Bedbaths and Bedmaking

[Ginger's Mom]

On another forum is has been stated that US nursing students have the bulk of their nursing experience making beds and doing bed baths.

As an instructor, I would never assign students just to do baths and make beds. Could you please post what your clinical day is like?

In my clinical.

First hour - getting report and completing the nursing assessment and Preconference.

Second Hour- meds and treatments

Third Hour - continue with meds , treatments, chart review

Fourth hour- dinner breaks and coverage

Fifth hour- pm care and more medications treatment

Sixth hours- charting medications

Seventh hour- winding down, completing the above

Eighth hours Post conference

Not too much time for bed baths and bedmaking.

[shrimpchips, LPN]

I usually did bed baths every week and rarely changed bed linens unless the patient requested it (usually because they have not been changed in a few days) or if the linens were soiled. My day this semester generally started at 0645 with getting report, doing vitals/morning assessments and charting them (we didn't earn the privilege of charting assessments until the last few weeks of clinical, so the entire time we just used our cheat sheets and wrote out narratives instead), provide any AM care/meet pt needs (feeding, toileting, etc...) and then throughout the day was also spent meeting the needs of the patient and doing our paperwork - finishing our assessments, looking up lab values and creating a care plan, all which took a lot of time. If we were passing meds, we usually did them at 0900 or 1100. We would break for lunch at around 1200, return to the floor at 1300 to check on our patients and continue to meet their needs and finish our paperwork. We would also answer call lights and assist the PCAs, LPNs and RNs with whatever they needed. At 1430 we went down for post-conference which usually lasted anywhere from 30-60 minutes and after that we were done. This semester's clinical was on a general medical-surgical floor.

[Kiplingzero]

In the UK - nursing instructors (we call them 'mentors') have a saying about nursing students:

"Too posh to wash"

Well, on behalf of all nursing students - we're not!

My typical day on a ward is -

Handover - 715 - 745

Meet and greet patients - 745 - 750

Assign food & fluid charts, as required - 750 - 8

Drug round - 8 - ...

Having assessed patient/client need during meet and greet, assist/encourage washing/dressing

Those able to get out of bed, change bed - this takes 5 mins/pat - those unable to vacate bed - well...prioritise!

A 9 bed bay, 2 staff: 4 able patients, 5 unable - assign each patient according to need, time to assist in washing, dressing etc. unable patients - I reckon about 15 mins each....I never count, but they look so much better after a wash and bed change....

Ok, so it's now lunchtime...inbetween drug rounds, doc rounds and MDT stuff - my patients are clean, refreshed, have a clean bed and feel better for that. Isn't that the majority of what nursing is about? Yes, I know there is so much more. The endless expectations of our instructors/mentors to give us so much more and believe me, they really want to impart their knowledge, but remember guys...the patient always comes first - their recovery, comfort and well-being above all else. As nursing students, we can learn so much from our instructors, but, let's face it, we learn so much more from our patients. It is in basic nursing that we undertake each day that we learn so much. Remember, the patient is the expert about their illness or incapacity and by performing basic nursing care and talking to the patient you will learn so much.

[cursedandblessed]

here's how our day has been:

0700: staff member comes in and tells us to get on the floor, instructor will be there soon (i thought we weren't allowed on the floor without an instructor)

report-vitals were done before we got there, bs too, so no chance to practice that.

check on patient, look for new orders, find instructor and give her report

0800: assess patient, check foley lines, fms lines, iv sites, peg's, etc.

0900: pray that you get to give meds with the nurse.

1000: bedbaths, bed making, more assessment (skin while you're giving the bath), oral care, help out the cna's, because they help me.

1130: go get the bs from the cna, check mar to see if patient needs insulin before lunch, report findings to nurse or ci, possibly give insulin, or hang 1200 ivpb.

1230: lunch maybe for a half hour if i'm lucky.

1300: back on the dot. wound care,check on patients needs, brief changes, oral care.

check vs, finish charting.

1400: take out the trash, clean up the room, give nurse the report, and pray you're not late for post conference.

1430: i finally remember my bladder is full.

1600: finally in my car, and on my home.

[nerdtonurse?, BSN, RN]

First, clinicals are NOT like the real world. Saying a clinical prepares you to be a nurse is like saying playing Flight Simulator prepares you to be an air traffic controller (at least for the kind of floor I'm on, anyway). I'm an LPN, now in RN school, and the difference between the two....as students, we are NOT being prepared for the real world.

Here's what it's like on my floor, real world, not clinicals:

1845: Clock in, get your patient list (which is 6-8 on my floor), listen to report.

1915: Track down the nurses who had the pt's before and get updates/get clarifications on things they didn't mention (did the Troponins keep going up? How's the neuro checks?)

1925: Print out my med list for all patients, and then go look at their VS trends for the last day -- do they routinely spike a fever at night? Do they tend to bottom out their sugars before sunrise, or are they over 400? Is anyone getting incompatible meds? (Aldomet IV q6h with a NS IV going at 50 -- you can't hang Aldomet with NS, so make sure there's a D5W flush bag, etc.). Quick look at critical labs -- cardiac enzymes, KCL, hgb/hct, wbc/rbcs

1930 - 2030: Assess pts, look at the charts for "stealth orders" that the docs ghosted by and wrote without anyone knowing...like DC'ing the med you were about to give, etc.

2030 - 2200: Big 2100 Med pass, FSBS coverages. Also assess any bandages for excessive drainage, redo PEG dressings, checking dates on IV tubing, bags

2230: Start the REAL fun. Begin performing chart check (you look up EVERY med, EVERY ordered lab since the last chart check, even the "c'd" off ones to make sure they were actually done and done correctly -- ordered on the right day, etc., and all the standard labs for heparin drips, coumadin dosing, etc., are ordered.) Anyone on a q2 turn, q2 med, q2 restraints check, you're back in their rooms. And of course you'll probably be getting an admission at this point.

Midnight: neuro checks, q2turns, ciwa, restraint checks.First scheduled reassessment. We have to go in every room, even if we were just in there, to assess IV site, pain, telemetry, any change in mental status. And they check this against our trackers that we wear.

0100: Review the 0100 vitals, still doing the chart checks, looking at labs/radiology that's coming back. Call the doc for PRN Bp meds, report fevers, etc. Anyone on CIWA, restraints, with sundowners, etc., is usually off the chain at this point, and screaming the house down. You're trying to keep the a/o patients from having ANOTHER MI just from the stress of hearing someone scream "Momma! Momma! Moooooommmmmmaaa!" for hours at a time. And the family doesn't want the screamer "sedated."

0200: neuro checks, q2turns, ciwa, restraint checks again. The computers go down for the nightly reboot -- sometimes the come back, sometimes they don't. This is usually when the ER decides to dump all their patients on the floors, so you may get 2 or three admissions at once-- it takes 2 nurses (one to assess, one to interview) and we're lucky if we've got 5 nurses -- usually we have 4, sometimes only 3 to up to 30 patients. So if 4 of 5 nurses are tied up doing admissions, and you've got one aide who spends more time smoking that working, and one nurse is with her trach patient who's circling the drain, well, I guess the rest of the floor just gets to go on autopilot.

0300: This is the time you bathe the total cares, do your dressing changes, etc. If you've got someone with c.diff, or a GI issue, you're already 2 hours behind at this point. You're also charting, charting, charting.

0400: neuro checks, q2turns, ciwa, restraint checks. You start getting surgery patients ready. Bath, assessments, preop meds, assessing surgical sites, making sure consents are signed before the person gets narcotics, etc. This is the time I record report for the next shift, because I'm too busy after this point.

0500: Docs start hitting the floor and wanting you to round with them, and various docs will be rounding from this point on. So you're giving report on how the pt did over night, current labs, pointing out problems (potassium is low, decreasing hgb -- of course, we've called them stat if there was a critical lab that comes in during the night). A bunch of new orders get written, and since we don't have pharmacy at night, that means we're entering the orders, double checking for allergies/cross reactions, calling the lab to tell them to do add ons, and doing now doses. Patients for surgery who were boardline for med release for surgery get assessed by the doc, and if they're not stable, you're on the phone with the admin rep and surgery telling them that Mrs. Smith's keeping that gallbladder one more day. And depending on who's rounding, you'd better either have a cold Coke or a hot cup of coffee ready, or you life is crap.

0600: neuro checks, q2turns, ciwa, restraint checks. Second mandatory room check (now you see why this is so insulting) assessing IV sites, pain, telemetry and mental status changes.Surgery/anesthesia is on the floor, looking over the charts for the folks going first. So you check sugars, and depending on the result/MD order, you may or may not cover the patient. Infection control comes in, looks over all the isolations, usually berates us for "overuse of PPE" (read: $$$), and pharmacy comes by to pick up the order sheets. So they can DC and put in the stuff we've already done.

0630: Usually another big med pass, and checking patency of saline locks, so you get to restart anyone with a blown SL. Familes start coming in and demanding to see the docs, you're chasing around trying to get all the new orders in the system or dc'd as the case may be.

0700: Dayshift comes in, drinking coffee and wanting to chat with each other while you just want them to listen to report so you can leave at 0730.

Now, that's a normal QUIET night. If you've got really bad off people, or someone trying to die, or someone did die, or two people died within 45 minutes (that happened last month), or someone codes, or you 6 admissions in 2.5 hours (like happened last weekend), all that extra work has to get shoved into some little slice of time you didn't have. And did you notice that I didn't mention breaks or lunch? or potty stops? I have nights where "lunch" is bolting a cereal bar as I'm running down the hall because a bed alarm is going off, and others I don't get to eat. There's no "going to break." And in the middle of this you're doing brief changes, bed changes, checking PEG placements, draining colostomy bags, chest tubes, JPs, fecal collectors, putting someone's dressings back on, AGAIN, that they've pulled off and smear fecal thru, because either you've got one good overworked aide, or one bad aide who spends more time smoking and MIA than working. And we're in a hiring freeze, so we're not getting anyone else..

Now, as I said, what I described, that's a normal, Quiet night. Nothing like clinicals at all. If they wanted to make clinicals "real world" last semester would be like what my aunt went thru -- there were 3 RNs on the floor, plus the teacher, but the students ran the floor. The instructor/RNs were there for a crisis and to double check to make sure nobody forgot something and a patient was put in jeopardy, but the students functioned real world, with the RNs working in a preceptor position. She came out prepared. We don't.

[Sarah Hay]

I am in an ADN program and my clinical days really do not provide a lot of learning experiences. We mostly just provide patient care such as bathing them and changing their beds. If they need help we will feed them and help them with anything they need. The instructor picks a few students to pass medications but not all of us. The most exciting thing I did in my clinicals was walk down to the x-ray with my patient. He sang to me the whole way. Other than that... I cannot say I learned or am learning much in clinicals.

:redpinkhe Sarah Hay, SN

[flightnurse2b, LPN]

our first fundamentals clinical (before we completed pharmacology) was almost all personal care... baths, showers, bedmaking, feeding, ambulating, transfers, etc...

after we completely pharmacology and proved competency on basic bedside care, our clinicals were more focused on med pass, assessments, communicating with doctors/other staff nurses/family, delegating, transcribing orders, treatments, etc.