of treatment for residents, I can't say much for the quality of their supervision.

In any case, I think I would be looking for a way to get some publicity about this practice so the general public will know how their relatives will be treated if admitted to this facility. Do you have any friends working in local newspapers or television stations who might be looking for "human interest" stories? Of course, you know you will need to find another job if you make any waves.

Surely this sort of treatment is against the BoN code:

• Function within the legal boundaries of nursing practice based on the knowledge of statutes and rules governing nursing.
• Accept responsibility for individual nursing actions and continued competence.
• Communicate, collaborate, and function with other members of the health team to provide safe and effective care.
• Seek education and supervision as necessary when implementing nursing practice techniques.
• Respect the dignity and rights of the patient/client regardless of socioeconomic status, personal attributes, or nature of health problem.
• Maintain each patient/client's right to privacy by protecting confidential information unless obligated, by law, to disclose the information.....

30+ years ago when I was a nursing assistant working night shift in a nursing home we were told to start dressing patients and just let them lie in bed until 6 or 7am when we were to get them up to the dining room for breakfast. I didn't like doing it then and as the years went by heard that many a home was dinged by the state for allowing this to go on as it was a violation of the patient's dignity and rights. Recently, we've had showers assigned to the night shift, but only a few. And, they were done very early on the night shift or just before going off the night shift. The patients were chosen carefully as ones who either stayed up late or were very early risers. I would say that the state surveyors from the state department of health would have a lot to say about these practices IF they knew for certain that they were going on.

I am flabbergasted by what I am reading. My rule of thumb is that if I wouldn't want it done to me- then I can't do it on others (or "do unto others as...) and G-d willing when I reach my "golden years" and I don't HAVE to get up at the crack of dawn- don't you dare wake me!! Where I work (an SNF with all kinds- from oriented to totally disoriented and non-communicative clients) we are not allowed to awaken any patient before 6am unless it is their wish (and we have one who insisits on getting up at 4:30 for prayers!). And we respect requests to let the patient wake up late (although we can't hold breakfast for more than an hour for fear that it will spoil etc.)
But criticizing the policy isn't going to help you because it is obvious to any rational thinking human being that the policy is cruel. It can lead to extended periods of time sitting that can cause a rise in pressure sores, it can interfere with the circadian rhythm of the client, it can disrupt meal times as I hope you provide a hot drink and something for the belly if you are going to pull the patient out of bed by 4am. It can exacerbate illnesses like diabetes, COPD , stomach ulces, Psych disorders, infections etc., etc.. It will throw the alzheimers and dementia clients out of wack completely and disrupt any benefit that can be had by starting the day on the right foot so as to maximize his/her day (as well as lead to noncompliance problems!)
So the question is WHY did they change the policy? Once we had a head nurse who decided that all routine (QD etc) Blodd Pressures be taken at 2am so as to maximize the night nurses hours!! Can you imagine? waking a patient who is on a host of blood pressure meds at 2am to take his BP? I protested to deaf ears. Even the doctor wouldn't back me up! After a pateint stroked out(And died two days later) from high BP (We were reporting 240/200 and the head nurse claimed it was because we weren't waking her up gently enough!!). So I know crazy policies go on- but if you can determine the etiology of the disease you can heal it faster. Is there an abundance of nights staff and not enough day staff? Is there a reason the clients have to be up so early (doctors visits or something)? Can you tip off the SW and have her complain on behalf of the clients. Do the families know? Although you can't tell the families (it would look like insubordination).
Good Luck and have patience

Says more about the speaker that about the patient!!