Do you expect the CNA to wash all patients in the day shift?

[crunchytaco]

I had a question for the nurses. I am a nursing assistant in the float pool. All floors are different in how things are done, but I wanted to know if you expected the CNA to wash all the patients during the day shift. I understand day shift (7am-3pm), this is when the patients are waking up and become oriented. However, I feel like everyone looks down you when they hear one of their patient was not washed. I am running around everywhere trying to do vitals every 4 hours, blood sugars before breakfast and lunch, answering call bells, new admits, etc. I try to get to as many patients, and I get so overwhelmed. There are 3 shifts, can't I leave the patients to other shifts when I can't get them washed?? I sometimes do not go on my breakfast break or cut down on my lunch so that I can finish what I can..

[Nursetastic]

If I were an AAO patient and was awakened at 0500 for a bath so that the night shift could get it done, I'd throw a fit! In my opinion, AAO patients should be encouraged to help in their care as much as possible and that includes being given a choice regarding when they are bathed. I work in an ICU and I offer bathing to all AWAKE patients between 0500-0630 or right before they settle in for bedtime. They typically choose bedtime cleaning. All vented or otherwise total care patients (when awake) get bathed when I have time during the shift. On my unit, techs/CNA's really only help when asked (and that includes sugars, bathing, feeding).

[Bess87]

yes and no-as a former tech, I know how busy techs are with all of the little things that the nurses do not or cannot get to. On the other hand, nurses have more responsibilities than techs...so it depends on the day, patient load (I work on a busy oncology/medsurge floor), etc.

[turnforthenurse, MSN, NP]

Ensuring a patient gets washed up is as much a nurse's responsibility as it is a CNA's. I try to help my CNA's as much as I can; nursing is a TEAM EFFORT. Where I work, bathing is expected to be done on the day shift but of course things happen...patient refuses, patient has been off the floor all day for tests, unit was really busy so all of the care couldn't be done...etc. Baths should always be offered. In the ICU, night shift staff are expected to bathe their patients. There are no CNAs in ICU so it's up to the nurses to help each other out. If a patient is pretty much a "walkie talkie" we just set them up and encourage them to do as much of their own care as possible.

Oh, and I worked as a PCNA and a NT (nurse tech) prior to working as an RN. As a PCNA, I was responsible for up to 12 patients on dayshift; on nights up to 16. As a NT, I was responsible for anywhere between 12 and 24, it depended on if I was the only NT on the unit. I was expected to do all of the VS, accuchecks, answer call lights, help with admissions, help with transporting patients and toilet/bathe everyone before my shift was over.

[tokmom, BSN, RN]

No, days should not get the brunt of the baths. Some people prefer to be bathed at night, before bed. The comfort/total care can be done on night shift.

[PediLove2147, BSN, RN]

As a nurse I expect patients be offered to bathe in the morning. I know it is not always possible though. As a former tech I know how busy it can be. My hospital has the RNs taking 8AM VS in order to free up the techs, giving them time to do baths, blood sugars, and meal ordering.

Do what you can, like another poster suggested - find out what is priority. If it can wait, pass it along. Nursing is a 24-hour job.

[ashleyisawesome, BSN, RN]

when i worked days, i would make sure all of my patients were washed. if the aid couldnt get to it because he/she was busy, i would do them myself and just ask the aid to help me turn them if need be.

[Tashiarox]

I think the expectations of you should depend on a few different factors: acuity, how much help you have and status of pt's. I worked mostly nights as a tech, but when I did work in the daytime, I could get everyone bathed, beds changed and vitals, blood sugars and labs drawn if I stayed organized and managed my time. I would first get report and do the first round of vitals and blood sugars. Then, AAO pt's had breakfast and I let them know that after breakfast I would change linens while they showered. If we had total care pt's, I would team up with the other tech and we would take care of all of them together. I know a lot of nurses get accused of not helping out the techs, but I was never refused help if I simply asked for it keeping in mind they had a crap load of calls, medications to pass, charting and all the other tasks to be done to make sure pt's were receiving the best possible care. You might not get to everyone and some may choose to clean up at a later time. Just make sure you do all you can to ensure your pt's are receiving the same level of care that you would expect if you were in their shoes. If you are a hard worker, people notice and are more willing to help. The less time a nurse has to spend chasing down vitals and blood sugar reports or anything else we had to do as techs, the more time they will have to help you with the pt's. Stay encouraged, do your best and don't be too hard on yourself.

[Ntheboat2]

When I was a tech, I was expected to bathe all the patients (10 of them), change the linens, and get their vitals along with answering all the lights, toileting, etc. It was do-able, but could get hectic.

I know that you might think night shift should be able to handle some baths, but unless you've worked at night then you really don't know. It depends on how many patients they have and what their job assignments are. I worked at night before I worked days and at night I had 20 patients and was the only tech. When you're getting vital signs every 4 hours on that many people, answering lights, toileting, etc....before you know it, it's time to get vitals again. There's no way I could've done baths with 20 patients and being the only person to help toilet and answer lights. The only reason it was possible during the day is because there were 2 techs (with 10 patients each) so if one of us was tied up with a bath then the other would know so they could watch for our lights.

I think it depends a lot on how many patients each shift has, what the dynamic is between staff, and several other factors. Some places have monitors that just automatically record vital signs. Some have the machine that you have to take in and out of rooms and check individually. Some places have staff that work together and help each other out while other places don't. Where I worked at the time, the techs were expected to answer the lights. Some of the nurses would do it, but most of them wouldn't. So, if I were working at night being the only tech with 20 patients, someone might be waiting a long time to have their light answered if I was in a room giving a bath. Then, I'm sure I would've been blamed for not answering a light if a patient wet the bed.

I think everyone should have to work all the shifts during orientation so that they know what goes on during the opposite shift. It would put an end to the myth that there's less to do on night shift, etc, etc. While that might be true at some places, it definitely wasn't the case where I worked. I worked both shifts and I actually found day shift to be "easier."

[Ruby Vee, BSN]

I think the CNAs should be busy helping to ensure that the baths get done rather than "hiding", going to the market to buy lottery tickets, outside on smoke breaks, hanging out in Central Supply to talk to the guys there, or shopping on the internet. We have some good CNAs who really try, but most seem to have an awfully lot of "down time."

[HyperSaurus, RN, BSN]

On our unit, baths are typically done on days. Walkie-talkies are set up, and the aides do the baths with the help of the lpns and rns. Sometimes they will get done right before bed, on afternoons, if that is their preferences. On nights, there is one aide, responsible for 16 to 24 pts (aides don't do vitals though). I'm not sure if it is any different on the other floors, such as ICU.

[healthstar, BSN, RN]

It all depends on how complicated the pts r!!! If someone needs to go to the bathroom every 5 mins, or needs a bed change frequently bc of incontinence! Theres no way the pcna can give everyone a bath. Considering some pcnas have 12+ pts! Even 8 pts require to much work.

[proud nurse, BSN, RN]

When I was a LTC night charge nurse, my CNA's had 4 get ups each. They were expected to wash all their get ups. If the CNA came to me and said the resident for whatever reason wanted to stay in bed, I'd ask them to still wash and dress them so whenever they did decide to get up, all 1st shift had to do was help them out of bed.

It was the expectation at the facility that the resident got washed when they woke up and before they went to bed. That's one thing I did like about that place...the resident's were very well taken care of with the collaborative effort of all of us.