I have been working on CCU (nights, 7P - 7A) and generally like it a lot. But I am curious as to how other CCU's handle baths. There is a lot of pressure on my unit to get most or all baths done on night shift, and it continues to be a sore spot with me.
It's not that I don't want to bathe my patients. Certainly, if they are ventilated and sedated and don't know the difference between night and day, it is a great opportunity to do a full assessment of every square inch and catch/treat skin breakdown problems early.
But, I also get a fair number of patients who are alert and oriented and TIRED. It's bad enough that there is sound and light pollution, round-the-clock meds, labs to be drawn, etc ... it seems downright cruel to me to wake someone from a halfway-decent sleep at 3:30 am and go through the whole bath routine for basically no other reason than day shift's convenience.
Also, we are always short-staffed on nights. Everyone will pitch in and help out with the most critical folks who require multiple assists, but there are only so many hours in the shift. And I only have one back -- I am not going to sacrifice it, or my pt's safety, for lack of assistance.
As it is, I do almost always get at least one of my pts bathed. If they are responsive and able to tell me they're just not up for it, I chart it. Still, I get dirty looks in report for saying a pt has not been bathed. Is this common? How does your unit do baths?
I strongly feel that day shift is entirely too busy to take the time to bathe both my patients. Between all the doctors, orders, procedures, treatments, PT/OT, road-trips, transfers, post-ops, multi-disciplinary rounds, etc, I'm lucky to get all my charting done and get home on time.
Where I used to work, we had a CNA scheduled for every shift. Baths were always done on nights, except those who were fresh post-op (CABG's) who were bathed before being extubated. We were able to get at least 80% of the baths done in the first 2 hours of the shift (14 bed unit, average census 8-12), the rest were done in the morning after drawing the AM labs. Our CNA's were excellent and just powered down the line with the nurse helping to turn and do sheets, if not helping with the whole bath. It takes dedicated and organized people, particularly the CNA to get this done though - some who floated felt overwhelmed. However, the night nurses were so used to the routine, that it was still done.
Where I work currently, the thinking is different and people are bathed whenever - hopefully at least once q24hrs. Now if only I could change the thinking here......
I work in a general critical care unit, my specialty is cardiac. We don't have any CNA's, nurses do total care. The goal is to have one pt done at night, the other on days. If it's a nice nurse at night and a pt isn't crashing, they'll do both pts. (i'm day shift). I don't mind bathing, but a doctor always seems to show up 10 minutes in, so then you have to stop/start. It can be very frustrating. I completely agree that days is very busy; sometimes just finding someone to help turn is impossible, much less helping long enough to clean backs and change sheets. Night nurses hear our plea-give us one less thing to fit into a crammed day!
I work in the cadiaothorecic intensive care unit. We bathe the patients Q12h, usually at 20:00 and 06:30 the next day. It seems to be a routine, no matter how busy you are or what is happened on the patients.
I work in the cadiaothorecic intensive care unit. We bathe the patients Q12h, usually at 20:00 and 06:30 the next day. It seems to be a routine, no matter how busy you are or what is happened on the patients.
Every 12 hours? That's insane. Frankly, I think the bath thing is one of those strange nursing habits that nurses have done for so long, they don't think about it anymore. Obviously, smelly icky patients need to be bathed. But in one unit I worked on, nurses bathed patients who REFUSED the bath, and I was required to bathe a patient having an MI. I was taught in school to minimuze the demands on the patient during the early stages of the MI, but this unit seemed to think that cleanliness was better than health and critical thinking.
What about elderly patients with dry, thin skin? Perhaps pericare and spot cleanup is more appropriate.
I just think that the pt bathing thing could be rethought on a lot of units.
I just think that the pt bathing thing could be rethought on a lot of units.
Oldiebutgoodie
I completely agree! I'm healthy and I bathe once a day. If I'm sick, I'm lucky if I feel good enough to bathe once a day. Twice a day, even if someone was doing it for me, would make me miserable!
I think changing sheets when they are wet or soiled, wiping and sometimes lotioning backs when turning, wiping faces in the morning, and providing proper peri-care should be sufficient between q night baths.
I work overnight and we do all the baths. I think a&o pts should have a bath during the day (if poss), because there are stock clerks to help turn, and a part-time RN who comes in to do xfers/trips for procedures. (BTW, I have worked days, and always tried to bathe at least 1 of my pts.)
Talking to some of the nurses who have been there a long time, the "all baths @ night" started long long ago. (Use the force, Luke.) However, back then, we didn't have 24hr procedures/ct scan/in house on-call everything to get that scope/cath/etc done now. Of course, now we do have all those things around the clock. So, in our large hospital, there really are times when we end up being just as busy (if not worse) than day shift- with less staff (no transport RN, no stock clerks).
We have 18 beds, and for a few weeks during an acute night shift shortage, day shift helped out by doing like 1/2 the baths and it was wonderful. Heck, even a few baths done would free up time for the night shift to help each other.
*sigh* No easy answers. When something becomes so part of the culture, it's hard to change. And, Oldie, I agree- if my pt is too unstable/can't handle the turn- the bath goes out the window!
ccrnjen
22 Posts
I strongly feel that day shift is entirely too busy to take the time to bathe both my patients. Between all the doctors, orders, procedures, treatments, PT/OT, road-trips, transfers, post-ops, multi-disciplinary rounds, etc, I'm lucky to get all my charting done and get home on time.
Where I used to work, we had a CNA scheduled for every shift. Baths were always done on nights, except those who were fresh post-op (CABG's) who were bathed before being extubated. We were able to get at least 80% of the baths done in the first 2 hours of the shift (14 bed unit, average census 8-12), the rest were done in the morning after drawing the AM labs. Our CNA's were excellent and just powered down the line with the nurse helping to turn and do sheets, if not helping with the whole bath. It takes dedicated and organized people, particularly the CNA to get this done though - some who floated felt overwhelmed. However, the night nurses were so used to the routine, that it was still done.
Where I work currently, the thinking is different and people are bathed whenever - hopefully at least once q24hrs. Now if only I could change the thinking here......