Well, it happened again yesterday! I got notified that I had an admission coming to RMXXX and it was canceled. The reason that it was canceled was because they had a different admission for us due to the obesity of the patient. Huh? I did not know this was a criteria for floor placement. I was told that due to the fact that we have "big" rooms that the other floors send the obese patients to us. This was not a surgical patient (I work a surgical floor) this was a chronic CHF patient that should have been admitted to our Medical Telemetry floor. Everyone was up in arms when the news was spread. Some very unhappy nurses!
Then the patient is rolled up in a wheelchair by a PCT from the other floor. She promptly leaves the patient in the wheelchair in the room and is gone. I gather the Physical Therapy tech and a gait belt and go to the room to get the patient in bed. The daughter tells me that mom has to go to the bathroom. I tell her that we have to get her in the bed and then she can use the bed pan. They say no, she has to go to bathroom. I released the PT tech because he had been working with another patient and could not spend an hour in the room. So, they rolled the patient into the bathroom while I went to find a walker. They put the walker in the bathroom and then said that she had to be lifted out of the wheelchair to a standing position so she could manuver to the toliet. I told the daughter that she could go ahead and do that, that I had to release the tech. She said it took two people to lift her. I told her that I couldn't lift her since I have a bad back (disc, spinal arthritis from, guess what?, lifting patients!) and that we would have to get more help. My PCT jumped in and the daughter and PCT got her up and onto the toliet. Well, I went and did the accuchecks for the PCT because I knew she would be tied up for awhile (an hour, just as I guessed!). However, the patient decided she wanted to sit on the toliet for awhile. So the PCT left and took a patient out for discharge. So of course the obese patient decides she wants to get out of the bathroom and they call the desk. Fortunately for me I was tied up down the hall doing a dressing change. The charge nurse went to the room and helped get her back to bed. Luckily, the MD ordered a foley due to large does of Lasix to be given and the need for accurate I&O. I was able to explain to the patient and family that our original intention had been to get the patient in bed and let her use the bed pan. The only question the daughter had then was how she would have BMs? I told her that we would use the bedpan. I was then able to admit the patient.
Back injury in health care workers, nurses in particular are on the rise. The number of pounds we lift on a daily basis surpasses that of the average warehouse worker (statistic from ANA). I have been promoting the ANA Handle with Care program since I have been at this hospital. We have no equipment and no training on how to safely lift, transfer and move patients. The ANA has a position paper that demonstrates that we should do none of the above, the technology is here to elminate those needs. (http://nursingworld.org/MainMenuCate...re.aspxLack)of
awareness and lack of worker advocacy within the nursing profession has allowed the continuation of work related injuries to nurses. Due to my advocacy, we have purchased one transfer device. One. It took 6 months to get a slider board ordered.
Nurses are aging. We can not afford to have nurses injured and not able to work. And frankly, all the lifting and pulling is turning off new nurses. This economy is going to turn around and the shortage is going to come back with a vengenance. We are going to look around and ask "who is going to work with us today?" I can only safely care for 6 Med/Surg patients at time on days, how many more will we have to take to deal with holes in the schedule?
I would like to know if you have a Handle with Care Progam in your hospital and how does it work? If you don't have a formal program how are you handling the safe transfer of patients. I work with total hip replacements, knee replacements, lumbar lams, ACDFs, gamma nailings, fractures, colon resections and other major surgery. The patients are getting larger, heavier and more demanding. What works? What doesn't work?
Thanks in advance for sharing your story.
Jan 6, '11
This particular patient was 5'6" and weighed 405 lbs. 69 years of age. Extremely limited locomotion due to her obesity caused joint issues. Her daughters and sisters all weighed above the 300 lb mark. Remarkably, the men in the family were all very slender! Her husband could not have weighed over 150 lbs. The concludsion could be made that the daughters were feeding their mother. The first question out of all of them as I met them was "when can she eat?" No question about what were we going to do to treat her mother for the pain and the SOB. Just when can she eat?
I refuse to injure myself any further. I have informed my employer that I will not engage in activity that will injure or re-injure my back again. I have documented everything. All the unanswered requests for equipment and trainig. Any injury that occurs in our organization is the liability of the organization. Now I am raising awareness.
And I will not accept assignment of this patient. This patient is an injury waiting to happen.
Did I mention that the family wants a consult with an orthopedist for her knees? Our orhopods will tell her "NO WAY!" They cannot justify knee replacement with her inability to do rehab. Plus the CHF and other problems. It is simply amazing to me how people can practice unsafe health activities and then expect the medical community to fix them when they become broken.
Last edit by sirI on Jan 7, '11
: Reason: referred to deleted post
Jan 7, '11
by sirI, MSN, APRN, NP
Please note posts have been removed.
Please stay on topic: ANA Handle with Care Program-Injury of Nurses.
This is not the thread to discuss obesity of nurses, smoking, addictions.
If future posts do not heed this respectful request, they will be deleted and infractions issued.
Last edit by sirI on Jan 7, '11