Baths!

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    I've been off of orientation for a few months now as a PCA in an acute care unit. I usually have 9-12 patients. We have a pretty heavy workload, including bladder scans, ekgs, blood draws, etc. We might have 5 or 6 bed bound patients each at a time, and we have shared showers. In orientation, my trainee said she will usually give 3 or 4 baths a day and leave some of the bed bounds for night shift. I bathed 7 people one shift and left 3 for night shift and the night PCA jumped my case and reported me. This PCA also reported me b/c a ice pitcher didn't have new ice in it and the trash was halfway full at shift change in two rooms. Now, I'm being hovered over by our charge nurse and I hate my job already. There were a few pts one day I didn't bathe b/c they had bathed the previous day and they were not dirty, so I just provided peri care with soap and water. I got reported for that too. I think overwashing when not dirty leads to more skin breakdown? There are no guidelines where I work on this issue. What are some of your policy's on baths at your facility? Between rounding, procedures, and everything else, I don't even take lunch in the 12 hour shift, so bathing everyone is impossible it seems. I just don't want to get in trouble.
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  3. 13 Comments so far...

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    Also, the hospital allows you to transfer to another unit after 6 months, and I really want to, but feel obligated to stay. I've floated to other units, and I liked them much better, and even got asked to stay at one, but my six months won't be up until October.
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    I would ask the charge nurse exactly what is expected as far as baths go. In our hospital we feel it is a 24 hour process and what doesn't get done in the first 12 hours gets done in the next 12 hours to get it all done. I would do my very best to do what is expected and then try to transfer as soon as you can if you don't feel it is the best environment for you. Good luck, and hang in there!
    Busybee77 likes this.
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    The charge nurse stopped me from bathing a bedbound pt twice b/c they had one the previous day, and said it over-dries skin in older pts w/ thin skin, yet when the night PCA complains, I get in trouble. So, I'm kind of torn. You're right, I am going tp have to set time aside and talk with the charge nurse and see what exactly she wants. I'd hate to leave at 6 months, but I don't think it is the right fit for me. All of the PCAs are permanent; the temporary employees walked out, and I am temporary for a little over a year until graduation. The other temporary PCA had a breakdown the other day, dropped out of school, and is going to leave. Thanks for the advice, I will hang in there as long as possible!
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    It seems very silly they write you up for this, if it was your first or so day... sounds like a communication breakdown. Ask your manager for the protocols, job description, or simply how their unit does things. Until you ask their expectations flat out, you will keep guessing!
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    It sounds like you are lacking communication with your nurse manager and other PCAs. As exactly what is expected of you regarding bathing. Remember, this more senior PCA that is reporting you might just want to give you a hard time because you are new of this person got a bad impression of you.

    Just ask! And if you are confronted, tell them that you were told otherwise during your training.
  9. 0
    Quote from Nursingschoolzombie
    I've been off of orientation for a few months now as a PCA in an acute care unit. I usually have 9-12 patients. We have a pretty heavy workload, including bladder scans, ekgs, blood draws, etc. We might have 5 or 6 bed bound patients each at a time, and we have shared showers. In orientation, my trainee said she will usually give 3 or 4 baths a day and leave some of the bed bounds for night shift. I bathed 7 people one shift and left 3 for night shift and the night PCA jumped my case and reported me. This PCA also reported me b/c a ice pitcher didn't have new ice in it and the trash was halfway full at shift change in two rooms. Now, I'm being hovered over by our charge nurse and I hate my job already. There were a few pts one day I didn't bathe b/c they had bathed the previous day and they were not dirty, so I just provided peri care with soap and water. I got reported for that too. I think overwashing when not dirty leads to more skin breakdown? There are no guidelines where I work on this issue. What are some of your policy's on baths at your facility? Between rounding, procedures, and everything else, I don't even take lunch in the 12 hour shift, so bathing everyone is impossible it seems. I just don't want to get in trouble.
    I don't know. I'd kind of feel a sort of way about dayshift pushing their work off on me, too. I would've said something abolut it to you, too. LOL If it were that pressing and I couldn't save the showers for the next day? I'd stay and help my relief get everyone showered. I've done it before (just not with showers). But...changing residents. I leave at 2 pm. Lunch runs from 12p-2p and it's difficult to get through my final round in between those lunches, sometimes. So, I cut a deal with the oncoming aides on the heavier, poopi-er residents. I help them transfer or assist them with changing.
    Why?
    It's not about being a Super Aide. LOL
    It's my work to be done. Passing it off...? Y'know, I'm not even going to play the 'continuity of care' card. LOL You don't just up and leave YOUR work for others to do. "Oh, I'll do 4 and night shift can do ---:
    Nah. I'm sorry....LOL
    But...I suppose that things work differently in the hospital?


    In all this I wonder: Is it even acceptable to do that? To unload on the night shift? You said something about the aide saying that she leaves her showers for the nightshift to do. Did you talk to the nurse about this? Is it an acceptable policy?
    On matters like this, you need clarification.

    When we're very busy, a modified wh-re bath is acceptable. LOL
    I do pericare, get the pits, the feet and the face.
    Some people bathe 3 or 4 times a week. I'm in LTC (psych). Those who can ambulate will shower daily if they feel like it. I did clinicals in the hospital and really like those waterless shampoo caps. Also, there's this antiseptic type wipe that you rub on the pt's skin after their bath?
    Wish we had some of that where I am.

    9-12 pts? 5-6 bedbound?
    Sounds nice.

    Some aides are just a-holes. They show no mercy to the preceding shift. These are the types who'll see the mistakes once they get on shift and make a stink after the relief has gone home....
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    First off, I'm wondering how you can give proper care to 9-12 patients. That's a heavy patient load, and it's also a patient safety issue. What happens if you have a few fall risk patients who need to use the restroom at the same time? You can't leave one to get to the other, but you can't ignore the other because you know damn well they'll hop out of bed and attempt to ambulate to the restroom. I'm in the flex pool at my job (meaning I get floated to whatever unit needs the help that specific day) and the most patients I've had at once is 8. That was in our "observation" unit, where the majority of patients are independent. I can't imagine having 12 patients and half of them being a 1x or 2x assist, if not total care.

    Additionally, it sounds to me like your unit doesn't work as a team. There are many shifts that I don't finish up all of my duties. Sometimes things just happen in the last hour and a half that prevent you from tying up loose ends. The other night, we got 3 new admits within the last 2 hours so I was unable to change sheets, clean up my last few patients, and tidy up their rooms. So while giving report to the oncoming techs, I let them know what still needed to be done. Know what we did? For the next 45 minutes, we worked together to get start of shift vitals, linen changes, and baths. That way, the oncoming tech didn't feel like I was leaving them with work to do AND all of the patients (and their rooms) were cleaned, changed, and ready for the rest of the day. And we got it done quickly because we worked together. It's so much easier to bathe and change the linens on bed rest patients when you've got help.

    And, yes, some techs are just a-holes anyway. I've noticed that the student nurse techs at my hospital are the ones that are the best to work with. The ones that have been techs for years are the ones that like to make a stink about "not pulling your workload". Instead of reporting you, she should have come to you and said "Hey, don't know if you know or not, but this is what should be done. Would you like me to help you so you can see how to do it efficiently so you're not running around at the end of the shift trying to get everything done?"

    Sounds to me like you're on a crappy unit that has no concept of teamwork. We have one of those units at my hospital. Whenever I'm on that unit, I'm made to feel like I'm incompetent and I'm spoken to like I'm an idiot for not doing things their way (keep in mind, I'm part of the Flex Unit- and each unit in my hospital has different standards for what they expect out of the techs each shift). But when I'm in other units, the nurses are usually pretty surprised that I'm willing to do work. I've had nurses tell their charge nurses that they're suprised to see someone who actually does work. On units like critical care where the nurse to patient ratio is pretty low (we have a 2:1 ratio for our level 1 CC pts), some nurses are so used to doing all of the work including bathing, linen changes, lab draws, etc. that they are surprised when I'll step in and offer help. But on another *unmentioned* floor, the nurses couldn't be bothered with doing any other than administering meds and expect the techs to do everything else.
    duskyjewel likes this.
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    12 would be a slow day where I work, sometimes I have up to 24ish more or less. And many are confused, fall risks, you can easily have 10+ complete cares....
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    That is beyond unsafe for patients. And I'm not saying that you're not good at your job, but there is NO WAY any person can give proper care to that many patients. Doesn't matter how amazing you are. You guys are being overwhelmed with work and your patients are being denied proper/sufficient care. Sounds like a recipe for disaster. I can't believe that you guys don't have an astronomically high fall rate.

    Are you expected to do q2 or q4 vitals on 24 patients? Bathe them all? Set up their meals for them? Do blood draws? Get some of them off to various therapies and procedures through out the day?

    I don't care how good you are- there is NO way you can do q4 (let alone q2, depending on unit policy) vitals on 24 patients in addition to ADL's, transports, blood draws, and meal set ups. You'd be running around all day getting vitals. And documentation? Yeh, there's no way you can do that properly. You guys are overworked and your patients are being denied proper care. I'm sorry you have to operate in that type of environment.
    duskyjewel likes this.


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