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.. .

[KJ87, BSN, RN]

This is a big problem in LTC and it is the saddest thing I've ever witnessed. I had to get out of there before it sucked out the last bit of desire I had for this profession. People deserve better than that, and that goes for both sides, patients and employees.

[No Stars In My Eyes]

Back in the mid-80's I worked at a hospital and we had a sad, sad case admitted; it was a young man, essentially veg'd, who had been sooooo neglected at his nsg. home, that he had multiple decubiti. The very worst was that he had a catheter and you could actually see the catheter through the sides of his member where he had holes along the shaft where the skin had broken down completely! As I recall, we gave him 4 baths before he was clean. It was truly sickening that a health-care facility cared so little as to let someone end up in such a deplorable condition.

[thenightnurse456]

This whole thread makes me feel gross!

I can't believe the differences in cultures from USA to Aus regarding hygiene cares and other ADLs.

Most areas of my country the nurse is responsible for these tasks. I can't imagine a colleague saying to me "there was no CNA on so they haven't had a shower and their bed is soaked".

If a new grad said things like "I wasn't trained to do that nasty stuff" they'd probably find themselves unemployed.

It's so sad that this is happening, hygiene and ADLs are the foundation of nursing.

[0.adamantite]

Let me describe a typical night for you on my med surg unit:

8 patients per nurse

1 CNA from 7-2:30 am

3 sitters that each get 15 min breaks x 2 and a 30 min lunch break=3 hours the CNA is off the floor to break the sitters plus the CNA's breaks so I only have a CNA for 4 hours

2 legal holds

2 confused agitated totals complete with trachs, PEG tubes, and dressing changes on contact isolation

1 400 pound woman having chest pain and needs a foley put in (took 3 nurses and 4 hours to do it)

2 people who need pain meds q2-3hrs, one of whom needs 2 units of PRBCs

1 patient with TPN, abx every hour and a fever of 102 that just won't go down also on isolation

Plus all the charting we have to do that we'll get written up for if we don't get it done, calling doctors, transferring patients to the unit, dealing with family members, putting in IVs that got pulled out, doing 5 accuchecks, oh and don't forget the new admission that will replace the one I transferred and will take me 2 hours to complete. And did I forget to mention that the sitters are only sitters, they're not CNA's so they're not allowed to touch the patient if the patient tries to get up or pull anything out. They tell me and I get there in time to stop the bleeding.

There's one of me and 8 of them. The CNA doesn't have any more time than I do. So yeah, oral care isn't exactly at the top of my list of priorities. If I can get it done, great. If not, last I heard this was a 24 hour job so the next shift can take a crack at it if they get the time.

Oh, but all that time I was probably sitting on my butt gossiping and waiting to collect my paycheck right?

OP glad to hear you "reported these incidences to the appropriate parties". Why didn't you try talking to the nurses/CNA's who had these patients before you instead of tattling on them? This is one of the biggest problems in the world of nursing right now. We need to work together and realize that the hospital administration, nurse managers, CEO and CNO are the problem, not each other. Once we realize that, we can make real change for the patients and for the future of nursing.

Quoted for truth. Do you work with me? This is a typical scenario where I work. I do most of my own turns and changes when possible. I do all my own oral cares and ambulations. But I suffer for it, because on top of everything else we are responsible for, I'm running like a chicken with my head cut off all shift.

[TriciaJ, RN]

Poor care has multiple causes: 1. Bean counters in charge of staffing numbers. Some places are just so poorly staffed things can't get done properly. 2. Substandard education. People graduating from nursing school who aren't taught to do the icky stuff? Unbelievable. 3. Poor leadership. Someone has to set and enforce standards. When this isn't done and there is no accountability, care suffers. 4. People who are just plain lazy. Every workplace has at least one. Unless you have good leadership and they are gotten rid of, there will be people who prefer to coast.

It seems to be the rare facility nowadays where care is valued and all the pertinent factors are addressed.

[No Stars In My Eyes]

I wax nostalgic for the day when we had an RN, an LPN, and two aides for 25 patients on a med-surg floor for the 3-11 shift. At 8 PM we all did evening rounds, each of us had patient assignments. We straightened out the bed linens, gave fresh water, did oral care, and GAVE BACK-RUBS, settling folks in for the evening. Then we charted and took care of things as they came up. If there was a particularly difficult patient (for whatever reason) we all pitched in together. Not that there weren't evenings when things got crazy, but we worked as a team and nobody, staff or patient, got thrown to the wolves. Sometimes even one of the supervisors would help on the floor if things were particularly hairy.

No twelve hour shifts, no 'bastardized' half-assed Primary-Care nursing with it's assignment overloads. We worked as a team.

Imagine the luxury of knowing your back was covered!

[TriciaJ, RN]

I wax nostalgic for the day when we had an RN, an LPN, and two aides for 25 patients on a med-surg floor for the 3-11 shift. At 8 PM we all did evening rounds, each of us had patient assignments. We straightened out the bed linens, gave fresh water, did oral care, and GAVE BACK-RUBS, settling folks in for the evening. Then we charted and took care of things as they came up. If there was a particularly difficult patient (for whatever reason) we all pitched in together. Not that there weren't evenings when things got crazy, but we worked as a team and nobody, staff or patient, got thrown to the wolves. Sometimes even one of the supervisors would help on the floor if things were particularly hairy.

No twelve hour shifts, no 'bastardized' half-assed Primary-Care nursing with it's assignment overloads. We worked as a team.

Imagine the luxury of knowing your back was covered!

And the length of stay was a little longer at one time, too. People didn't go home until they felt somewhat human. You weren't doing on-the-fly discharge teaching one minute, and admitting a fresh postop into that very bed the next.