enemas and nurses

[makes needs known]

We have a new policy in our LTC/rehab facility that states the nurse is now responsible for giving the enemas. Apparently there was an incident where a elderly, confused lady was due for an enema. She resisted and sustained a fractured arm. I don't know all the details but now our policy from management is that the nurse gives the enema. What is next? Who wants an enema???? They can refuse. And it sounds like this lady refused, you don't have to be the nurse to make that judgement. Resident rights is something that all employees should be aware of.

[makes needs known]

When I was a cna, I remember a little lady who was very frail and she never wanted to take a shower. She resisted and I always gave her a really good bed bath. She barely ate, maybe a couple of ice creams everyday. I documented that she refused her shower and she was clean. BUT my coworkers, fellow cna's would always complain to me that I should have MADE her have a shower. But I did not want her to get hurt and I was respecting her wishes, and I was bathing her. I was never in trouble for not giving her a shower. My point is that some cna's forget that patients can refuse.

[tyvin, BSN, RN]

Where I'm from it is the nurses job to do the enemas and the suppositories. It is considered administering medication. The CNAs use to do it years ago until they brought up the fact that is was administering meds and the policy was written that it has to be the nurses who do it. I have to agree that it is administering medication and is the nurses job.

[wooh, BSN, RN]

I have to agree that it is administering medication...

Depends on the enema.

[RN-ing, BSN, MSN, NP]

We don't even HAVE CNAs!!

The nurse does it, or it doesn't get done.

[makes needs known]

Thanks for responding to my posts. We have 42 patients and 1 nurse, and I sure am appreciative of our cna's. But I agree with the fact that it is a medication and should be given by the nurse. The cna's fill in our BM tracker and from that we determine if a patient needs to start the protocol. Thank you all for your input.

[tyvin, BSN, RN]

Depends on the enema.

I agree; yet in all my years of nursing I have never seen an enema order for clear water. A fleets is medication no matter how you want to look at it (same with soap suds).

I know this is not a popular view with many nurses but it is fact. My question is why don't the CNAs who get certified in everything from feeding tubes to wound care have a certification for administering the enemas or suppositories? Or do they?

Another side of this coin is if we keep delegating nursing duties to the CNAs and med techs it will be soon that we RNs will be doing less and less therefore being in demand less and less (food for thought); or is it already happening?.

[wooh, BSN, RN]

(same with soap suds).

Well then we need to take baths away from CNAs, after all, we don't want them administering that medication "soap" topically.

[roser13, ASN, RN]

Well then we need to take baths away from CNAs, after all, we don't want them administering that medication "soap" topically.

Hmmm....guessing you're not a nurse?

[JDZ344]

'A CNA is perfectly capable of checking a tray for dentures, or shaking out the sheets to make sure nothing is left there. You don't need a college degree to do that, just common sense. '

In our nursing home cna's have been allowed/trained to give enemas until this incident. We all attend inservices that make it clear to all of us that a parient can refuse whatever they choose, whether its attending an activity or refusing a particular medical tx. We have a bowel protocol, with the nurse giving 30ml mom, and if not effective the nurse giving a ducolax suppository, and now it just makes sense that the nurse should follow up with the enema. I gave enemas as CNA 15 years ago, and have no problem doing it now.

But more and more responsibilities are being shifted to the nurse.

I 100% believe that a nurse SHOULD give enemas. I am an aide, and I have no desire to give enemas. The responsibility for doing this is not being shifted to the nurse, IMO, it IS the responsibility of the nurse, period. It's a medication, and an aide really has no business giving it. Is this a common practice in LTC?

[JDZ344]

Depends on the enema.

As far as I am concerned, if it has to be prescribed by a doctor, then a nurse needs to give it and sign it off on the MAR chart or whatever you use. Since where I work, no enema is ever given without a prescription, then its classed as a medication We're not even allowed to apply TED stockings any more because they need to be signed off.

[Batman25]

We do all enemas so I have no issue with that being done here as well. Enemas should be done by the nurses.

I do however agree that in some instances things are taken away from CNAs or other departments and pushed onto the nurses and there is only so much we can do. That is the fault of management if they aren't holding other employees to appropriate standards.

[ShannonRN2010, BSN, RN]

I dunno about anyone else, but I was taught how to give enema's in nursing school, not in my CNA training.

The fx arm...wow...I would like to think that this wasn't a result for force, but maybe the lady was attempting to get to the bathroom and fell.