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.

[Emmeline22]

Just now, Nunya said:

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.  

Our admin has told us that for urine incontinence they just need wipes and for fecal incontinence they are allowed to shower  most of the time. Our admin is all about saving money and really make it a horrible place for patients. They have even gone as far as to state if in the morning we notice a wet patch in a bed to just assume that the patient spilled water and only to change linens if it smells like urine. 

[hppygr8ful, ASN, RN, EMT-I]

27 minutes ago, Emmeline22 said:

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.

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.

Oh I forgot to say that none of our patient bathrooms have doors only a heavy shower curtain type thing. This not aimed at you but at your facility but it is shameful to make a patient wait 45 minutes to an hour. I would love to know what State you are in and what the rationale is for this. I can foresee a situation where a patient slips on their own waste and has a fracture. When that happenes you facility will ask you to lie about staffing to cover their behind. 

I just checked the rights of patients in mental health facilities and patients do have the right to immediate access to proper hygeine facilities/supplies to the extent that they are physically able to care for themselves.

[Emmeline22]

2 hours ago, hppygr8ful said:

Oh I forgot to say that none of our patient bathrooms have doors only a heavy shower curtain type thing. This not aimed at you but at your facility but it is shameful to make a patient wait 45 minutes to an hour. I would love to know what State you are in and what the rationale is for this. I can foresee a situation where a patient slips on their own waste and has a fracture. When that happenes you facility will ask you to lie about staffing to cover their behind. 

I just checked the rights of patients in mental health facilities and patients do have the right to immediate access to proper hygeine facilities/supplies to the extent that they are physically able to care for themselves.

This is Missouri. During training we had the locked bathroom doors explained as a safety mechanism. I'm only about 3 months in so still getting oriented to the place, but everything is always explained briefly and when you ask questions they tell you they don't have time to answer. 

Maybe now you understand a little bit more about why our patients are often so embarrassed. At my last shift I had a 23 y/o female who was able to perform all ADL's independently come up to me at 11am and ask to use the bathroom. I was alone at the nurses station and told her I would radio. Put in the radio call for a float staff to come assist. She comes up again at 11:15, 11:30 and about 11:55 and each time on the radio I am told there is a code and to wait. She comes up at about 12pm asking again saying she really had to go. I put out on the radio again stating it was a urgent. An admin asks if it's threatening I say no but she has been waiting. So for about 15 minutes I watch her do an akward potty dance until I see the puddle forming around her feet. She begins to cry and I tell her, "It's fine." She replies "It's not fine. I am 23 and just peed my pants." I tell her "don't worry about it." She then accuses me of not trying to help her and states, "Do you really think I am going to want to live if I'm forced to pee my pants?" I try to tell her it's our fault. She then asks if she can get some extra clothes to change. I tell her that she needs to wait until a staff member can come as our policy does not allow patients to have two pairs of scrub bottoms at the same time. We also keep all bedroom doors locked during the day so she has to just sit there covered in urine for about 30 minutes until somebody comes. At this point I grab some fresh clothes and ask her to follow me to the bathroom. She then asks if she can go in alone and I tell her I have to come. While watching her remove her wet clothing and wipe herself down I don't really know what to say. So yeah maybe now you understand why it's horrible to both be a patient there and work there. If you have any ideas for what to say to patients to make it less embarassing while I work on reporting it to the appropaite people and creating change.

[hppygr8ful, ASN, RN, EMT-I]

2 hours ago, Emmeline22 said:

This is Missouri. During training we had the locked bathroom doors explained as a safety mechanism. I'm only about 3 months in so still getting oriented to the place, but everything is always explained briefly and when you ask questions they tell you they don't have time to answer. 

Maybe now you understand a little bit more about why our patients are often so embarrassed. At my last shift I had a 23 y/o female who was able to perform all ADL's independently come up to me at 11am and ask to use the bathroom. I was alone at the nurses station and told her I would radio. Put in the radio call for a float staff to come assist. She comes up again at 11:15, 11:30 and about 11:55 and each time on the radio I am told there is a code and to wait. She comes up at about 12pm asking again saying she really had to go. I put out on the radio again stating it was a urgent. An admin asks if it's threatening I say no but she has been waiting. So for about 15 minutes I watch her do an akward potty dance until I see the puddle forming around her feet. She begins to cry and I tell her, "It's fine." She replies "It's not fine. I am 23 and just peed my pants." I tell her "don't worry about it." She then accuses me of not trying to help her and states, "Do you really think I am going to want to live if I'm forced to pee my pants?" I try to tell her it's our fault. She then asks if she can get some extra clothes to change. I tell her that she needs to wait until a staff member can come as our policy does not allow patients to have two pairs of scrub bottoms at the same time. We also keep all bedroom doors locked during the day so she has to just sit there covered in urine for about 30 minutes until somebody comes. At this point I grab some fresh clothes and ask her to follow me to the bathroom. She then asks if she can go in alone and I tell her I have to come. While watching her remove her wet clothing and wipe herself down I don't really know what to say. So yeah maybe now you understand why it's horrible to both be a patient there and work there. If you have any ideas for what to say to patients to make it less embarassing while I work on reporting it to the appropaite people and creating change.

It really does seem you are between a rock and a hard place. Honestly I would quit under those conditions file a complaint with the Joint Commission and the Center for Medicare/Medicaid services. Anonymous complaints usually don't get much traction so you have to be willing to go on the record.

I still don't understand your staffing model as there should never be just one person staffing a unit by themselves. There should be at least 1 license in the nurses station at a minimum of 1 floor staff. Example My unit holds 14 patients. I have two floor staff, 1 medication nurse and myself (Charge nurse).  If a code is called 1 designated person (Usually a floor staff)  on each unit runs to the code. In the situation you described I would have gone to assist the patient locking the nurses station behind me. All they can do is fire you and quite frankly you would have a pretty good wrongful termination case unless Missouri is an "At Will" state.

 

I looked at Missouri's Mental Health code  CRS 10-7.120 States that mental health in-patient's have the right to Immediate Access to bathrooms that are clean and well stocked. The key word here is "Immediate". Also check the policy and procedure manual for your facility. There should be a copy in every nurses station. 

Also Missouri state law 630.110 states the patient has a right to wear their own cloths. Here California a physician would have to order a denial of rights with specific Rationales and renew it daily.

I know you are fairly new and in a tough situation but you also have a duty to advocate for your patient.  I guess I will be crossing Missouri off my list of states to move to. 

Hppy

[areason4stars, ASN, RN]

On 11/22/2020 at 4:08 PM, Emmeline22 said:

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.

Wow that's really sad. I cant imagine regularly having to wait that long to use a bathroom.  That sounds dangerously understaffed. I mean if it takes that long to get an available staff to unlock a bathroom I cant imagine how long it would take to get staff available for various other situations as well. 

[Sour Lemon]

4 hours ago, Emmeline22 said:

Maybe now you understand a little bit more about why our patients are often so embarrassed. At my last shift I had a 23 y/o female who was able to perform all ADL's independently come up to me at 11am and ask to use the bathroom. I was alone at the nurses station and told her I would radio. Put in the radio call for a float staff to come assist. She comes up again at 11:15, 11:30 and about 11:55 and each time on the radio I am told there is a code and to wait. She comes up at about 12pm asking again saying she really had to go. I put out on the radio again stating it was a urgent. An admin asks if it's threatening I say no but she has been waiting. So for about 15 minutes I watch her do an akward potty dance until I see the puddle forming around her feet. She begins to cry and I tell her, "It's fine." She replies "It's not fine. I am 23 and just peed my pants." I tell her "don't worry about it." She then accuses me of not trying to help her and states, "Do you really think I am going to want to live if I'm forced to pee my pants?" I try to tell her it's our fault. She then asks if she can get some extra clothes to change. I tell her that she needs to wait until a staff member can come as our policy does not allow patients to have two pairs of scrub bottoms at the same time. We also keep all bedroom doors locked during the day so she has to just sit there covered in urine for about 30 minutes until somebody comes.

Okay, that sounds a lot more concerning than what you originally wrote. I've had patients who cannot go in a bathroom unattended, but they have 1:1 attendants and would never wait an hour plus.

Hppy seems have some useful knowledge and good advice.

[FolksBtrippin, BSN, RN]

When I worked inpatient psych I found generally that I was discouraged from thinking on my own and using my own judgment when it came to my patients.

I think if you feel like the patient needs a shower and the patient feels like she needs a shower then she needs a shower.

If you feel like you should offer the patient something to wear you should do it.

If you feel like the sheets need to be changed then they need to be changed.

If you think a patient can handle having more than one menstrual pad at a time then you should give them what you think they need. 

This is one of the reasons I left inpatient psych. I had to follow stupid policies against my judgement and I felt totally disrespected as a professional.