Lack of basic care--appalling!

[kool-aide, RN]

hey folks,

i know we've all read threads on this topic before, but i just need to talk about it!

lack of basic care is really starting to get under my skin, so to speak..

last weekend i was working in two completely different units, at different hospitals on friday and saturday night and ran into the same problem:

first, on friday i took care of a trached pt who was npo and having a lot of secretions and while his trach was capped, those secretions where presenting themselves orally. well, upon a closer look at my pt, the poor man's mouth was a complete mess! his mouth was dry, dirty, smelled terrible and seemed to be peeling around his lips and his lips were cracked! i looked back in the electronic chart and he hadn't had oral care all day!!!! no oral care was charted from 04:00 to 20:00 when i gave him oral care. over the night, i gave him oral care q2 hours along with his normal q2 hour peri-care and turn. in the am his mouth looked wonderful!

second, on saturday night i took care of a total care pt who was also npo and had not had oral care all day!!! again, his mouth was dry, smelly, lips cracked, tongue had a thick layer of white coating on it, and worst of all, this pt also needed to be suctioned frequently which only made things worse! again, i gave him oral care q2 hours along with oral suctioning, peri-care and a turn. it took me all night to remove the thick white coating from his tongue. i don't know if it was yeast or not, but that can surely be prevented with frequent oral care.

i have reported these incidences to the appropriate parties, but i just needed to vent about it.

if it were you laying in that bed, and not able to eat or drink, wouldn't you love and appreciate it if someone provided you with the basic necessities of care?

let's not forget our basics, folks!!

ahhhhhhh, that feels much better.. .

[kool-aide, RN]

i'm calling bs.

it takes seconds to provide oral care.

you or the tech will be in the room at some point anyway... just flippin' do it.

thank you!!!!

[MassagetoRN]

I also think that the take away here is that we all need to work as a team. I never ask the aide to do something that I myself am unwilling to do. If I have a total care pt what needs to be cleaned, I get in there with the aide to get it done. Treat your aide like gold and they will take good care of your patients, and help you out when you're stressed.

We don't need to fight each other, its the system that needs to be changed. And families need to be educated as well. I don't think anyone should stay alone in the hospital. It breaks my heart to see someone's mother or father neglected, but at the end of the day, we can't do everything. We have to prioritize.

[FLArn]

I often teach oral care to patient's families. It is an important task but it is easy to teach to families and is a way they can feel involved in caring for their loved ones. (Of course, I make sure the mouth is in good shape when I turn it over to them). I will also "delegate" changing cool compresses for febrile patients to families. When everyone is involved in the care we really are a team.

[anotherone, BSN, RN]

Wow...I have to say I'm a bit disappointed by some of what I'm seeing also. My pts are total care pts and are to be turned q 2 and I have to ask like 3 or 4 times for help turning my pts. I mean seriously, you're at the nurses station gossiping and laughing loudly.....(be quiet anyway, people are sick)!!! Also, did it ever cross your mind that you're making me do things late because I have to wait on you to stop talking and help me? Did you know that I was trying to keep everything caught up and as timely as possible so that I can take care of my pts to the best of my ability. Why can't we just take care of the patients?

I can NOT do all parts of basic care such as turn and repo pts by myslelf. If we don't have an aide and the rest of the nurses are lazy, behind, unwilling to help than I STILL CAN'T DO IT . even if I am all caught up. There is no way I can turn and repo a 300lb person, even a 200lb person by myself if they can't help much! or change some of them. (this can take up to 30mins for some pts, who are huge and in alot of pain etc) I HATE that part of the job and it makes me feel terrible. you are dependent on others to help you but sometimes there is no one to help. or your co-workers aren't free to help when you are. If its not done it is still your fault even if you ran around begging some co-worker to help or worse LOOKING FOR A COWORKER, there are times bells are going off left and right and there is no one to answer them as all available staff are in patient's rooms!

[anotherone, BSN, RN]

No wonder I am burned out . THe following is a common enough occurance: 1 pt needs to be changed. Takes 3 people . Walking to the room, I am informed that another pt's blood sugar is 56. and another pt's bp is 75/40, with a temp of 101.9F. i have to prioritize AND KNOW that someone must wait to be changed.There is a lack of competent aides on our floor also. In the above type of situation I have asked one cna to ask another to help as I have to deal with a serious situation and was b****** at along with the other cna working in my hall, for asking the other cna, doing nothing, to help with my patient......drives me nuts

[npakulski]

Yes, it is very sad! Compassion, apparently is not allowed! I worked in an LTC facility and I could not believe how overworked with ppwk things were. Sure, I know charting has to be done, but getting to know my patients should be a part of that and time allotted to do that. But unfortunately, it all seems to boil down to money. It always ends up being about money!!! What a shame! We can complain and complain about needing to get to know our pt, but nothing ever happens to improve it!

[jadelpn, LPN, EMT-B]

Ah, but the average RN comes out of school and has not a clue that they HAVE to do any sort of hands on care at all. That is what the CNA's and/or LPN's are for.

Only a number of facilities are not hiring either one. And the general theme is get em in, get em out, back to whatever skilled facility they come from. Otherwise, the patient is a self care and can do these things themselves if they choose to.

Literally have had more than my fair share of more recent grads, nurses who are 5 years or less as an RN say to me "I do NOT do this stuff, I do not know how, I have not been trained, and that is just NASTY, I am uncomfortable with it, they need to hire CNA's to do it, I won't......"

Clinical placements of students need to stress just as much the basics as the advanced. Until that happens, "oh well, the people in the skilled care can do this when the patient returns there".

And a number of nurses practice with the thought of "if there's no one to delegate this to, it just doesn't get done"

If I had a dime for every single patient who I see in the early morning who have a completely soaked bed from head to toe because the nurse "had no CNA" and "the patient was sleeping and I did not want to wake them" I would be really rich.

[tarotale]

Devil's advocate here also:

on a regular MS floor, with 6 patients, if you think you can spend jolly times chatting about lunch, grand kids, dogs and life experiences... you gona have a bad time... if you can manage while you chat up your patients for a long time and still not have tasks after tasks backed up on your orifice, trust me, you are working on a rare floor unit.

and to comment on others, I think the healthcare is extremely industrialized and capitalized that there is not much human-ness left in it. patients are just numbers and work to do, charting is rigorous, management punitive, administration greedy, it's a vicious cycle of no-one-gives-a-damn-except-money; and voila we have butt-wipe business pricks (yes, I hate those white suit turds running the hospitals) running the healthcare and setting impossible expectations, overworking nurses, and gradually but surely, it's just a bitter profession... and maybe that's why nurses don't care as much as they did back then.

[TU RN, DNP, CRNA]

I can hear my clinical teacher's voice echoing in my head with this post "if you didn't document it, you didn't do it." I can also remember several times where I've gotten too busy doing patient care to document it afterwards. While in the OP's situation (which was almost 3 years ago by the way) it sounds like oral care was actually neglected, I wouldn't go off of the documentation as the truest indicator of whether or not it was done. Look at the patient.

The other day I was joking about how intense documentation is in nursing (what other jobs are under such constant scrutiny?) and joked about how we're going to have to start counting and recording our patients' farts soon. Then I realized, there actually is a section of our computer charting for that because flatulence is an indicator of functional, patent bowel. So yes, in a way, we count the farts.

[toomuchbaloney]

meh

35 years ago there were RNs who neglected the oral care of dependent patients. They were often the same nurses who rarely had time to bathe the patient, or couldn't manage regular position changes. It was shocking to me how often I was assigned ICU patients who had their ADLs ignored by a nursing professional who had a list of excuses at the end of his/her 12 hour shift. Not much has changed. There are still nurses who are not that interested in ADLs and are more than willing to let their patients lie dirty and miserable in bed.

[smartin13]

Not a solution to the problem of the lack in care necessarily however when I see that one of my patients needs oral care and isn't receiving it consistently I get an order for nystatin swish and swallow/spit or biotene scheduled. It is amazing to see the difference in oral care after that. Also on my floor (Neuro/Neurosurgery) many of our patients are total care or require mouth care. With recent cuts in staffing oral care seems to be falling to the wayside for more "important" tasks.

[MissM.RN, BSN, RN]

i am one of those nurses who LOVES do to hygiene/turns/ambulation/trach care etc. I just love it. it feels like you're actually doing something that matters and makes the patient feel great. when i walk away from a pt who smells better than i do in a nice recliner chair, then i have done my job :) of course that assumes my other patients aren't circling the drain. most of the time, I never chart that I did these things either. i prioritize charting hard data, VS I/O, MD notifications, rhythm strips. there is just not enough time to do it all.

a caveat - more and more often, there is no time for these moments for several reasons beyond the nurse's control, like 1:1 sitter need left unfilled by staffing, multiple medications missing, labs left undrawn by prior RN, acute change in mental status requiring imaging and tele transport....i could go on and on. yes, we all know of our frequent lazy colleague-offenders. maybe because of your high patient ratio you couldn't do oral care Q2, but come on, do it a couple of times.