Nasty ....

TheCommuter, BSN, RN · Mar 30, 2017

My mother was hospitalized for three weeks before succumbing in early January of this year. For much of that time she was on a ventilator. Based on my observations, the nurses and RTs performed meticulous oral care on her.

Nonetheless, oral care and foot care are often overlooked, especially in settings with high nurse/patient ratios and many tasks to juggle (e.g., long term care, med/surg, subacute rehab, etc.).

These areas of nursing also have one thing in common: chronic short-staffing. It is a complex problem that seems easy to solve. However, oral care and foot care take a backseat to other tasks when the nurse has many patients to care for.

DiplomaNurseRN · Mar 30, 2017

Granted, a tough one. Especially with mouth breathers and diabetic ischemia. Yet, for me, short staffing is not an excuse in delivering a bit of comfort care. I'm talking basics here, Nursing 101, right up there with bed making and washing your hands. There is no excuse where a patient has crud in their mouth or skin peeling from their feet and between their toes when a few minutes of TLC might help to resolve. It may not solve the problem, but will certainly make them feel better.

marie.rn2419, RN · Mar 30, 2017

I'm sorry for your loss TheCommuter!

And to address the OP, when I worked tele, I found it difficult to address these areas you describe for the same reasons as Commuter stated. In a perfect world, we'd be able to do 'primary care nursing', where we meet all of the comfort/hygiene/upkeep for our patients. But, for this to happen, we need to be staffed appropriately. Floor nurses tend to need to lean on the techs and CNAs for a lot of help in this department, for the sake of patient safety and priorities of care. You can't knock the floor for doing what they can with what they've got without standardized ratios.

jennylee321 · Mar 30, 2017

Also sorry for your loss TheCommuter. Glad to hear you were happy to with the care your mom received. I find with vented/ICU patients people are usually much more diligent with mouth care because it is part of the VAP bundle so it'll be audited frequently and closely tracked as a quality indicator.

DiplomaNurseRN · Mar 30, 2017

Aw c'mon. We have always worked short staffed, from Flossie til modern times. There was a time when such was not an excuse for providing the basics in patient care. Bottom line, we, the RN were responsible to insure everything was addressed. Not just the 'fancy stuff' but the hard line grit also. Yes, our NA's and Practical Nurse's tend to bear that charge, but it is our responsibility to see it through.

marie.rn2419, RN · Mar 30, 2017

But, I've experienced receiving a long-winded report about how "Mrs. Robinson was fluffed, buffed and pampered with essential oils... but electrolytes didn't get replaced and oh, the patient went into Afib a little bit ago... you think you can call cardiology? I still need to chart"

I get where you're coming from, bud. When I have time, I'm known to detangle and french braid my immobile patient's hair. All I'm saying, is that we have to prioritize certain aspects of care in the acute setting as it is today. Staffing and assignments based on acuity absolutely affects the care we give our patients.

DiplomaNurseRN · Mar 30, 2017

First off my name is Mickey, not 'bud', and I guess the issue boils down to personal time management. What you are willing to forego (breaks, lunch, chat, etc.) to get the job done. Pretty simple to me.

DiplomaNurseRN · Mar 30, 2017

BTW - there are no 'absolutes' in our profession, only our willingness to stand up and addtess a problem.

Libby1987 · Mar 30, 2017

Are you referring to acute or LTC patents?

The acute patients we receive have such short LOS these days that they're barely stable let alone groomed when they're discharged home. That's another reason to discharge with home health, to get their resources in place to avoid them presenting in that condition in the first place.

NightNerd, MSN, RN · Mar 30, 2017

First off my name is Mickey, not 'bud', and I guess the issue boils down to personal time management. What you are willing to forego (breaks, lunch, chat, etc.) to get the job done. Pretty simple to me.

Call me crazy (or a terrible nurse), but I don't think anyone should have to go 12 hours without eating at work. Of course patient care comes before my leisure time and even my documentation. But this is physically and mentally strenuous work, and a few minutes for our own basic ADLs (or just a bathroom break and protein bar) are NECESSARY. I love my patients and take good care of them, right down to the most minute detail of their personal hygiene (no lie). I give baths, I wash feet, I brush teeth on the regular. But when there are medical emergencies, the techs are busy trying to keep everyone from jumping out of bed, and there is literally no time to breathe, sorry, certain things will have to wait for the next shift. I will not martyr myself over a few skin flakes or stinky breath, and I will not take ownership of this problem if it lies in inadequate staffing. (I totally agree that other stuff - 15 smoke breaks, Candy Crush, whatever - should not be prioritized over any nursing task, to be clear.)

pixierose, BSN, RN · Mar 30, 2017

First off my name is Mickey, not 'bud', and I guess the issue boils down to personal time management. What you are willing to forego (breaks, lunch, chat, etc.) to get the job done. Pretty simple to me.

While I do agree that mouth care can be quite neglected (saw it myself as a student)...

I'm sorry, I'm *not* willing to forego my lunch/dinner break.

I need that sustenance break. It helps me recharge, etc etc so I am available to meet my patient needs for the rest of the day. Without it, I'm slower, more fatigued, crankier, you get the gist. Not good for the patients. More room for error.

I'm no martyr, and I'm also a new grad. I don't plan on learning the part of martyr during orientation, and by skipping breaks ... that ain't great time management either. I'm lucky in that I work (so far) with great techs that I can delegate tasks to if needed, so if I'm drowning in meds/charting/calls to docs etc and it's been a nutty day, I can ask a tech if they wouldn't mind helping me out with Ms. Smith's oral care. Or, if there isn't anyone to help out, Ms. Smith's oral care can wait until the next available moment (which might be a while). Prioritization.