Outta Line........

[hbncns35]

What a day!!! I get 9 patients and 3 different nurses. I'm an Extern, PCT or whatever you wanna call me. I had the middle hallway which included the nurses station so I was spread out. I started at one end of the hallway and proceeded to get everyone washed up, changed and beds made. After I had a good handle on one end of the hallway I went to do a quick check on the other end. Looked like 59 went for a test so I asked Nurse "B" where he went and when he would be back. I got a "Who wants to know?" I said " I do." So I knew at this point he would be gone for awhile and I could concentrate on someone else. 63's daughter pulled me in and had me help her change the bed at least three times over 1.5 hrs while we kept her upright in a chair. She was semi-alert. So most of my time was spent with her. Halfway thru I checked on 59 and he was back so I went in there, got him washed, changed his gown and his top sheet (he would not let me change his bottom sheets, he did not want to roll over - two infected fistulas in either arm) I tried to sweet talk him but he wouldn't budge or roll over. So I got him comfy and went back to 63. I passed Nurse B and asked if she needed anything and she said "just get 59 comfortable" I replied that it had already been done. So 63 wanted to get back in bed- did that- went and drew bld on 67, changed 68, put 58 on bedpan, changed 60, and then to my surprise got accosted in the hallway by Nurse B.

She ranted and vented on me saying that she was so embarrased that 59's bottom sheet and pad were not changed, yelling at me saying that the family had to see it and the doctor was there as well. She said That is unacceptable- you were supposed to get him comfy!!!!! I looked at her and mentioned that he would not let me and she kept ranting...I figured if I tried to do anymore explaining then it would just be an argument. So I said nothing while she pounced on me, then when I thought she was finished, I said, OK and walked off. (Whatever!!! I'm thinking)

As far as I'm concerned I did make him comfy and did my best to get those sheets but he was yelling at me to get away. If she saw the sheets needed to be changed then she should have taken it upon herself to change them.

Doesn't she know we all help each other out? I couldn't get to him in her required time frame but I did make him comfy.

Any nurse that thinks it is beneath her/him to change a bed should go back to nursing school..............Oh that's the tech's job............Sometimes you gotta help out- she knew I was busy with 8 other patients. Get a grip on your emotions...............Geesh.................I let her throw her weight around and when I did not respond the way she expected, she gave up and later was civil to me..............Give me a Break!!!!HB:madface:

[Bipley]

The OP didn't mention anything about an appy. I was using it as an example when she mentioned aggressiveness.

I've seen some appy's up and walking hours after surgery. That's fine for them but not for everyone. In the case I mentioned, the man was elderly, very groggy and a 2 assist. No way could we leave him in a chair. He'd fall asleep and fall out of the chair. Like you said, it depends on the pt.

I wasn't referring to this particular patient. I was writing in general.

[hbncns35]

Just an update - Ms. Yell-o decided to be alot more civil to me today actually helping me change a patient and being more agreeable, guess she realized her mistake and made more of an effort..............Hb

[jschut, BSN, RN]

Thank you for everything you do....believe me...all your work is appreciated!

[psalm, RN]

...Next time a patient refuses to have anything done, treatment, bed or gown change, meal, etc, always DOCUMENT it in the nursing notes. This is of course after you have encouraged the activity. But pts. have a right to refuse treatment, etc. Document, and quote the pt. if possible...pt refused to have bottom sheet changed, "I don't want to be bothered now with that, do it when I am in the bathroom". BTW, I think you are doing well, juggling all those pts!

[DADENTY]

Thank you. I graduate BSN in May and this nurse on a different occasion told me to be more aggressive with a patient just out of surgery. She wanted him to take a shower. Well you know I just plain don't believe in being "aggressive" and overpowering my patients to bend to my will. I mean really.............This isn't Nazi death camp!!! I believe in the power of persuasion and being stern but not aggressive. I guess she was displaying "aggressive" behavior with me........Different styles I guess----

Haven't seen her compassionate side yet! HB:confused:

I am a new grad on a surgical/ paediatrics floor. I too felt that you shouldnt be agressive with post op patients. BIG mistake 13 yo appy, ended up with an ileus b/c he didnt get up and move around enough. Ended up in ICU for a week and needed 4 more surgeries before his insides got sorted out. My motto- Good morning here are your towels , I will change your bed while you shower, I will lock that iv for you for a few minutes. Some people will NEVER get up. They need the extra push to prevent complications.

[casper1]

At one time I agreed with you. I too felt it was cruel to get an elderly post-op patient out of bed shortly after surgury. In fact getting a patient out of bed and ambulating following surgury is one of my least favorite duties. I still feel I'm being mean. But I've come to realize it's in their best interest.

I've also been on the recieving end of a doctor's tirade because I failed to get a post-op patient out of bed.

Getting a patient out of bed and moving after surgury is very important to a quick recovery. It prevent blood clots, ateletisis, post operative infection.

It important to start a patient moving and to institute post-op breathing exercises as quickly after surgury as possible. It may seem cruel ,but it will prevent complications down the road. I have had patients who refuse to get out of bed after surgury. Those are the patient who develop complications .

[dsomday]

Just an update - Ms. Yell-o decided to be alot more civil to me today actually helping me change a patient and being more agreeable, guess she realized her mistake and made more of an effort..............Hb

Why can't people just say "I'm sorry" instead of kissing *** when they KNOW they have done wrong? This drives me crazy.

[hbncns35]

For the last three posts:

I like the documentation idea, and I will certainly pursue that in the future but I probably would have been yelled at anyway despite that.

I understand how important it is to get someone up after surgery for all the complications stated but this particular patient was not post-op. It did take 3 of us to get him in the chair scale, we did have him sit there while we attended to his daily washing, then we put him back in bed and about 45min later had him up in a chair again for his family.(this was the next day after being chewed) In some cases PT arranges this if it is too difficult to move the patient. They usually have 2-3 people with them. Sometimes its hard to get 3 techs together at one time when there is just 3 techs for 26 pts. I think each situation is different and it is a good idea to work with the patient as much as possible unless their health indicates otherwise as to a more than stern move on the patients part.

Why is sorry such a hard thing to say? Must be an ego problem..........

HB

[chadash]

At one time I agreed with you. I too felt it was cruel to get an elderly post-op patient out of bed shortly after surgury. In fact getting a patient out of bed and ambulating following surgury is one of my least favorite duties. I still feel I'm being mean. But I've come to realize it's in their best interest.

I've also been on the recieving end of a doctor's tirade because I failed to get a post-op patient out of bed.

Getting a patient out of bed and moving after surgury is very important to a quick recovery. It prevent blood clots, ateletisis, post operative infection.

It important to start a patient moving and to institute post-op breathing exercises as quickly after surgury as possible. It may seem cruel ,but it will prevent complications down the road. I have had patients who refuse to get out of bed after surgury. Those are the patient who develop complications .

True, but of course check orders before moving a pt in anyway. Ambulate as ordered, not based on your experience as a CNA. Aren't there exceptions? and Turning and repositioning the pt has to be done by some means to prevent pressure sores. (check to see if there are any special criteria on how) Sheet change is a good opportunity for repositioning. I know I don't like to be moved after surgery, but communicate to the pt the rationale, and they are more likely to cooperate. "Mr. so and so, I am going to roll you to change your sheet and take the pressure of this area. Support your abdomen with this pillow. now I am going to lower the bed.....etc. {if he is resistant then say } how about if I will get the nurse to help roll you, to make this more comfortable..."The nurse will just love that! :wink2:

Possibly it was time for pain meds, and he would have been more willing after his pill. It has got to be done if it is soiled, so sometimes giving a limitted option, like, would you rather I wait for you meds to take effect more? Sometimes, if you approach things casually as if it is assumed this is going to happen, and just do it as empathetically as possible, it just happens. Of course, if someone really refuses, well report and record.

from a NA

[chadash]

oops,,,guess this was arm fistulas? There again, another worker to support his arms while you turn him or what ever will make the process more comfortable. Always get all the help you need to assure the pt is dealt with in the most comfortable and compassionate way.

but unless indicated for some strange reason, they gotta be repositioned at least every two hours anyhow!

Of course, this is coming from some one who cant even get a job in the hospital!

[purplemania, BSN, RN]

As a nurse I feel the techs/aides are there to help me, not do it for me. So I try to work together to get the work done faster. It also helps the patient to see the nurse involved and I get to examine skin, etc. Hope you have a better day next time.

[kadokin, ASN, RN]

True, but of course check orders before moving a pt in anyway. Ambulate as ordered, not based on your experience as a CNA. Aren't there exceptions? and Turning and repositioning the pt has to be done by some means to prevent pressure sores. (check to see if there are any special criteria on how) Sheet change is a good opportunity for repositioning. I know I don't like to be moved after surgery, but communicate to the pt the rationale, and they are more likely to cooperate. "Mr. so and so, I am going to roll you to change your sheet and take the pressure of this area. Support your abdomen with this pillow. now I am going to lower the bed.....etc. {if he is resistant then say } how about if I will get the nurse to help roll you, to make this more comfortable..."The nurse will just love that! :wink2:

Possibly it was time for pain meds, and he would have been more willing after his pill. It has got to be done if it is soiled, so sometimes giving a limitted option, like, would you rather I wait for you meds to take effect more? Sometimes, if you approach things casually as if it is assumed this is going to happen, and just do it as empathetically as possible, it just happens. Of course, if someone really refuses, well report and record.

from a NA

Good advice. I agree.:wink2: