Am I being unreasonable about my concerns regarding safety/hygiene?

[Emmeline22]

I am about 3 months into my first nursing job out of school and have been offput by some stuff on my unit. For reference I am on an adult psych crisis stabilization. Can people either validate my concerns or tell me if I am being unreasonable.

1) There is no actual procedure in place to ensure that patients get a change of underwear and scrubs. We have been told by management not to offer new clothing to patients unless they directly ask or we see that somebody is visibly soiled. Most patients shower in the morning, but don't change clothing. Because patients don't think we have spare clothing often times I will see patients walk around with period leakage, feces stains, etc. and when asked why they didn't ask for some new clothing they report that they didn't know that was an option. I often worry that patients are sitting in their own mess for an extended period of time before a staff member notices and approaches them to offer new clothing.

2) We are only allowed to give patients one pad at a time. Management states this is for safety purposes, but leads menstrauting patients to hang around the nurses station all day asking for supplies. We also do not offer overnight pads which often leads to bloody sheets in the morning.

3)We are also told not to change sheets unless they are visibly soiled. Our average patient stay is only 6 days, but still this seems like a long time not to change sheets. Furthermore, we are told if they are wet to assume it is just spilled water unless it smells like urine and then change the sheets. 

4)With instances of urinary incontinence patients are not allowed to shower. This often happens while patients are sleeping hence they are completely soaked from head to toe. To make matters worse we are required to stand and watch them strip naked, give us the wet clothing before we can give them the dry clothing. As if the patients aren't embarassed enough to begin with they must have a nurse watch them remove their wet clothing. 

 

Can people tell me if they also think this is problematic and/or I am just being unreasonable. What does your unit do differently? Thank you.

[Sour Lemon]

6 minutes ago, Emmeline22 said:

I am about 3 months into my first nursing job out of school and have been offput by some stuff on my unit. For reference I am on an adult psych crisis stabilization. Can people either validate my concerns or tell me if I am being unreasonable.

1) There is no actual procedure in place to ensure that patients get a change of underwear and scrubs. We have been told by management not to offer new clothing to patients unless they directly ask or we see that somebody is visibly soiled. Most patients shower in the morning, but don't change clothing. Because patients don't think we have spare clothing often times I will see patients walk around with period leakage, feces stains, etc. and when asked why they didn't ask for some new clothing they report that they didn't know that was an option. I often worry that patients are sitting in their own mess for an extended period of time before a staff member notices and approaches them to offer new clothing.

2) We are only allowed to give patients one pad at a time. Management states this is for safety purposes, but leads menstrauting patients to hang around the nurses station all day asking for supplies. We also do not offer overnight pads which often leads to bloody sheets in the morning.

3)We are also told not to change sheets unless they are visibly soiled. Our average patient stay is only 6 days, but still this seems like a long time not to change sheets. Furthermore, we are told if they are wet to assume it is just spilled water unless it smells like urine and then change the sheets. 

4)With instances of urinary incontinence patients are not allowed to shower. This often happens while patients are sleeping hence they are completely soaked from head to toe. To make matters worse we are required to stand and watch them strip naked, give us the wet clothing before we can give them the dry clothing. As if the patients aren't embarassed enough to begin with they must have a nurse watch them remove their wet clothing. 

 

Can people tell me if they also think this is problematic and/or I am just being unreasonable. What does your unit do differently? Thank you.

1. I don't see any major problem here. It sounds like they can ask and staff can offer ...there's just not a set time or a set way. Am I understanding correctly?

2. Psych patients are frequently hoarders, so this makes perfect sense to me. They also find interesting things to do with their items, especially when they have too many of them.

3. I only change my sheets at home weekly. Sometimes every two weeks if I'm feeling lazy. I don't see a problem here, either. It sounds like you have the option to change the sheets if you feel they are soiled.

4. A psych patient so medicated that they wet themselves in the night should not be put in the shower, IMO. I would give them a quick "bath" in bed and try to get them in the shower when they woke in the morning- hopefully in a more alert state. Supervising a change of clothes makes sense to me for the same reason, although I would drape the new clothing around them as the old clothing was removed.

[hppygr8ful, ASN, RN, EMT-I]

I have been doing Psych for about 20 years now and have rarely had it be a regular thing for people to wet or soil themselves. Even people with early onset dementia and some developemental delays still seem to have the wherewithall to make it to the toilet so I ask just what kind of unit this is. Is it a combo med/psych, gero/psych etc....

1. At our facilty we do not provide scrub tops and pants. But we have agreat network of staff and people in the community that provide donations of T-shirts/pants and athletic shoes to our patients. The law states that psych patients have the right and should be encouraged to wear street cloths. Sometimes they come in with their own clothing that is soiled and we give them a fresh set wash the ones they came in with and return them so now they have two sets of cloths. We are actively encouraged to make sure our patients are clean and comfortable. 

2. We give our female patient's up to three pads at a time. Our pads are small and when patient's have a heavy flow they may need more pads, however they do to try to flush them and the really psychotic folk can do some very interesting things with them. So we keep a pretty close eye on pad usage. 

3. Like @Sour Lemon I usually change my own sheets at home weekly and if the patient's bed is not soiled by blood, urine or feces the hospital does not change the sheets. Still no patient is denied a change of sheets so long as the old set goes directly into the hospital lawndry.

4. Again like @Sour Lemon I feel that if a patient is so medicated/confused that they are soaking/crapping the sheets. they pose enough of a fall risk that they should not be allowed to shower without supervision. If a patient is an up and about Walkie/Talkie they can usually shower on their own. Still we do assist with clothing changes and drape gowns so patients has some small measure of privacy. if they tend to soil due to just being heavy sleepers we have night staff wake them ebvy 2 to 4 hours to assist with toileting. 

So at least in my part of California the Department of Mental Health takes a dim view of people being discharged in soiled cloths or without shoes. We had a patient a couple of years ago that got on the wrong bus and rode it all the way from somewhere in the Midwest to California. After arrangements were made to get him back to his home city in December weather the whole staff came together and got him a good coat, knap sack and hygiene supplies.

Hope this helps answer your questions.   

[Emmeline22]

1 hour ago, hppygr8ful said:

I have been doing Psych for about 20 years now and have rarely had it be a regular thing for people to wet or soil themselves. Even people with early onset dementia and some developemental delays still seem to have the wherewithall to make it to the toilet so I ask just what kind of unit this is. Is it a combo med/psych, gero/psych etc....

1. At our facilty we do not provide scrub tops and pants. But we have agreat network of staff and people in the community that provide donations of T-shirts/pants and athletic shoes to our patients. The law states that psych patients have the right and should be encouraged to wear street cloths. Sometimes they come in with their own clothing that is soiled and we give them a fresh set wash the ones they came in with and return them so now they have two sets of cloths. We are actively encouraged to make sure our patients are clean and comfortable. 

2. We give our female patient's up to three pads at a time. Our pads are small and when patient's have a heavy flow they may need more pads, however they do to try to flush them and the really psychotic folk can do some very interesting things with them. So we keep a pretty close eye on pad usage. 

3. Like @Sour Lemon I usually change my own sheets at home weekly and if the patient's bed is not soiled by blood, urine or feces the hospital does not change the sheets. Still no patient is denied a change of sheets so long as the old set goes directly into the hospital lawndry.

4. Again like @Sour Lemon I feel that if a patient is so medicated/confused that they are soaking/crapping the sheets. they pose enough of a fall risk that they should not be allowed to shower without supervision. If a patient is an up and about Walkie/Talkie they can usually shower on their own. Still we do assist with clothing changes and drape gowns so patients has some small measure of privacy. if they tend to soil due to just being heavy sleepers we have night staff wake them ebvy 2 to 4 hours to assist with toileting. 

So at least in my part of California the Department of Mental Health takes a dim view of people being discharged in soiled cloths or without shoes. We had a patient a couple of years ago that got on the wrong bus and rode it all the way from somewhere in the Midwest to California. After arrangements were made to get him back to his home city in December weather the whole staff came together and got him a good coat, knap sack and hygiene supplies.

Hope this helps answer your questions.   

@hppygr8ful It is adult crisis stabilization. The reason many accidents happen is that all bathrooms are locked so when patients need to go they have to get a staff member to assist. Given that we are chronically short-staffed (we are down South) this can take a while

[Jedrnurse, BSN, RN]

I wouldn't be surprised if money concerns played a part in these practices.

[TheMoonisMyLantern, ADN, LPN, RN]

In my state crisis stabilization units are considered residential facilities and thus are regulated by different agencies than inpatient psych hospitals. Unfortunately the standards of care can be quite low and the budget to run the facilities non existant. That said, incontinence issues should be rare in this population since crisis stabilization isn't considered a "medical" facility but a "residential" facility. However if you are seeing these issues often I would do what is safest and preserves the dignity of the patient. Look at the human rights for psychiatric patients in your state, these always trump company policy.

[hppygr8ful, ASN, RN, EMT-I]

12 hours ago, Emmeline22 said:

@hppygr8ful It is adult crisis stabilization. The reason many accidents happen is that all bathrooms are locked so when patients need to go they have to get a staff member to assist. Given that we are chronically short-staffed (we are down South) this can take a while

I only know how things are done in California with regard to psych. But locking alert, oriented and continent people who are not on 1:1 ATC/RTC status would actually be a considered a violation of patient's rights and might result in an Immediate Jeapordy Citation which can be costly for the facility and also lead to losing Medicare and Medicaid contracts..

I too work in crises stabilization and all of our patients have a room mate and a Semi Private bathroom. I would first check to see what actual patient's rights are on this subject. If as I suspect the facility is in violation  of patient's rights then I would beat feet out of there.

Hppy

[areason4stars, ASN, RN]

I just wanted to say at my facility the bathrooms are locked as well. And clients must have  staff unlock it  as needed. But there is ALWAYS staff on the floor that will unlock it at clients request. The only delays with a client needing to use the bathroom is if there are certain clients already in the bathrooom and those clients arent allowed in the bathroom with ANY other clients per their safety plan. 

 I work at a residential psych facility for children and teens. Now we have a few clients who have behaviors involving fecal smearing  and some clients do wet the bed at night BUT we don't have a wide spread  problem with clients soiling/wetting themselves. 

[caliotter3]

On 11/20/2020 at 10:06 PM, Jedrnurse said:

I wouldn't be surprised if money concerns played a part in these practices.

I am surprised that OP did not say the water faucets were turned off and bolted between uses and that each use had to be appropriately documented and turned in to the unit manager at shift end. 

[TheMoonisMyLantern, ADN, LPN, RN]

45 minutes ago, caliotter3 said:

I am surprised that OP did not say the water faucets were turned off and bolted between uses and that each use had to be appropriately documented and turned in to the unit manager at shift end. 

Shhhh don't give admin any ideas.

[Emmeline22]

9 hours ago, areason4stars said:

I just wanted to say at my facility the bathrooms are locked as well. And clients must have  staff unlock it  as needed. But there is ALWAYS staff on the floor that will unlock it at clients request. The only delays with a client needing to use the bathroom is if there are certain clients already in the bathrooom and those clients arent allowed in the bathroom with ANY other clients per their safety plan. 

 I work at a residential psych facility for children and teens. Now we have a few clients who have behaviors involving fecal smearing  and some clients do wet the bed at night BUT we don't have a wide spread  problem with clients soiling/wetting themselves. 

Yeah, well on our unit it can take anywhere from 45 minutes to an hour before there is a staff member available to unlock/supervise bathroom.

On 11/21/2020 at 8:58 AM, hppygr8ful said:

I only know how things are done in California with regard to psych. But locking alert, oriented and continent people who are not on 1:1 ATC/RTC status would actually be a considered a violation of patient's rights and might result in an Immediate Jeapordy Citation which can be costly for the facility and also lead to losing Medicare and Medicaid contracts..

I too work in crises stabilization and all of our patients have a room mate and a Semi Private bathroom. I would first check to see what actual patient's rights are on this subject. If as I suspect the facility is in violation  of patient's rights then I would beat feet out of there.

Hppy

No, our facility is allowed to lock the bathrooms. The main problem is we are so understaffed so from the time that a patient requests the toilet to the time a staff member is actually available to unlock/supervise them 45 minutes to an hour is not unusual. We usually walk to find the patient who requested the toilet only to find that they have already had an accident.

[Nunya, BSN]

So... I've never worked Psych except for being pulled a few times, and then it was usually for meds or 1:1 at night.  I also understand being short staffed.  But #1 and 4 sound disgusting. Would you treat patients on a med-surg floor this way?  No, of course not.  Part of inpatient care is making sure your patients are clean.  That includes bathing and clean clothes.  Do you even give incontinent patients a basin of warm water and a wash cloth before giving them dry clothes?  If not that's inappropriate.  And they shouldn't be required to strip down in front of you, that's demeaning.  These people are PEOPLE.  Would you like to be treated this way?  be I'll bet if the person who made these tiles had a loved one in there this wouldn't continue.  If women are going through pads at night and there's blood on their sheets they should be given more pads.  Why not, when dirty sheets in the morning means more work for you, not to mention ugh.  I can understand some may try to flush them but if bathrooms are locked.... I'm not sure what you can do about them needing pads during the day and "hanging around" but the unit I floated to didn't allow patients to hang around the nursing station.  I don't think most hospitals do, and most patients understand this, but with psych patients you may need to be more direct. 

And as far as changing sheets, I can see going a week without changing unless patients are spending more than just the night in bed.  Of course that's with the premise that they're bathing at least every other day so their bed is staying relatively clean.  It seems like your facility is trying to save money at the patient's expense.  Obviously there are always exceptions esp if the patient is very unstable or violent but it shouldn't be the norm.