Baths on night shift?

[RNforLongTime]

I work night shift, M-F in a 6 bed ICU/CCU. Been straight nights since November. Worked at this place since last Feb. We have a new nurse who's been an RN for awhile and worked nights for 16 yrs. She's working days/eves for us. Since I started here, it hasn't ever been impressed on me that as a night nurse, I am EXPECTED to do baths on my shift. Usually, if my patient is intubated and sedated, I WILL bathe them on nights. When I worked days, I'd get irked to come in and find that NONE of my patients had been bathed on nocs. When I mentioned it to my manager, her response was well if they didn't do it, they didn't do it.

Now that this new nurse is here, and only works days/eves, she seems to think that us night shifters should bath at least 1/2 of the pts in the unit. Cause that's what she did when she worked nights at her last job. She SAYS she mentioned her concerns about baths to our nurse manager who told her

that she agreed with her. Now, this isn't how we've been doing things where I work. Nor has it ever been an issue with any other day shifter until this woman started working here. And frankly, where I worked before, at the only trauma hospital in the ICU, we didn't do many baths on nights there either.

Now, usually on nights, the nsg supervisor pulls our aide to the med-surg floor as their night shift aide quit, or she'll get pulled to the detox floor or the medical psyc unit. She's even been pulled to OB. Our aide works 4 nights a week--no weekends--and maybe gets to stay in ICU with us 2 of those shifts.

This new nurse said that she's been there for 6 weeks now and we on nights have not done ONE bath. Well, we haven't had any vented pts in awhile and most of our pts have been alert and oriented. I am not gonna wake an alert and oriented person in the middle of the night to give them a bath. If they are sedated on a vent, or confused with no concept of night or day, then I have no problem giving them a bath IF I HAVE TIME. New nurse says there's been plenty of confused pt's in her 6 wk tenure that we could've bathed on nights. Whatever lady. I think she's trying to cause trouble. She hasn't made any friends and believe me there's plenty of things that she doesn't do.

Now mind you, we run skeleton crew on nights and as a 6 bed unit, we never have more than 2 nurses on the unit...no matter what the acuity. Also there is no respiratory therapy at night either, so I have to do my own vent checks and respiratory treatments. Also have to restock the med area and do 24 hr chart checks on nights.

So, what is the policy where you work regarding bathing pt's at night?

[incublissRN, BSN, RN]

I usually bathe my vented and sedated or confused patients. There is no way I'm waking up an alert and oriented person for a bath. Usually they want to get as much sleep as they can and the mornings are busy with doctors rounding so it doesn't get done on my shift.

[RNforLongTime]

That's exactly how I feel. This new nurse seems to think that it's perfectly acceptable to bathe someone after they've had am labs draws--which in our unit is around 4:30am---since they're awake. Usually, the pt goes right back to sleep.

Even sometimes with the confused ones, if they've been restless all night and finally fall asleep around 2am, I certainly am NOT gonna wake em up then either to bathe them.

We usually don't have super sick patients in our ICU as I work at a small community hospital. A lot of times we get patients that don't need to be in ICU simply because the attendings know that they'll get better care in the ICU as compared to being on the floor. We get all GI Bleeds, especially if they're going to need transfused. The floor is too busy to hang blood you know.

The evening this new nurse told me this stuff, I was assuming care of her vent patient (which I had a LOT of HER work to do to catch up on-and he was her ONLY patient for 4 hours!!) AND was getting a brand new GI Bleed admission to which I had to give two units of PRBC's. PLUS, I was expected to bathe the vent pt at some point, per a note from my nurse manager--only because there was another pt in the unit--weighing over 350lbs--who's daughter had a FIT that day because momma was not bathed by 9am that morning! This daughter expects momma to be bathed before she comes in at 9am.

So, our manager left me and my other night shift co-workera note to please bathe the vent pt and this other confused lol so that the day shift aide could bathe momma. Mind you, there was no aide on night shift, and we got two admits between 8pm and 10pm!!! I did my bath and the other nurse did her bath. I told the day aide that if I got a third patient that chances are I would not be able to get to ANY baths as there is no aide or secretary on nights to help with charts, vitals, chemstrips, etc.

I'll be curious to see what becomes of this whole matter. I don't think new nurse plans to stay at our facility very long.

[momof2RN]

I work in a 16 bed ICU and we have the bath battle all the time. We have no aids in our unit. I work nights and we usually bathe all the vented pts., and usually bathe at least one pt. per nurse. If 7 nurses- we try to give 7 baths. However, this apparently is not enough for day shift. They complain to our unit manager all the time; she finally had a unit meeting and informed us that nights would do all baths, all dressing changes, all IV tubing changes in addition to everything we already do like 24 hr chart checks, am lab draws, am CXR, and regular pt. care. Of course she had a night shift mutiny on her hands after this announcement. Not to mention that at the time we were already short staffed on nights anyway.

To compound it even more she told us it was corporate policy. Well one night we called a sister hospital and asked their ICU nurses what their policy was. There isn't one. So, she flat out lied to us.

Anyway this didn't last long. We're back to one bath per nurse. If someone has 2 awake, alert patients who refuse baths they usually help someone else do an extra bath.

[RNforLongTime]

Day shift almost always has an aide in my unit! The aides are also unit secretaries/ward clerks. The one gal (on days) doesn't like to do baths and huffs and puffs about it if you ask her to help. The part time girl is a dynamo! We'd love to clone her so she'd be there 24-7! She does her job like she is supposed to without being asked. The others won't do a thing unless you ask them to help you.

That in itself is a problem. When the aides are there, they dont do anything unless you ask them to. They take no initiative whatsoever. I shouldn't have to nag the aides to do a bath. That is their job! I have no problem helping them whatsoever. And if they're busy doing something else, I have no problem getting started but expect that when they are finished doing whatever else, that they come in to help me finish. With two people, the task goes much quicker.

They can't do the chart checks, vent checks, resp treatments that I have to do. Some of them seem to forget, I can do their job, they cannot do mine.

And like I said earlier, for a 6 bed unit, the most nurses we'll have is 2 per shift. Last fall we had 5 pt's on a vent in the unit at the same time. No extra help and they STILL pulled our aide to the med-surg floor every night!

[Creamsoda, ASN, RN]

i work in a 24 bed ICU, and it is just expected that we do baths on nights. This doesnt mean we wake them up in the middle of the night to do their bath, most get the bath done by 2200. Even if the patient is alert and oriented, their bath is usually done by 2200, so it shouldnt matter that its done on nights. Its usually just far to busy on dayshift to do baths, so it is the unit routine to do it on nights so if you dont do it, you have failed to do what you were supposed to do. I dont think it should be up to each shift whether the patient gets a bath. Its too easy to say "I didnt have time", so they let the next nurse deal with it. Sometimes I will bathe the patient on days if its around 4-5 pm and im sitting on my but, but it would proably be a good idea to start of routine, so everyone knows when it should be done.

[walk6miles]

Darn! I thought we put that particular geenie in a bottle and threw it overboard!!

We thought we got rid of her and I guess she migrated to your life...making it miserable???

She will go into an alert, oriented person's room at 4 a.m. throw on the light, pull back the blanket and proceed to scrub the patient no matter what they say! She DUMPS half the bucket of water into the bed and sops it up with the linen! Honest to God!

I have threatened her if she went near my rooms -- she increased one of my patient's sedation drip WITHOUT consulting with me ( I was weaning him down with a goal of extubation in the a.m.)

When she gave notice, we all applauded! Sorry, looks like you found her!

[lifeLONGstudent]

I work in a high acuity teaching hospital, 15bed ICU. You are expected to bathe one of your two patients. Sometimes, I do both patients. I really don't mind doing baths. Our PCAs, when we have them, aren't really all that helpful, so I just do it myself and ask someone for help when I am ready to turn and change sheets.

Also, if I choose to bathe an awake patient, I will do it right before I WANT THEM TO GO TO SLEEP! I even tell them that their warm bath will help them relax so they can rest..... subliminal messages .. he he hee heee.

If both my patients were not bathed on days, then I pick the dirtiest (or smelliest or one who poops the most) and bathe that one. I try not to make it a day shift / night shift thing, but they do have PCAs on days and they do staff with more nurses on days (so more patients are singled meaning that there are more hands to help bathe/turn).

It is a waste of time and resources (linen, supplies, etc) to bathe patients twice a day, but sometimes it gets done just so as to NOT piss off the next shift because we (nights) only did "X" baths. I don't do it. It is a waste.

I work with a good team. If I am really busy and don't get to bathe either patient, no one busts my chops. I tell them I was busy and didn't get to it. They can look at my MAR and pages of orders to verify that.

LifeLONGstudent

[RNperdiem, RN]

I work in a Level I trauma unit in a 16 bed ICU. All of our patients are bathed at night. Since the night shift arrives at 7pm, they generally bathe the patients around 10 or 11. These patients are generally all vented and sedated. Nobody is going to get any long stretches of sleep anyway when they need frequent assessments.

In big teaching hospitals patients are seen my many teams of doctors, and have many trips to CT, MRI and VIR. Patients that are less acute graduate to the stepdown unit, and they do many day baths in that unit.

My unit is generally well staffed and has a night secretary.

[Christie RN2006]

I work in a 10 bed ICU at a level II trauma center... the night/day shift bath battle is a constant thing. I am a 3p-3a person, so I try to do at least one or both of my baths before I leave at 3a, it all depends on how busy I am. If I have an alert and oriented patient I give them a choice of if they want a bath or not and if they refuse, I chart it.

[RNnewgrad]

Our baths are expected to be done before midnight. No one gets written up for not doing one...if your busy, your busy! But day shift definetly won't be doing them.

[Guest193822]

Ok this will piss me off!

U need to bath the pt's. As a military officer we have to work both night's & day's. I work on a 14 Bed SICU/TICU & policy is night shift baths the pt's between 9pm & 11pm. There's just no excuse not be bath your pt. how in hell are documenting skin intergity if U aren't bathing them.

The only way U don't bath a pt is he's unstable (open hearts, septic pt) or a very, very, crazy busy night.

We also don't have aides the RN's do it all but on night shift we have team bath nursing. My head nurse expects pt's to be bathe expecially the soldiers who come back for Iraq & Afghanistan they are filthy. They need to be hosed down, spray & scrub down. If it's not done U'll hear in in the morning.

Infection Control #1 is a clean skin your 1st underline protection from bugs!