DO NOT pass on the poop

[durantetodalanoche]

Hi gang! I've been an RN for almost 3 years now. My first two years was spent in a medical clinic and now a brand new ER nurse. My training has been going well and I've been confident with my progress in the ER until I made the huge mistake of leaving poop cleaning for the next nurse on shift. Call me an idiot but I had no idea that doing so was a NO, NO! I'm certain that it was the headline of the day. In the clinic, I was often delegated to deal with enemas and manual disimpactions so it didn't seem like a big deal to me to inform the next nurse 5 minutes before my shift was over that changing was needed. Following that incident, I was told that passing on the poop is not proper nursing etiquette. Call it a case of common sense not so common. I'm thoroughly embarressed and now that I think about it, I can understand that it was not cool for me to do that. I did speak with that nurse and apologized and cleared the air. But still...if I was delegated that task by a nurse whose 12 hour shift was just about over, I would gladly do so with no complaint. I would appreciate any thoughts anyone might have about this and any other common nursing etiquette no-no's that would help me survive my new position in the ER. Thanks in advance!

[jadelpn, LPN, EMT-B]

If you realize that a patient has been incontinent, then you need to clean the patient up right then and there.

It is never a good idea to realize it, leave the room, wait for the oncoming nurse, then advise that nurse of the situation. That is just not good patient care. You have a patient sitting in poop for longer than they should be. And a chance of breakdown of skin.

If it were a patient that you needed assistance with as the patient was unable to turn on their own, then perhaps you had no choice but to get someone else to help you. And that person may just be the nurse coming on, if no one else was available. But then I would ask for the nurse's assistance, as opposed to a "the patient was incontinent. I have not cleaned the patient up. Ok, thanks, have a good night!"

I understand it was near the end of your shift, however, patient's needs have got to come first, and it was not a situation where your shift was over and you were clocking out and this came to your attention.

This is just poor practice.

[Bringonthenight]

Imagine if it were you or your loved one that was dirty. I can never leave a patient dirty, even if its at that hideous shift change period! it's not just bad nursing etiquette, I just think what if it were me or my family member in that situation, I'd want to get cleaned ASAP!

[roser13, ASN, RN]

As has already been eloquently expressed, your primary mistake was leaving an incontinent patient in a dirty bed, rather than inconveniencing the next shift.

I'm not certain, from your original post, that you understand that basic nursing principle. Your only concern seemed to be with regard to your peers. Apologies to the incoming staff are all well and good, but an apology to the patient, along with immediate clean-up, would have been better.

[BloomNurseRN, ASN, BSN, RN]

As has already been eloquently expressed, your primary mistake was leaving an incontinent patient in a dirty bed, rather than inconveniencing the next shift.

I'm not certain, from your original post, that you understand that basic nursing principle. Your only concern seemed to be with regard to your peers. Apologies to the incoming staff are all well and good, but an apology to the patient, along with immediate clean-up, would have been better.

I completely agree with this post.

I'm a new nurse but I would never leave a patient to be changed by the next shift. Skin breakdown, infection, discomfort; all of these are things to be avoided and even a few minutes is too many if it is realized and can be remedied.

During my second semester of nursing school I received report on my patient with my instructor present. My patient's colostomy bag needed to be changed and my instructor was glad for me to get to do it. To say the bag needed to be changed was a HUGE understatement. The bag was almost full, was leaking everywhere and obviously had not been changed all night. This was also a new colostomy and her abdominal incision was only 2 days old - we had to do total dressing changes because those were also covered in fecal matter. It was a mess and a half but certainly taught me something about patient care. My instructor let the charge nurse know about the situation and of course the nurse that had left her patient like that was going to be talked to (it didn't help that another student had an incontinent patient who had dried feces all over her back and it was a patient of the SAME nurse).

Anyway, I really hope this has shown you not that you need to be more considerate of your fellow nurses (or techs) but of your patients.

[nrsang97, BSN, RN]

I would not have left that for the next nurse. I would have cleaned the pt up myself. I would never knowingly leave a pt that had been incontinent to be cleaned up by the next staff.

[durantetodalanoche]

Thanks for the feedback. I do realize the patient care aspect. I do want to say this patient was not sitting in bm like assumed, but rather was just starting to go while I was trying to wrap things up. I changed this pt just an hour before using 2 briefs because after the 1st one, the pt immediately went again while I was fastening the briefs as she was not quite done. My thought was to give it few more minutes to make sure the bm was complete. Next time, I'll wait and do it myself even if it means a little OT.

[jadelpn, LPN, EMT-B]

Thanks for the feedback. I do realize the patient care aspect. I do want to say this patient was not sitting in bm like assumed, but rather was just starting to go while I was trying to wrap things up. I changed this pt just an hour before using 2 briefs because after the 1st one, the pt immediately went again while I was fastening the briefs as she was not quite done. My thought was to give it few more minutes to make sure the bm was complete. Next time, I'll wait and do it myself even if it means a little OT.

If the patient realizes that they are about to have a BM, then perhaps putting the patient on the bedpan may have been a better option. Again, if a patient is "not quite done" they know that they need to urinate or have a bm, so I would have attempted a bedpan, or to get the patient to the commode if the patient could get up and transfer.

The bottom line is that this has little to do with nursing etiquette, and has everything to do with patient care and practice.

[SNB1014, RN]

I second the vast majority of the above comments. I was hoping to add something re: " etiquette"....

Do a quick double check one hr before your shift. Make sure the Foley's are emptied, fluid bags aren't about to be dry , pt isn't slumped down half way out the bed, if pain Rx is available, give it, etc.

I always preface my last rounds as this : " hey, I am tiding up my loose ends with everyone before I head off for report @1845. Is there anything you need, want me to pass on or I can get you before I go home?"

And do a quick scan of the room to double check side rails, bed low, tubes connected etc. A quick reposition or whatever. I work ICU step down and then I can also jot down the current vitals to share at report.

Its a fair warning that hey man, I'm about to be done here and will be busy at such and such time .....last call , if u will.

Unless the pt has soiled themselves after you did your last round of checks , you must take care of it. Nursing is 24/7 , yes, but for me at least, receiving a pt that is a hot mess infuriates me.

If at 30 mins before shift report a pt has a cardiac rhythm change, I expect that nurse to at least of notified the MD/ answering service. I can wait for the call back and implement whatever orders.

Speaking of orders, ensure that whatever the last ones written have at least been faxed over. It's part of chart checks.

Good luck. You will soon enough be on the receiving end of a sloppy pt and it will cement all this in your mind ;-)

[AgentBeast, BSN, RN]

That's just ****** nursing. You don't dump on the oncoming nurse.

[Fiona59]

S/he who finds the poop, cleans the poop.

I've had managers clean up poop that they sniffed while doing rounds because they were there.

Five minutes is plenty of time to clean up.

[lyndy]

Irregardless of the inconvenience to the on coming nurse, more importantly it's a dignity issue for the patient!