I work night shift, M-F in a 6 bed ICU/CCU. Been straight nights since November. Worked at this place since last Feb. We have a new nurse who's been an RN for awhile and worked nights for 16 yrs. She's working days/eves for us. Since I started here, it hasn't ever been impressed on me that as a night nurse, I am EXPECTED to do baths on my shift. Usually, if my patient is intubated and sedated, I WILL bathe them on nights. When I worked days, I'd get irked to come in and find that NONE of my patients had been bathed on nocs. When I mentioned it to my manager, her response was well if they didn't do it, they didn't do it.
Now that this new nurse is here, and only works days/eves, she seems to think that us night shifters should bath at least 1/2 of the pts in the unit. Cause that's what she did when she worked nights at her last job. She SAYS she mentioned her concerns about baths to our nurse manager who told her
that she agreed with her. Now, this isn't how we've been doing things where I work. Nor has it ever been an issue with any other day shifter until this woman started working here. And frankly, where I worked before, at the only trauma hospital in the ICU, we didn't do many baths on nights there either.
Now, usually on nights, the nsg supervisor pulls our aide to the med-surg floor as their night shift aide quit, or she'll get pulled to the detox floor or the medical psyc unit. She's even been pulled to OB. Our aide works 4 nights a week--no weekends--and maybe gets to stay in ICU with us 2 of those shifts.
This new nurse said that she's been there for 6 weeks now and we on nights have not done ONE bath. Well, we haven't had any vented pts in awhile and most of our pts have been alert and oriented. I am not gonna wake an alert and oriented person in the middle of the night to give them a bath. If they are sedated on a vent, or confused with no concept of night or day, then I have no problem giving them a bath IF I HAVE TIME. New nurse says there's been plenty of confused pt's in her 6 wk tenure that we could've bathed on nights. Whatever lady. I think she's trying to cause trouble. She hasn't made any friends and believe me there's plenty of things that she doesn't do.
Now mind you, we run skeleton crew on nights and as a 6 bed unit, we never have more than 2 nurses on the unit...no matter what the acuity. Also there is no respiratory therapy at night either, so I have to do my own vent checks and respiratory treatments. Also have to restock the med area and do 24 hr chart checks on nights.
So, what is the policy where you work regarding bathing pt's at night?
Specializes in ICU of all kinds, CVICU, Cath Lab, ER..
Sorry, but Mr. Military got my dander up. You, sir, have obviously never spent a 12 hour night shift keeping one of your patients alive. Titrating drips, infusing blood products, managing the respiratory status and all the other systems that can crash on a patient. And you want me to bathe the patient? Turn and replace linen that, unless bloodied or stooled or urine-soaked, doesn't matter an inch when skin integrity may not be a problem if I fail at what I am trying to do - KEEP THE PATIENT ALIVE!!
When nurses get so darn tunnel-visioned, the patient suffers. Let me share an example with you: 42 yr old middle division weight lifter post valve replacement. The patient was a difficult intubation (per cardiac surgeon and anethesiast - DO NOT TURN THE PATIENT - DO NOT BATHE THE PATIENT - DO NOT MESS WITH THE PATIENT EXCEPT TO CARRY OUT WHAT YOU ARE TOLD..... enter I AM THE WORLD'S BEST NURSE - I KNOW MORE THAN THE DOCTOR. She convinced her pal, I WILL GO ALONG WITH HER OR SHE WON'T LIKE ME, they bathed and turned the patient in order to change perfectly clean linen , the tube fell out and by the time the anesthesiologist was able to reintubate, the man was brain dead!!
I still say that bathing is important, but use common sense. No one ever died from one day's dirt.
The military man did make an exception for the unstable patient. I appreciate his gung-ho style and sense of work ethic.
Laziness can creep in unless there is an understanding about baths. These patients need turning every 2 hours anyway, they get soiled linen often enough. What is so hard about adding on a bath and fresh linen? In 8 years at my current job, I have only had one patient who didn't get bathed by the night shift, and she was alert to refuse a bath.
Specializes in ICU (hearts,trauma,NICU, PICU, ER).
Thanks RNperdiem U understood what I had to say.
U don't move a unstable pt NO WAY. I said that clearly. These pts U don't move beside U are to busy with them throught the day/night to bath them for the reason walk6miles mention above.
Wake6miles to let U understand the military. Iraq & Afghanistan nursing U are tunnel-visioned 24hrs a day 7 days wk for 12hr shifts. U get use to that after a 1year :). They still got bushed down. That's a long flight to the states stinking up the plane with others on it who are trying to keep U alive.
And for the record I was a civilan nurse in NYC I now what it's like to saving lives on both ends.
Our unit is pretty relaxed about the baths. I try to bathe people on nights. My coworkers try as well. When we're full (6 beds) we get an aide and it gets done. Sometimes we just team up and go on a "mad bathing spree" and get 'em all done within an hour or so, if they're all stable. It's kinda fun, builds teamwork, no one hurts their back, or if they do, they don't do it alone.
I've also done the style of bath that I call "piddling" where I keep the wipes handy and go head to toe, in between a bunch of other stuff, with a big break for a bunch of dressing changes and emptying drains and stuff. There may not be a bucket of water and it may have taken me all darn night, but they're alive and clean. Weeee! This bath style is reserved for the bedridden, vented, patients who don't realize I've been fiddling with this or that thing all night.
It depends. Try to do it on nightts. Doesn't always get done. And not everybody gets a full bath. Sometimes it's literally pits and slits due to staffing, census and acuity (27 bed Trauma ICU).
This discussion comes up constantly in my unit. I think some nurses are so compulsive that they feel they HAVE to give a bath. Personally, if my pt is awake and alert and can refuse a bath or request then so be it, not too many of them want a bath at 12am, maybe in the morning, but I have found that most just want pits and peri and they feel refreshed. If i have a super sick pt I am not gonna further increase their discomfort by scrubbing them and what not, sometimes I find baths help relax pts, others it just makes matters worse. So really i think the focus should be what is the best interest for the pt. Not the fact that a. it is nites, b. you are the nite nurse and c.all baths must be done on nites. I personally love giving baths, it really helps the pt to feel better and is great for assessment, but sometimes you just need to let that pt rest and clean them up as needed.
I work in a 13 bed SICU, and night shift does 99% of the bathing. All vented/sedated and confused patients are bathed at some point during the night, unless they're unstable. Alert/oriented patients get bathed between 7p and 11p so that they can "sleep". The A/O's rest better when they're bathed early!
Night shift generally has more time to do the "maintenance" type things... and therefore should be responsible for the bathing. There's no clipboard sorts around, the docs are generally gone, there's less traveling for tests, and limited family visitation.
Before I get flamed for my opinion let me assure you that I've worked both shifts for 14 years and I can appreciate what nurses on each shift have to do. Aside from having a crappy night with a super sick patient, there's no reason why nights can't do baths.
I work in a 48 bed ICU and we generally have 2 pts per nurse. There is not a set policy that I am aware of, but since I started there we try to be curtious to one another and the day shift will bathe one and nights bathes the other. It doesn't always work out that way, sometimes you just can't get it done, but we try. If my pts are alert and oriented then by all means, I am going to allow them to rest. And the day shift is generally understanding of this. Hope that this helps....
See, in the ICU where I work......the acuity is generally low. We have a lot of alert and oriented patients who like to SLEEP at night. Circadian Rhythms anyone?
Last night I had a vent pt. PT did get a bath for me.......I MADE the aide come in to help. Tonight the aide got pulled to the med-surg floor. I don't have the vent patient. Pt's a lot sicker tonight than last night and I doubt my co-worker will bathe this patient.
I totally agree that if the patient is sedated and intubated then by all means the bath should be done on night shift. BUT like I said earlier in my initial post.....where I work...there is NO ancillary staff on night shift. And by nights, I mean after 11pm. I consider 9-10pm still evening shift. We have NO respiratory therapy, no unit secretary....nothing!
Specializes in Vents, Telemetry, Home Care, Home infusion.
I usually bathe my vented and sedated or confused patients. There is no way I'm waking up an alert and oriented person for a bath. Usually they want to get as much sleep as they can.
:yeahthat:
Exactly how we worked on night shift Resp ICU/Telemetry unit ---middles even helped with baths if multi procedures on days.
ICU is a 24hr operation. If you know due to acuity pt not bathed that day and your not running around at start of shift, can offer basin to pt to freshen up along with backrub, draw sheet change while doing initial assessment in a pinch. Otherwise lulling to sleep is priority #1 to promote healing and the circ. rhythms.
In an ideal nursing world where coworkers all actually pull their weight, and shifts don't fall apart, all A/O patients would bathe during the day and sleep all night. I'd love it if my A/O patients were bathed on dayshift!! It would make my nights much easier.
However, if I come in and my patient hasn't had a bath since yesterday, then he/she is getting a bath. Period. Am I going to wake him up at o' dark-thirty to wash? Of course not... but I do make a plan with the patient: "Okay, Mr. Patient, I'm going to do my assessments, get some medicines passed, and do some charting. I'll be in between 10 and 10:30 to help you get cleaned up and settled for the night." If the patient refuses, fine. I've done my part in making the attempt. OR, sometimes they want to bathe in the AM... so I give them the option of doing it around labtime (4 am) or right before shift change (around 6 am). Of course this comes with the disclaimer that if something goes awry in the middle of the night I may not be able to follow through with the bath.
Most A/O patients appreciate a bath, even if it occurs on nightshift. Circadian rhythms stay more rhythmic if the patient can sleep, which he is more likely to do if he is clean and not laying in his breakfast crumbs!!
(And BTW, the only ancillary staff we have is a unit secretary on dayshift. Nights, we're on our own! We generally tag team and knock out most baths between 3 and 5a.)
walk6miles
308 Posts
Sorry, but Mr. Military got my dander up. You, sir, have obviously never spent a 12 hour night shift keeping one of your patients alive. Titrating drips, infusing blood products, managing the respiratory status and all the other systems that can crash on a patient. And you want me to bathe the patient? Turn and replace linen that, unless bloodied or stooled or urine-soaked, doesn't matter an inch when skin integrity may not be a problem if I fail at what I am trying to do - KEEP THE PATIENT ALIVE!!
When nurses get so darn tunnel-visioned, the patient suffers. Let me share an example with you: 42 yr old middle division weight lifter post valve replacement. The patient was a difficult intubation (per cardiac surgeon and anethesiast - DO NOT TURN THE PATIENT - DO NOT BATHE THE PATIENT - DO NOT MESS WITH THE PATIENT EXCEPT TO CARRY OUT WHAT YOU ARE TOLD..... enter I AM THE WORLD'S BEST NURSE - I KNOW MORE THAN THE DOCTOR. She convinced her pal, I WILL GO ALONG WITH HER OR SHE WON'T LIKE ME, they bathed and turned the patient in order to change perfectly clean linen , the tube fell out and by the time the anesthesiologist was able to reintubate, the man was brain dead!!
I still say that bathing is important, but use common sense. No one ever died from one day's dirt.
He was the sole parent for a 6 yr old daughter.