Delegating bedmaking, bedpans . . .

Well...as I see it if I have time I can do those things no probelm, and yes...I do use it as an assessment tool!

However, give me one bad case or case load...and all goes to heck fast. If pts were waiting for their trays while I was having to deal with a serious issue or upset family they may just miss their meals! Same with making beds...or changing them quickly if someone was incontinent.

Give me a total admit...oh heavens...no one would get anything for an hour (we have new paperwork that no one quite understands yet, and it is LONG!).

So I think assistants are vital and extremely valuable people! I love mine, and so do my patients! They are the....oh what did I call mine yesterday..."the sparking happy glue that keeps it all together!". :)

The act of washing a patient is one of the best way to assess your patient, emptying a bedpan gives you information that you need. I always wash at least 2-3 of my 6-7 patient assignment. I usually wash the most complicated patient. If you're going to assess it, why not wash while you're there? Nursing is much more than passing pills and doing paperwork. As you get more familiar with nursing you can integrate all of this in a manageable day. I always makes me laugh to watch some nurses go out and "assess" their patients, yet not do any care. If I'm rolling over a patient to check their bottom, I'm washing it! Why take an hour to "assess" and still leave all the care? Take an hour and a half and be done with the care! Nursing assistants are there to assist, not to replace hands on care.

The only time patients get baths where I work is if they have nursing students.

I would love to bathe a patient and get to spend time with them. Usually I count it lucky if they get off the unit still breathing...........

We have techs. Their job description on the floor is clear - beds, baths, passing trays, etc. Mine is very clear too. I have plenty to do without doing another person's job.

Before anyone thinks I'm a snotty RN too good to do these things, that is not what I'm saying. I very often give bedbaths, make beds and help with trays. It all depends on the day and the assignment. If I'm in a room and a patient wants a bedpan, I'm certainly not going to go running to a tech to do it. But I have no problem telling a tech "I got Ms. so and so up and have to run, can you make the bed please?"

Our techs are awesome and enjoy a low tech to patient ratio and have plenty of time to do their job. Our unit is set up that way. My ratio is often too high and too busy to take on anymore than what's my job. Often I team with a tech during a bath they can't handle alone and I actually like giving baths. I gave one yesterday in fact.

Too many people, especially new grads are intimidated by delegation and take on more than they can handle and if there is a tech culture that isn't nurse friendly wind up doing it themselves while the techs good off.

I'm not afraid of delegating someone their job descripition. I've very good at it in fact. Delegation isn't lazy, nor bossy, nor a bad thing.

I agree with Triage about using those types of tasks as an assessment tool. Very valuable as are CNAs. I, myself, need to do more delegating than what I do at times. I am someone who doesn't feel that I am above those nursing duties, but my intentions sometimes put me waaaay behind.

Well, I feel that these are the tasks that we may never give up. Of course there are places in nursing where you won't need to do these things however if you work hands-on pt. care it is kind of unavoidable. Yes, it is physically demanding but I have never worked with anyone who couldn't do it. Doing these tasks offer great opportunities to assess your patient. There are times when one can not give a bedpan, etc. but there are many times when you can. Also, I don't feel that pt's see me as a servant for doing these things but if they do, they most likely see other people in a negative aspect too.

sometimes you have to delegate bedmaking and bedpans. i think it depends on the job. i have two jobs that allow me to do that. i do use bed pan and bed making as an assessment tool. i've learned wound care over the years and love to get the chance to use my wound assessment and treatment skills for the benefit of the patient and/or resident and prevent bed sores. there are certain aspects of my job that i can actually say i "hate". i hate paperwork and run for the chance to answer a call bell for a bed pan. i also run to beat the rpn or psw so that no one is screaming or no one falls or no one really is uncomfortable. i try and keep my job interesting. i do that because if i get "bored" then i do other things that get me in trouble. so i try and keep to the actual needs of the residents/patients. as i said, i hate paperwork and would rather say "i didn't have the chance to do all my paperwork cuz of all patient needs." i mean, at the end of the shift, i can catch up on the paperwork and computer entries.... whatever.... well, each time i go to work, i try and make it the "perfect" shift so i can go home happy instead of scared....

but yeah, sometimes, changing a bed or running to get a bed pan isn't so bad. sometimes it doesn't even take time. i believe it's worth it. it's for the patient's and i say "scr*w the politics and "black and whites" of paperwork and tend to the needs of the patients! doesn't take long and they are happier. sometimes happiness does count. (sorry about the rambling.)

Like I said...it is a great assessment tool, heck...I use talking to patients, watching them smile and laugh to do my neuro checks, watching ambulation or watching them move in bed for many assessments....I will even rub lotion on feet to see hair placement/pedal pulses/nail health and get a really good picture of their circulation status from the furthermost area ! I have learned the art of assessment without having to break out the tools and doing the whole..."okay can you smile for me, what day is it, grip my hands, point your feet". I learned this from paramedics and from doing many ADL's and bed baths for patients while being a student nurse.

However, tasks that are given to techs or CNA's are extremely valuable! Our CNA's tell us things very openly and we have a great relationship with them. They let us know if there is a red area while they are doing a bath so we can check up or they will page us into the room to show us right away (since the patient is already in position to see it), will have us check out anything odd in a bed pan or BSC, and let us know even if the patient "just isn't acting like they normally do". But then again, our CNA's have been there many years and know what nurses/MD's need to know (our docs are so cool, they really do listen to all staff!!!)!

Many times I have wished to do a bed bath for some one on one time, and like a Murphy's law...something happens and I am taken away..chasing down docs, trying to get orders, talking with pharamcy to get a patients meds straightened out, paging RT's to do a stat neb, re-starting IV's that have blown, dealing with painful patients whos Rx isn't good enough or a probelm has occured....oh CALGON!

But those times I get to really BE with a patient...I love them and take advantage of it. I am a funny gal, and I love making pts laugh and share stories while I care for them. So when I have a moment..you can see me starting up a bed bath, or doing lotion to feet, or even sitting at the bedside laughing at what that dietary department considered tomato soup! LOL!!!!!!

Yes they should. Do they? Probably not with the ever increasing demands on their time. May I inquire what led you to ask this question?

This topic came up in our nursing class and most students argued that we should continue to perform these duties. I was in agreement with their rationales. Until I thought about looking for my first job.

As a nursing student doing 12 hour clinicals in med-surg, I was exhausted from these duties. I injured my back and was in constant pain. (I'm an older student) My peds rotation, on the other hand, was so much more managable because the parents helped with bathing/bedpans etc. I didn't suffer the injuries or physical exhaustion.

I want to work with adults so med-surg seems the place to start, but I worry about how I'll physically manage it.

The important thing to remember is that just because you are the nurse you are not above these task. IF you have techs these thing fall within their duties. That does not necessarily mean that it does not fall within yours also.

I have been a nurse for 10 years now and have never delveloped the attitude that I have witnessed often, "I AM A NURSE AND I AM NOT WIPING A BOTTOM OR CHANGIN A BED, THAT IS TECH WORK."

Now that being said we have plenty of things that we ourselves must do and if you can delegate certain tasks to assistive personel so that you can provide other imprtant care that is fine. But I would never leave a room with someone requesting a bedpan or leave someone in a soaking wet bed because that is the techs duty. I know that I would not like being left in wither of these situations nor would I like one of my loved ones left like this.

Though I have seen those that deem these tasks below them leave said patient and spend 15 minutes lloking for a tech to go perform these tasks. I find this reprehensible.

jmho

I want to work with adults so med-surg seems the place to start, but I worry about how I'll physically manage it.

You raise the bed to start with. I'm shocked at how many people don't do the simple act of raising the bed. It was understandable when I worked at the nursing home with the crank beds, but at the hospital where they're electric? Starting an IV? Bed's going up. Assessment? Bed going up. The extra seconds will add years to your career.

You don't be afraid to ask for help. I learned at the nursing home to change just about anybody's bed by myself. But it's stupid. Ask for help and be willing to help them when they need help with theirs. It goes quicker having the extra hands=more comfortable for the patient. You ask for help getting them out of bed. You ask for help walking them if you need to. No patient need is worth hurting yourself. If they're falling, slide with them. You CANNOT stop a falling patient singlehandedly, but you can hurt yourself. No reason for both of you to be hurt. If it's a combative or bariatric patient, you get ALL the help you need, even if it means calling for help from other floors. Even if it means, bariatric patient is crapping in bed instead of the bedside commode at night because there aren't enough people to SAFELY get them up.

Make your back a priority. Nobody else will.