Bedpan dilemma

[Pennyrieder]

I had situation today very upsetting to me and can use some advice. I am an RN in a rehab center was caring for elderly lady s/p fx ankle with surgical repair. She was experiencing major constipation issues. Gave her mom in am no relief then toward end of my shift gave dulce lax supp at approx 2:45 she was calling down hall for bed pan no CNAs around so I went in placed her on pan went back 10 min later she said needed more time so I gave her call bell went in hall spoke to CNA in hall told patient on bedpan he said okay. Then I went to dining area getting ready to leave unit to give report to oncoming shift told second CNA I had put pt on pan and she requested more time and she had her call light CNA said yeah that lady takes along time on pan and said okay. I went gave report to oncoming nurse told her had given supp put her on pan and she was still on and to check with CNAs if had results cause if none would need enema. Approx 2 hours later I receive call at home guest was still on bed pan and had red marks on her bottom. I said to nurse I told 2 CNAs both CNAs denied me telling them and nurse vaguely recalled our conversation. I feel scapegoated they obviously forgot to check and don't want to get in trouble but I feel awful for guest and feel I will take blame cause I placed her on pan. I am a wreck over this any advice.

[TriciaJ, RN]

You reported to 3 people and still got a call at home? If the oncoming nurse "vaguely remembered" the conversation, it's going to be pretty hard for her to weasel out of the responsibility. Are they not responsible for checking their patients are regular intervals? They all dropped the ball and now they're all trying to pass the buck. Do not accept it.

If your facility wants to implement a policy of not leaving a patient on bedpan at change of shift, so be it. Otherwise, you did your job; they are the ones who created a bad outcome.

[suanna]

You reported to 3 people and still got a call at home? If the oncoming nurse "vaguely remembered" the conversation, it's going to be pretty hard for her to weasel out of the responsibility. Are they not responsible for checking their patients are regular intervals? They all dropped the ball and now they're all trying to pass the buck. Do not accept it.

If your facility wants to implement a policy of not leaving a patient on bedpan at change of shift, so be it. Otherwise, you did your job; they are the ones who created a bad outcome.

I hope I'm never a patient in a facility where they can tell me it is against policy for my bowels to move at such an inconvenient time as shift change and I'll just have to tighten the sphincter till I'm allowed to go. The bottom line is the CNA should be responsible enough to follow through with the information they were given and checked on the patient. This doesn't require a nursing license, just a willingness to be responsible to the people in your care. This is one of my chief gripes about the support personnel I've worked with. Some think just because they don't have the responsibility of a nurse, they have no obligation to ensure the patients get the care they deserve. More often than not the CNAs I've worked with see their responsibility only as doing the least work possible, and none as long as there is a nurse that they can pass the buck to.

[Been there,done that, ASN, RN]

I feel for you with the lack of support from the CNA's. Yep, threw you under that bus. However YOU were driving the bus.

Dulce lax? MOM in the AM? Leaving a patient on a bedpan over 30 minutes?

Please learn and follow the established protocol for bowel management in your facility.

[shantel1621]

How often do nurses assess pt. at your facility? If it's every shift then the oncoming nurse should have known the pt. was on the bedpan even if she missed that part in report. It sounds like nobody checked on this pt. for more than 2 hrs.

[anon456, BSN, RN]

Part of their assessment as oncoming RN and CNA is to visualize the patient. If they had been timely in doing the first assessment they would have noticed the patient on the bedpan and taken some appropriate action about it. This is regardless of the fact that you told them-- they should have laid eyes on the patient early in their shift and noticed it and not allowed it to go in for 2 hours. That would make a valid argument to your manager *along with* the fact that you clearly told several people about the bedpan status before you left.

Same with any other part of nursing-- if I have a patient with a PIV running, I need to go in there right at handoff and assess the IV. If I go in an hour later and the arm is 10x bigger than it should be, it's on me and it's hard to say if it started on my shift or the previous shift. (And I have walked in on an infiltrated IV at handoff and the other RN has to take ownership of that, not me.) The same goes for pressure ulcers, which on some my fragile patients can occur within hours.

[suanna]

How often do nurses assess pt. at your facility? If it's every shift then the oncoming nurse should have known the pt. was on the bedpan even if she missed that part in report. It sounds like nobody checked on this pt. for more than 2 hrs.

I think what a lot of posters are missing is this is an ECF-not acute care. The oncoming nurse may have had 20-30 patients in his or her charge. In that environment routine rounds may not be possible until other priorities that require a licensed care givers attention are managed. It surely falls under the responsibility of the CNAs to follow through with the information that the patient was using a bedpan and needed checked. My gosh- if you cannot delegate that task, what can you trust them with. There is no way one nurse can manage to personally provide every iota of care for every patient with that team load.

[toomuchbaloney]

In my view, the nurses need to stop being wimps and take the CNAs to task on this matter. This important task was entrusted to the CNA(s) and they dropped the ball. They should be held accountable by the nursing staff.

[shantel1621]

Every delegated task require follow-up, I don't doubt for a minute that the CNA's dropped the ball but, can we take that to court? I don't care if you have a 20 pt. assignment it is the nurses responsibility to ensure they put "eye" every patient once report is given. What if that pt. had died? How would the nurse account for that? Would she be allowed to blame the CNA's? I worked in ECF before so I know it's no walk in the park...I use the first 15-20 min. to stop in and make sure everybody chest is rising, verify what's hanging and ensure no one is one the ground. I'm sure we all worked very hard for our RN Lic. and I am in no mood to give mind away.

[BrandonLPN, LPN]

Since you gave clear report to the oncoming nurse and the CNA, they are the ones responsible for the resident having been on the bedpan 2 hours after you left.

With that said, in the future, I would never allow a resident to be on a bedpan for more than 15 min. If they say they need more time, simply explain to them that the pressure of the bp is bad for their skin and offer to try again later or try something different like a bedside commode.

[Smiley2310]

Can a nurse lose her license over leaving a patient on a bedpan

[Double-Helix, BSN, RN]

Smiley, this post is over 2 years old, but there is no straight answer to that question. A RN can lose his or her license due to negligence. Whether or not leaving a patient on a bedpan for too long would be considered negligent depends on a multitude of other factors.