Ok, so there's this obese patient...

Specialties MICU

Published

....I'm caring for. She's approx 400lbs, and since I'm in the prn pool, naturally I am assigned to her for the night. So as usual, I dive right in and bathing her, cleaning her room. I normally don't mind as long as there's some help to turn her. Well, I'm finished with her front, and I come out to request help in turning. We need about 4 people to turn this woman as she is too weak to help.

Well, one nurse says, "I've taken care of her 4 days last week and my back hurts" She turns her back to me and I just stood there with my mouth open. Luckily a few of the staff took pity on me and came to my rescue.

I have said nothing to her, and I've only worked with her here once before and got the same attitude.

I'm definately considering a full time position in this hospital as the prn work isn't really my thing. I thought I would be able to deal with the attitudes, but it's become too much, and I really think the patient suffers.

Anyhow, just wanted to vent. I'm not going to say anything as I thought for sure my mouth would get me in trouble.

Thanks for letting me bend your ears, or eyes in this case.:uhoh3:

Specializes in LTC, assisted living, med-surg, psych.

Does your facility not have a Hoyer lift? I know the older models didn't hold very much weight, at least not by today's standards (I think our old one went up to 350#), but they make lifts now that can hold pts. up to 1000#. Of course, it's somewhat time-consuming when you have to go find the lift and the proper sized sling, get the sling under the pt., and then change the linens while he/she is in the sling, but you've got to do it anyway so you might as well use the machine. It takes fewer people, and it'll help save your back.....trust me on this one.

Naturally, none of this applies if the facility doesn't have the necessary equipment to take care of super-obese pts........and frankly, they shouldn't accept them if they can't take care of them properly! Where I work, pts. who are too heavy for us to manage (which happens sometimes, even with the 1000# lift) are transferred to one of our sister hospitals, which has a bariatric unit. I've never worked with anyone who weighed over 700#, but we have a number of 400-500#-range pts. who are frequent flyers.....believe me, I feel for ya!!

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:o

Dear Elizzy - my apologies if my words seemed harsh because my intention was certainly the opposite. Just merely wanted to verbalize from the other point of view as well as offer advice as to what works in our unit.

Linda

Ok...first of all: For lack of time and space I just gave the highlights of the story. I could've gone on and on...So yes, there sure is more to the story.

Second: I'm certainly NOT on a bariatric unit, I'm in a trauma ICU. As a 10 year veteran Neuro/Medsurg Trauma ICU I'm used to the team work and comaraderie of my colleagues. This experience has been quite a change for me.

Third: I certainly did, indeed, notify the charge nurse (who by the way has no (zero) patients) of my intention to bathe this patient at this time.

Fourth: I spent 8 weeks out of work last year for an L4-5 herniated disc myself, due to assisting in turning a 500 lb comatose trauma patient.

My point and question was, Whatever happened to good old fashioned professional courtesy? When the days I simply couldnt' help out because of my back, I would be in the room with my colleagues picking up the trash, maybe giving meds to the other patient, or simply just moral support.

I appreciate your input and comments, but sometimes if there is even the suspicion of more than "meets the eye" perhaps a clarifying question or two is more appropriate than lambasting someone who just wants to vent about what a rotten night she's having....

Have a heart Huh?

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Specializes in Trauma, ER, ICU~CCRN,CNRN.
:o

Dear Elizzy - my apologies if my words seemed harsh because my intention was certainly the opposite. Just merely wanted to verbalize from the other point of view as well as offer advice as to what works in our unit.

Linda

:) ...for that! I was having a really bad nite.

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Specializes in Trauma, ER, ICU~CCRN,CNRN.
I don't really understand. Were you upset that she didn't help you or that she wasn't polite about it? If she really couldn't help because her back hurts, I'd let that go. I'm sure you don't want her to be injured like you were and after 4 days of looking after that patient she may be very sore. If you're upset that she didn't offer other help like you did when your back was injured... well, maybe that simply didn't occur to her and you can cut her some slack. I've been offended at times when nurses didn't just jump in and help me when I was swamped, but I've found most of them will if I ask directly so that's what I do now and it works for me.

If she was rude, I would be mad too and maybe just mention it to her. It sounds like the real beef you have is you feel you're being dumped on. If that's the case I don't know what you could do other than speak to the charge nurse or unit manager. No one, whether they be prn or full time should get dumped on. That isn't fair.

To answer you question, this particular nurse has always shown some hostility toward me and I've only met her once. So, it seemed to me that she was just not interested in helping me. Sounds personal! Like I stated before, whatever happened to the care of the "patient!" I'm not there to make them like me, I just want to make sure these patients get the best care I can given them.

It didn't help that my other patient was 200 plus lbs with two broken legs!

For the most part, everyone I've worked with has lent a helping hand. Since my orientation to these units was extremely short, and I've been left to fend for myself and thrown to the wolves (so to speak). I'm a little on edge and distrusting.

I've already had issues with one other unit. I've spoken to managers and supervisors about this problem to no avail. Yea, I was dumped on. I do my fair share, don't get me wrong. I work my butt off. Being the PRN nurse, I always have to prove myself each and EVERY shift, I float to three different hospitals in 2 different units within the system

Have you ever worked prn? Try it sometime. It's interesting to see the other point of view.

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Specializes in Nephrology, Cardiology, ER, ICU.

I guess I'm just concerned that these obese patients aren't even getting turned! Is that correct? Did I miss something here? We have a large (no pun intended) bariatric program where I work and we have a lift team 24/7 that is trained in moving these very large patients safely for the patient and staff.

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To answer you question, this particular nurse has always shown some hostility toward me and I've only met her once. So, it seemed to me that she was just not interested in helping me. Sounds personal! Like I stated before, whatever happened to the care of the "patient!" I'm not there to make them like me, I just want to make sure these patients get the best care I can given them.

It didn't help that my other patient was 200 plus lbs with two broken legs!

For the most part, everyone I've worked with has lent a helping hand. Since my orientation to these units was extremely short, and I've been left to fend for myself and thrown to the wolves (so to speak). I'm a little on edge and distrusting.

I've already had issues with one other unit. I've spoken to managers and supervisors about this problem to no avail. Yea, I was dumped on. I do my fair share, don't get me wrong. I work my butt off. Being the PRN nurse, I always have to prove myself each and EVERY shift, I float to three different hospitals in 2 different units within the system

Have you ever worked prn? Try it sometime. It's interesting to see the other point of view.

This is one of the main reasons I don't work PRN or do travel nursing. I don't think it's fair that you get dumped on and I change jobs often enough to know how hard it is to always be the new nurse (I move every year or two). I hate that feeling of never knowing who you can go to for help or whose answers you can trust because you get 4 different answers to every question. I find it incredibly frustrating. For me, if someone is hostile to me once or twice I try to write it off (maybe they were having a bad day). If they are consistently hostile like this nurse is to you and also hostile to other people, I just completely limit how much I deal with them. It isn't worth the stress! I won't ask them for advice or help at all. It sounded to me like you were getting dumped on and I don't know that you can do much about that other than not work that unit and come here to vent on occasion (that works well for me;)).

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Specializes in Trauma, ER, ICU~CCRN,CNRN.
This is one of the main reasons I don't work PRN or do travel nursing. I don't think it's fair that you get dumped on and I change jobs often enough to know how hard it is to always be the new nurse (I move every year or two). I hate that feeling of never knowing who you can go to for help or whose answers you can trust because you get 4 different answers to every question. I find it incredibly frustrating. For me, if someone is hostile to me once or twice I try to write it off (maybe they were having a bad day). If they are consistently hostile like this nurse is to you and also hostile to other people, I just completely limit how much I deal with them. It isn't worth the stress! I won't ask them for advice or help at all. It sounded to me like you were getting dumped on and I don't know that you can do much about that other than not work that unit and come here to vent on occasion (that works well for me;)).

:coollook: :rolleyes: :balloons: EXACTLY!!!!!!!!!!!!!!!1

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I was a PRN CNA when I was in nursing school, and I got the same crap.....I'm not sure WHY but of course I get the heaviest assignment, and nobody wants to help.

I understand why you would rather go full time at this hospital, I feel the same way. I start as a new grad in the PICU and I know already it will be a better experience than the PRN pool!!!!!

I am sorry you had to experience this....some people are just burned out

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The non-critical bariatric patients are on regular "big-boy" beds. We'll help them turn, but we won't turn them because there's not enough pillows that could hold them over while not crushing them against the side rails. The critically ill bariatric patients are in the "Size-Wise Rotation" beds that automatically turn them. In my opinion, nothing really works that well. One time we had a patient in one of the speciality beds in the chair position. Unbeknownst to us, he wasn't completely oriented and decided to go for a walk and ended up on his face. We had to call for help in all the units plus security to body lift him back into bed.

Linda

I guess I'm just concerned that these obese patients aren't even getting turned! Is that correct? Did I miss something here? We have a large (no pun intended) bariatric program where I work and we have a lift team 24/7 that is trained in moving these very large patients safely for the patient and staff.
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Specializes in Trauma, ER, ICU~CCRN,CNRN.
The non-critical bariatric patients are on regular "big-boy" beds. We'll help them turn, but we won't turn them because there's not enough pillows that could hold them over while not crushing them against the side rails. The critically ill bariatric patients are in the "Size-Wise Rotation" beds that automatically turn them. In my opinion, nothing really works that well. One time we had a patient in one of the speciality beds in the chair position. Unbeknownst to us, he wasn't completely oriented and decided to go for a walk and ended up on his face. We had to call for help in all the units plus security to body lift him back into bed.

Linda

Exactly, these beds are really old too! There's no "turning" these people. Not to sound mean, but when they get turned for their baths, someone has to hold their leg as they don't fit together properly when lying on their side.

Not to mention how weak they are to begin with. It's simply not feasible to turn them on their side. Most of them have sleep apnea and lying on their side only makes it more difficult for them to breathe. Sitting up is the only position that seems to work for them

Another hospital I used to work at had Flexicare beds. They were great....the air circulated to decrease pressure points, and a great turning option that let the air out on one side to ease the patient to that side. This particular bed was so old, the mattress was maybe 6 inches thick....I couldn't understand it. The manager said they were too expensive...Go figure?:rolleyes:

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Specializes in Trauma, ER, ICU~CCRN,CNRN.
I guess I'm just concerned that these obese patients aren't even getting turned! Is that correct? Did I miss something here? We have a large (no pun intended) bariatric program where I work and we have a lift team 24/7 that is trained in moving these very large patients safely for the patient and staff.

Lucky you...we don't have that luxury. This unit is a trauma ICU, so it's really not equipped to handle these kinds of patients in the first place. It's really no excuse, but that's the way it is there.

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Lucky you...we don't have that luxury. This unit is a trauma ICU, so it's really not equipped to handle these kinds of patients in the first place. It's really no excuse, but that's the way it is there.

I know someone mentioned a hoyer lift,but let me elaborate a little...we also deal a lot with Sizewise,and they have this huge hydrolic lift that works with a sling placed under the patient..the lift slides over the patient's bed,and is controlled by a handheld device.by attaching the hooks to one side,you can turn the patient by yourself,almost,as well as "pull" him up in bed.This device was a must for our obese patients http://www.sizewise.net/pdf/ProductPoster.pdf

This poster illustrates it pretty well.Maybe you could see about getting them in your facility?We used it in our icu-with all the equipment,you could still get around it.

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