Do you have time to give baths?

allnurses Guide · Mar 9, 2011

There have been times I've come in to no CNAs and no kids washed up, and even then I find the time to do it, even if it's in the afternoon. I can't help but feel like my day is incomplete if I don't at least give a sponge bath, and change outfits and trach ties.

I had something of an obsession with how the babies looked, too. In fact, the minute report was over I made a bee-line to the linen cart to get the cutest blankets, and if I could snag a pink solid and a print for the girls my day was just awesome. Weird, huh? Nobody else seemed to care.

When I went to school baths for everybody every day were ground into our minds that if you skipped it you might as well just go jump off a cliff. I didn't really understand why a cachectic 105 yr old lady needed to be scrubbed down with with Camay soap (or was that Cashmere Bouquet?) that was hard to rinse off and very drying to the skin. I guess everybody else felt that way, too.

RNforLongTime · Mar 9, 2011

However that belief doesn't prevent you from giving a bath to a AAOx3 pt that didn't get one during day shift right?
You assess when they last had a bath and then ask if/when they want one and then do everything you can to make that happen? I'm sure you do that because, like you said, nursing is a 24 hour thing.

Sometimes I start my shift at 7pm so I'll offer the bath in place of HS care if time allows.

ObtundedRN, BSN, RN · Mar 9, 2011

I give my own baths. In critical care at my hospital, you're lucky to have a tech who restocks gloves and sharps bins in the rooms. We do our own baths for all our patients. But, we only have 2 patients. We try to split the patients in half between day and night shifts, and try to keep anyone who is a&o on days.

Also, being it is critical patients, you have to look at the fact that it usually isn't safe to delegate baths to a tech. Our patients can decompensate with just normal turning. I think bathing increases O2 consumption by 40% (I may be wrong on the exact number, it may be more?). Then you add in patients with vents, drains, tubes from every oriface, central lines with multiple drips, etc. It just isn't safe to let a tech do it alone. It goes against the "rules" of delegation.

It would however be nice to have a tech to assist with the baths!

RNforLongTime · Mar 9, 2011

I give my own baths. In critical care at my hospital, you're lucky to have a tech who restocks gloves and sharps bins in the rooms. We do our own baths for all our patients. But, we only have 2 patients. We try to split the patients in half between day and night shifts, and try to keep anyone who is a&o on days.
Also, being it is critical patients, you have to look at the fact that it usually isn't safe to delegate baths to a tech. Our patients can decompensate with just normal turning. I think bathing increases O2 consumption by 40% (I may be wrong on the exact number, it may be more?). Then you add in patients with vents, drains, tubes from every oriface, central lines with multiple drips, etc. It just isn't safe to let a tech do it alone. It goes against the "rules" of delegation.
It would however be nice to have a tech to assist with the baths!

This is what I think is how it should be. If my patient is that critical where turning causes a desat...I'm gonna turn as little as possible...NOR would I allow a tech to bath such a critical pt alone but I DO expect the tech to be in there helping me without having to beg!

NurseOnAMotorcycle, ASN, RN · Mar 9, 2011

I expect to do all care on my patients (7-8/shift). I've found that it takes 5-10 minutes for a quick bed bath. That's not that much. Once peri care is done, the rest is easy anyhow. If I'm not pressed for time, I do give baths with the wet nap/bath-in-a-bag as part of my skin assessments. If I am, then like someone above mentioned: 1 missed day is not that bad.

RN-ing, BSN, MSN, NP · Mar 9, 2011

Just because ICU RNs say patient stability is more important than bathing doesn't mean we put it off all the time.

I would rather have a patient stable and stinky...

RNforLongTime · Mar 9, 2011

Just because ICU RNs say patient stability is more important than bathing doesn't mean we put it off all the time.
I would rather have a patient stable and stinky...

Me too!!

locolorenzo22, BSN, RN · Mar 9, 2011

I expect to do all care on my patients (7-8/shift). I've found that it takes 5-10 minutes for a quick bed bath. That's not that much. Once peri care is done, the rest is easy anyhow. If I'm not pressed for time, I do give baths with the wet nap/bath-in-a-bag as part of my skin assessments. If I am, then like someone above mentioned: 1 missed day is not that bad.

wow, 5-10 mins? that's gotta be a record. Heck, sometimes it takes that long for the water to warm up and for me to get some washcloths and towels together. I can usually get one done in 20 mins or so, considering that I "came up" from being a CNA on nights, and often had to do the total care patients on nights. I like to use a little lotion after bathing, and shave the guys(especially if they're on bleeding precautions) and wash hair well. The biggest concern I have is everyone who keeps going back and forth between my/your job. It really is the NURSE'S job to ensure the ADLs are done. I am a firm believer in the fact that the patient care comes first. Now, I may not be able to do it for the first 5-6 hours of the shift, but if I know my tech isn't going to get around to it, or if it is a extremely heavy care patient who is alert enough to make decisions I will ask if they want to be washed up during the day or night....it is their right, in my opinion.

I also FIRMLY believe RNs should be oriented to the duties of a CNA for at least the first two weeks of their jobs....and made to work as a CNA while learning background RN info, or doing self-studies, etc on the floor. It really would help some people understand where the hard-working CNAs come from.

Don't hold the license/certification thing too highly. I know a lot of CNAs who can't reason it out, because they were never taught.

just my .02

ayla2004, ASN, RN · Mar 9, 2011

I work acute care of the elderly, we bath pt every day, showers or tub baths if we can can also. No one ever died from not having a bathm but as other have said skin assesments, pt comfort are important. and it can take only 20mins to bed bath and shnage a pt linen, and clothing. I see ADL as essene of care, along with turns, elmintion skin care and nurtion. If i have frail pt and im on night ill bath them in the morning so that i knwo they are clean comfortable and seem relaxed.

still i was a health care assitant for r6 year prior to being a RN just cant forget what make pt happy, and it aint' pills and procedures.

creativemom, BSN, RN · Mar 9, 2011

I do it because it's part of basic nursing. I get STNA's or a CT to the room and double team the patient.

If the patient can walk and is oriented I make them go to the bathroom some time during the day to wash up and then I follow through on them.

What most forget here is that when you do bathing you get to really "see" the patient's skin. I can't tell you how many times I've found items behind a patient's back, had I not found it, there would have definitely been skin breakdown issues. It's also a great way to validate if an STNA has been actually Q2T a patient or was just charting it. It also gives me a way to assess how the patient is moving and I can help them with ideas on how to move without pulling incisions or hurting themselves (muscles, joints). Also I can see how incisions look and check for additional drainages (fistulas) that may have popped up since the operation...

It's no wonder we have MRSA, Staph and at the minimum UTI's when people have the idea that bathing is not important. Skin is our first defense to bacteria and infections, it's our obligation to some how make sure it's taken care of!

sistasoul · Mar 9, 2011

I have taken plenty of my own patients to the bathroom, filled their ice pitcher, etc....all those things that the nurses YOU work with are above. One hospital I worked at, the CNA's LOVED to work with me because I was one of the few RN's who did answer call bells, etc as the previous place I worked, we didn't have the luxury of a CNA so I did do it all myself. I am not one to pawn off work nor do I think I'm better than you because you are just a CNA.. I'm in my patients room A LOT and have no problem assisting her to the potty or getting her a warm blanket.
I take issue with you automatically assuming that I am another one of your lazy RN coworkers. Seems like you need to take their laziness up with your boss.
And I'm with you in that most nurses in a nursing home wouldn't be caught dead doing ADL's or helping the CNA's with the residents...the ones I worked with all had a bad back and couldn't help me lift Mrs Jones off the toilet but could tell me that Mr Smith needed to go to the bathroom......Poor Mr Smith had to wait because I'm just one person and the LPN was too lazy to help.

I worked in a LTC for 5 months when I first graduated. I was told by the higher ups that I was not to interrupt my med pass for ANYTHING. This was reiterated over and over again. The med pass and treatments took the whole shift anyways. I would try to always help clean up and turn residents when I seen it was just one assistant trying to do this themselves. I would not want anyone throwing their back out. I have never minded helping any of the assistants I work with but they always leave on time while I am still charting after I give report. Then I hear about OT. It is not that most nurses do not want to help but who will do their charting and assessments and call the MDs when needed? I was an aide and am now a nurse so I understand both sides. When I was an aide I thought some of the nurses were lazy too. I did not realize they were sitting down charting for their lives so as not to have management get after them for OT. I do expect ALL to get up for a bed alarm. It is unbelievable that there are some nurses I work with who will not get up when they hear an alarm. I actually had a patient fall one time because of this and another almost fall. Because of this one fact I would never let my mother go to my floor if she was confused and crawling out of bed.

SolaireSolstice, BSN, RN · Mar 9, 2011

We have had 1 PCA for a 32 bed unit who is responsible for all accu-checks and vitals for a few weeks. She barely has time to get those done between assisting with tolieting and answering calls that she is able. When the other PCA is there, they both are able to assist with baths, but they are not "their" responsibility. It's all of ours. I do call the PCA for assistance when it's time to turn for the linen change.

But I don't do daily baths unless the patient is sweating a lot or gets soiled frequently. Since I work weekends, I generally have the same patients 3 days in a row, and I alternate baths on patients through the weekend. Luckily, most of our patients are walkie-talkies. Occasionally there will be one who I can put into the shower, but I feel better if they were supervised, and I've been known to pull my computer into the room so I can chart right in the bathroom door while the patient sits on the shower chair to wash with the shower curtain open. The ones who need full assistance in the shower, well I've been through the wet scrub contest, thanks. It's simply easier and faster to do a bed bath on those than end up getting hosed down in the shower.