Refusing to change/toilet pts

Nurses General Nursing

Published

I am not sure if this is in the right topic...

I have been working with an increasing amount of nurses who FLAT OUT REFUSE to change or toilet their patients. Is this a thing? Do your hospitals have policies or guidance on this topic?

I've brought this up to a few people unofficially and one answer I got was (from a VP) "the nurse may be too busy and you just don't know it." My thought is "If you know they are soiled or ask them to toilet them, why are they taking the time to find a CNA and not just doing it?"

Years ago someone was talking to a group and the toileting issue came up (different hospital) and this person asked us rhetorically how WE would feel if our nurse was in the room and we were soiled and they would not change us? Or if we asked to go to the toilet and they walk out and send in a CNA? I know I would feel pretty small.

Suggestions, comments, HELP...? Anything?

Don't worry about it, soon robots will take care of all this poopy business...

Up Vote Up Vote ×
Yeah, I dunno...If you're cleaning some poop and there is an emergency then stop cleaning the poop and take care of the emergency. I think it also sometimes comes down to work ethic. Even if it is per se the NA's job responsibility to do that, the RN is still accountable. Like if the family comes in and their person is soiled, and may have been sitting in it for a long time, they're not going to be seeking out the NA to find out what's up. Or if you're getting report from your fellow RN and the patient has dried poop under them, that isn't right. You can always sympathize with an RN that had a crap NA, but still doesn't change the fact that it's the RN's deal to make sure it gets done.

If an RN isn't doing anything as in the example put forth, then they can definitively clean up some poop for their patients.

I think we need to differentiate between hospital and LTC here though. Definitely more of the NA's deal in LTC.

If the nurse has 4 or 5 patients I see that, she/he can change the patient, but when you have 35-40, it is probably different. But when the CNA/PCA is sitting around, they can go ahead and change the pt.

Up Vote Up Vote ×
Okay, nobody is gasping for air. That person's comment was far off base. Communication is fine at this hospital, everybody has locators. By refusing I mean, REFUSING. I see nurses REFUSING to help the CNA change their total pt, telling them to go get another CNA. I see nurses calling out from the room for a CNA to toilet that pt they are in the room with.

I am not assuming anything. The nurses I see and hear doing these things are habitually doing this. Sure, we all have rough nights. We all fall behind. But I take issue when I see the same nurses using CNAs to toilet/clean their pts over and over again.

I get it, it ain't glamorous. But pts are here because they are sick. They can't do for themselves so we do for them, we are "nursing them" back to health. Right?

No,YOU are not nursing the patient, the nurse is nursing the patient. You are assisting the nurse. I have directed the assistant to get another assistant to help them clean the patient. If I stayed in the room to assist my assistant...my entire med pass would have been later. Administration really frowns on that.

Up Vote Up Vote ×
Specializes in OR.

I dunno...at the moment I am sitting at home being a "failed" floor nurse. After 14 years of doing a couple of other branches of nursing I tried my hand at the floor. Yep, crash and burn. Why? Sometimes i feel as though I can get a patient to the BSC, and back faster than I can go hunt down the CNA (who may be in with another patient.) Sometimes they are equally as busy as we are. I never did get that delegating thing down. I've been a patient in that bed enough times that I never cared to leave a someone sitting in poop (or whatever) any longer than absolutely necessary. Besides, i rationalized that helping with the clean up gave me chance to check the patient's skin on the bottom/coccyx area for breakdown, etc. The thing is i got further and further behind on those tasks that only the RN can do. Oh well, my compliments to those who can give good patient care, get everything done timely, communicate well with their CNAs and not pull their hair out.

Up Vote Up Vote ×

Until the day management does not fault a nurse for being late clocking out because he/she had a patient who needed to go to the toilet at the end of shift, can one really blame the nurse for delegating the duty to someone else?

Up Vote Up Vote ×
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.

I could go on and on about this, but I'll keep it short. I help when I am able. I can't remember ever working with a nurse that acted "too superior" to clean or toilet patients. Seriously. Nurses deal with emesis, sputum, blood, and all types of body fluids, so I really doubt that most believe they are too good to help with poop and pee. I also have always heard CNAs complain that the nurses don't help "when they're right there" or "they're not doing anything". I also have had CNAs roll their eyes or even refuse when I've asked for assistance because I had other priorities at the moment. I've never seen a CNA work overtime finishing their shift for more than perhaps 30 minutes, but I have seen nurses stay 1, 2, or more HOURS late finishing their work on a regular basis. When my 12 hour shift has morphed into 15 hours long and my CNAs left right on time, it can get really frustrating hearing this. I agree that CNAs have a very difficult job and are not paid nearly what they deserve, but this CNA vs Nurse crap has got to stop

Up Vote Up Vote ×

I'll chime in. When I first started at my hospital, I didn't have my RN license yet, and the job description form I had to sign listed that my responsibilities were activities of daily living (ADLs) and RN duties under the direct supervision of an RN. When I received my license, I signed a new form that listed my job duties as (in a nutshell) formulating the care plan, collaborating with providers, med admin, and delegation of ADLs. I was surprised by that. My cardiac tele floor also hires enough aids so that this plays out nicely, in theory. Everyone who accepted a job here knows what they signed onto.

That being said, the first thing I did on my shift last week was toilet a patient and then wash the commode out. I'll do that. I'll grab extra blankets and water. I'll grab extra socks. I'll stay in the room for five extra minutes trying to move pillows just right so that the patient feels comfy. And the reason I can do that is because on EVERY single shift I've worked so far, at least 2 (usually more) RNs ask if I need help with anything. And I do the same. We all have each other's backs. And so it isn't often that I feel too overwhelmed to help other disciplines out with their tasks. This does not happen, however, if my night gets crazy. And if I'm sitting at the nurses' station chatting, it's because instead of taking one of my 2 paid 15 minute breaks off the floor, I wanted to spend it chatting with friends on the floor (and I would like a moment to sit and breath and collect my thoughts--the aids get these breaks too and I cover them when they do). Or if I'm sitting, I may be waiting for transport to bring my admission up. Or maybe this was the 5th time a certain patient has yelled at me that night, and I'm sitting down trying not to cry. There are many reasons a nurse may be sitting down, and it not because that nurse is lazy.

Now that being said, if I happen to get an aid that sits all night, doesn't clean ANY patients, doesn't tell me about bad vitals (there is one aid like this on the floor that most nurses and aids alike have a problem with) I will delegate even if I do have the time. Because I'm sick of that aid doing nothing all shift while the rest of us aids and nurses bust our butts to take care of our patients.

And the reason people are asking for your job title is because you made it seem like you may have been a nurse, then said you were an army medic. You can't judge how busy a job is if you haven't worked it yourself.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.
I am sorry you are experiencing this behavior. I must admit I have witnessed this behavior in some nurses and NOTHING makes my skin crawl more than the nurse who looks for the CNA to toilet the patient...then sits back in the nurses station to finish whatever topic they were discussing.

I have no idea when this started but it seems more prevalent in the last 10 years or so. I have heard every explanation under the sun and the nurses being truly busy is not always the case. I am not sure if someone along the way said "When you become a nurse you won't have to do xzy" or they believe that since they went to college it is somehow beneath them. I have heard muttered in the hall "That's not what I went to nursing school for..." I think "Really?" I don't remember it being written anywhere that a college degree exempts one from the gross aspect of nursing.

Sadly, my daughter is a "nurse extern" a fancy term for nursing student/NA...they can't be called Certified because they are not certified....anyhow...it has become apparent to her that there are nurses who fel that particular task is beneath their schooling. They should be ashamed. She has come home and told me nurses have actually made that comment to her face...she was shocked and has made a promise to herself and her future patients that she will not be that kind of nurse.

I know that many are not going to agree with me, however, I believe that if it takes you 5 mins to track down the aid...you can toilet the patient. Yes we are busy. Yes were have tasks to do that have to be performed by the licensed staff member. But I do not believe in dictating directives that don't include a please and a thank you.

It has always been my personal "policy" that please and thank you go a long way. I believe in saying.....Sandy....can you please help Mrs. Pottie to the bathroom. I need to give this med to 14 then I will meet you in 12 so we can double team and clean them up....again...lol" 9 times out of 12 I gt...."That's fine...but I'll get 12 then we can meet in 13 to walk her" The caring of every patient is all of our responsibilities. I still cannot walk past a room with a light on. I know we are busy but we are not too bust for please and thank you.

Up Vote Up Vote ×

This sounds like something to bring up at a staff meeting.

I have always liked as much hands on with my patients as possible and consider that the CNA is there to help me. 2 is always better for a clean up, plus I could inspect skin, note the stool and see if the patient had some GI issue etc. I don't know anyone who enjoys cleaning up an incontinence, but I consider that it is my job and part of why I get paid. When I am too busy to help, I let the patient know that I need to get help for them as I am involved with something else. I hope to never trigger humiliation for anyone.

I am what you call a seasoned nurse close to retirement baby boomer). Do you think this is a generational thing or is it floor nursing? I have worked mostly ICU and ER. ICU nurses clean up a lot of incontinence, esp. because of tube feeding etc. I rarely had to clean people up in the ER, but we always teamed up and did it right away as we always were interested in preventing skin breakdown.

It would be interesting to do some kind of quality assurance on this to discover what the hindrances are, and to provoke improvement.

Up Vote Up Vote ×
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
I am sorry you are experiencing this behavior. I must admit I have witnessed this behavior in some nurses and NOTHING makes my skin crawl more than the nurse who looks for the CNA to toilet the patient...then sits back in the nurses station to finish whatever topic they were discussing.

I have no idea when this started but it seems more prevalent in the last 10 years or so. I have heard every explanation under the sun and the nurses being truly busy is not always the case. I am not sure if someone along the way said "When you become a nurse you won't have to do xzy" or they believe that since they went to college it is somehow beneath them. I have heard muttered in the hall "That's not what I went to nursing school for..." I think "Really?" I don't remember it being written anywhere that a college degree exempts one from the gross aspect of nursing.

Sadly, my daughter is a "nurse extern" a fancy term for nursing student/NA...they can't be called Certified because they are not certified....anyhow...it has become apparent to her that there are nurses who fel that particular task is beneath their schooling. They should be ashamed. She has come home and told me nurses have actually made that comment to her face...she was shocked and has made a promise to herself and her future patients that she will not be that kind of nurse.

I know that many are not going to agree with me, however, I believe that if it takes you 5 mins to track down the aid...you can toilet the patient. Yes we are busy. Yes were have tasks to do that have to be performed by the licensed staff member. But I do not believe in dictating directives that don't include a please and a thank you.

It has always been my personal "policy" that please and thank you go a long way. I believe in saying.....Sandy....can you please help Mrs. Pottie to the bathroom. I need to give this med to 14 then I will meet you in 12 so we can double team and clean them up....again...lol" 9 times out of 12 I gt...."That's fine...but I'll get 12 then we can meet in 13 to walk her" The caring of every patient is all of our responsibilities. I still cannot walk past a room with a light on. I know we are busy but we are not too bust for please and thank you.

I think I would like you for my RN, if I'm ever in need of one at a bedside.....

Up Vote Up Vote ×
Specializes in SICU, trauma, neuro.
Guys, we found NOADLs!

I'd wondered where he was! :laugh:

Up Vote Up Vote ×
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.

Report what?

Up Vote Up Vote ×
+ Add a Comment