Currently on shift and disagree with instructions from charge nurse. WWYD?

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Hello all I hope you are having a great thanksgiving- for those working I feel ya. So I’m a newish nurse working on a child and adolescent psych ward. Reading @Emmeline22 recent post I actually gained some new perspectives from seasoned nurses and think that the charge nurse today was out of line. 

Today while doing morning safety checks (a tech and I walk through all the rooms to check that there isn’t anything dangerous) I noticed that one of the rooms belonging to a 16 y/o F patient smelled like urine. Upon inspecting the linens it was clear that they were wet and under her bed I found a pair of wet pajamas, underwear and a T-shirt. After finishing all the rounds I updated my charge nurse on what I had found and told her that while the kids were still in morning group I was going to go discreetly change the linens and get the girls clothing in the wash, then after group discreetly tell the girl “I changed your sheets and your clothes are in the wash. If this ever happens again feel free to tell us if you need clean sheets.” I was also going to offer for her to take a shower as the kids are only usually allowed to shower during the evening. My charge nurse told me that I shouldn’t do this with the rational being that at 16 she needed to learn how to advocate for her own needs. I totally agree that this should be a goal of hospitalization, however, I can only imagine how embarassed this girl would be having woken up and discovered that she was wet. I then asked the charge nurse how long to give her and she said “until she finds the courage to speak up for herself.” I just disagree with this but maybe I’m being unreasonable? I’ve now also missed the mark for discretion as the kids are throughout the ward and this patient shares a room. WWYD?

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Specializes in Psych, Addictions, SOL (Student of Life).

I would do exactly what you did. Leaving Urine soaked bedding and clothing is a health hazard and needs to be dealth with. 

Yes in an ideal scenario you could require the patient to change their own cloths and bedding but I would need to know more about the patient and setting. I work exclusively with adolescents and in an acute crises stableization unit. When our patients come in delusional or psychotice they often don't care about their hygiene so when they come to you for help that is a sign of progress. The same is true with severely depressed young people. It is not therapeutic to make a huge deal and embarrass/humiliate the patient. 

Hppy

 

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I totally agree with your instinct. I can only imagine that the young patient woke up this morning and realized what what had happened and was terribly embarassed. I think now that the kids are throughout the ward I would take the patient aside and kindly ask if she had an accident. Maybe something like "It's quite common for patients to have accidents while in the hospital did you have one?" We aren't allowed to wash patient clothing so in my facility we would place them in a sealed belonging bag for her parents or guardian to pick up. Definitely think you should say "It can be unhealthy to have urine on your body so why don't you take a shower"

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2 minutes ago, hppygr8ful said:

I would do exactly what you did. Leaving Urine soaked bedding and clothing is a health hazard and needs to be dealth with. 

Yes in an ideal scenario you could require the patient to change their own cloths and bedding but I would need to know more about the patient and setting. I work exclusively with adolescents and in an acute crises stableization unit. When our patients come in delusional or psychotice they often don't care about their hygiene so when they come to you for help that is a sign of progress. The same is true with severely depressed young people. It is not therapeutic to make a huge deal and embarrass/humiliate the patient. 

Hppy

 

@hppygr8ful I haven’t actually done anything yet since the charge nurse said not to and now the kids are throughout the unit. Right now I’m on my break but when I go back I plan on asking the charge nurse if I can do something

This is not the highest acuity. Patient is here for depression, but very independent. Can perform all ADL’s independently normally. We were actually discussing why this might have happened since has not had any changes to her medications. Any ideas?

 

4 minutes ago, Emmeline22 said:

I totally agree with your instinct. I can only imagine that the young patient woke up this morning and realized what what had happened and was terribly embarassed. I think now that the kids are throughout the ward I would take the patient aside and kindly ask if she had an accident. Maybe something like "It's quite common for patients to have accidents while in the hospital did you have one?" We aren't allowed to wash patient clothing so in my facility we would place them in a sealed belonging bag for her parents or guardian to pick up. Definitely think you should say "It can be unhealthy to have urine on your body so why don't you take a shower"

I’m not sure if I should call parents since that may embarrass patient more

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Specializes in Psych (25 years), Medical (15 years).
47 minutes ago, RileyisSmiley said:

WWYD?

I would do exactly as you did Riley for the same reasons as given and allow nature to take its course.

As Thoreau said, " ... any man more right than his neighbors constitutes a majority of one..."   

In this case: ... any staff nurse more right than the charge nurse...

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Specializes in Psych, Addictions, SOL (Student of Life).
3 minutes ago, RileyisSmiley said:

@hppygr8ful

This is not the highest acuity. Patient is here for depression, but very independent. Can perform all ADL’s independently normally. We were actually discussing why this might have happened since has not had any changes to her medications. Any ideas?

 

 

 

Enuresis can have many causes and is usually not a matter of laziness. I have seen adolescents who have been sexually assaulted, neglected or abused suffer from this common problems. Sometimes they have been given medications to help them sleep and don't wake up. Thay may have a developemental delay or some other organic problem. In any case nothing is served but humiliating the patient. We have a washer and dryer on the unit specifically for patient clothing. Patients put their soiled cloths in a pillow case and given to the nurses who do them during the noc shift and place them outside the patient's room. We also will wash cloths when they come in and have been sitting in an ER for several hours. We encourage all our patients to wear thir own cloths and will call families to bring a change or we will find appropriate dress from our donations cabinet. 

HPPY  

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@hppygr8ful can you give me feedback about how I handled the situation since I also feel like I work in a place where I can’t ask for advice and get constructive criticism. 

So I got back to the unit and pulled the patient aside who was in the dining area lounging around. I asked her “hey, it’s not a big deal if you did, but did you pee in the bed last night?” At this point she began tearing up and I said “you’re not in trouble for having an accident it just happens sometimes I just want to get you cleaned up.” She then asked why it happened and I responded that there are many reasons. She then asked if this meant she was getting worse which is what I really stumbled through. I said something like “well what happens during the day and night are connected to an extent, but during the day you make choices and what happened at night wasn’t an choice.” She then stated that only little kids wet the bed and I responded “that’s not correct. People of all ages have accidents at some point in their lives. It wasn’t your fault.” At this point I asked her to come back to her room with me and told her she needed to shower since urine could cause burns and put on fresh clothes. While she showered I put the wet linens and wet pajamas into a bag as is policy at our facility and she asked me if I was going to tell anyone. I stated “this stays between us don’t worry.” She then stated that he was really sorry. I told her “you don’t need to apologized I signed up for his.” She asked if it would happen again and I said “we have no way to know that. But if it does happen again just let a staff member know.” She asked how to do that and I stated “just go to the nurses station and quietly whisper that you wet yourself.” 

 

What could I have done better since there was definitely some awkwardness. 

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Specializes in Oncology, ID, Hepatology, Occy Health.
38 minutes ago, RileyisSmiley said:

 

 

What could I have done better since there was definitely some awkwardness. 

There was awkwardness because it's an awkward situation. You did fantastic in my book.

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Specializes in Psych, Addictions, SOL (Student of Life).

You did a very good job. There is just one critcism which is when you told patient you wouldn't tell anyone. What I usually do in these situations if the patient asks if I am going to tell anyone is to say that "I encourage you to share this with your doctor especially if this is something new." Where I work minors have privacy rights from age 7 and up. We are not allowed to tell the parents if they have positive UDS, Pregnancy, or STD. I always encourage them to talk about it in their family session as there is a mediator present to keep conversations productive. 

I think you have the instincts of a very good adloescent psych nurse. I am a crusty old bat charge nurse now but members of my team would never think they needed to ask permission for what you did. I am a resource for members of my team but I am not their boss. We work together to give our patient's the best care 

Hppy

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Specializes in Community health.

I used to be a school teacher and I think you did a great job!  Only one piece of advice: I wouldn’t start with “Did you have an accident?”  Because when embarrassed, many people will lie, and then where does that leave you?  Like, if she had responded with “No!” you would have been in a more awkward situation. I would have opened with “Hey I was in your room and noticed that you accidentally wet the bed” or however you want to phrase it. Since you already KNOW it happened, I wouldn’t phase it as a question. 

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Specializes in Peds ED.

I think you did fine. I agree to not ask it as a question, something like “I noticed your linens and pajamas were wet” and continue on with assisting her to shower and change to clean clothing. Also, given that it’s likely related to stress, medication or illness, it is something that should be discussed with the treatment team. Perhaps she will need to limit fluids late at night or be allowed time to clean herself in the morning. I would encourage her to tell the provider, and if it happens again you can discuss with her that it is something the people taking care of her need to know about so they can help her but that it will be handled in a way that protects her privacy.

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6 hours ago, HiddencatBSN said:

I think you did fine. I agree to not ask it as a question, something like “I noticed your linens and pajamas were wet” and continue on with assisting her to shower and change to clean clothing. Also, given that it’s likely related to stress, medication or illness, it is something that should be discussed with the treatment team. Perhaps she will need to limit fluids late at night or be allowed time to clean herself in the morning. I would encourage her to tell the provider, and if it happens again you can discuss with her that it is something the people taking care of her need to know about so they can help her but that it will be handled in a way that protects her privacy.

Also while I was changing the sheets another kid asked me what I was doing and just said she spilt water is there a better way to approach this?

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