Night Shift Neglect.

[Magsulfate]

The other day I was floated to med/surg to help out with charging. I ended up having a couple of patients, which was okay with me. At just before 8am I went in to assess one of my patients and realized he was laying in his own urine and feces. There was so much of it that it had migrated to his pillow and was on his head. The man had a diaper on, and was clueless as to his situation. This doesn't make it any better, but thank god he didn't realize the neglect that he experienced all night.

At that moment, I could absolutely not believe what I was seeing. I could not believe that this could happen in a place that I work. IT WAS SO DISGUSTING, it was outrageous. I was just speechless. I cleaned him up and during the process almost started crying. This cute little old man was smiling at me, and I almost cried. He was laying in his own waste all night. How could this be happening?

Then a little bit later, the day shift CNA came to me and said 5 other patients were very messy with BM's this morning. Some of them had dried feces on them. ALL OF THESE PT's belonged to the same night shift CNA.

At this point, I never want to see that night shift CNA again. I wrote her up, using facts, and left my emotions out... err.. I tried to. But I couldn't help to add a final sentence at the end of the page about how NO HUMAN should be treated like these patients were treated here in this hospital, and how I feel so angry that this happened to our patients.

I hope that something happens to this CNA. If nothing happens, I will not stop until something is done, hopefully she is severely disciplined or fired. She needs to know her job, and if she doesn't want to do it, she needs to leave and work somewhere so she can't harm these poor old people.

I'm sorry, I just had to vent. I had to get on here and tell my story. I am still in a state of disbelief.

Let me just add one thing... I spoke with the night shift charge and she said that this certain CNA was lazy and hardly worked at all. I just don't understand how it could get this bad, how could they let her be lazy and not say anything until something like this happened???

[eriksoln, BSN, RN]

I remember being a night shift CNA. I got put on that shift from days because the one who had been on nights was.......well, just needed to move on to other pastures.

I never let myself sit. I'm not physically built/menataly prepared for nights and never will be. I had to keep from falling asleep by staying bussy. If all the incontinents were clean, I'd perform mouth care on the ones who were awake and needed it. After that, I'd move on to things that werent necessarily mine to do but I had to keep bussy (I used to sweep the carpets at the nurses station with on of those manual push sweepers, the kind at restaurants). But, thats just how I am.

Now, as far as your CNA goes, you did the right thing. Remain professional and do what needs done.......the write up in your case.

Now, its the next step that is harder. Most of the time, management does not have your back and nothing is done. Then, people like your CNA, seeing nothing comes from doing things the way the are used to and they feel justified to continue doing it. Thats when it gets hard on us.

If no improvement comes of your write up, next time you have to not only write up the CNA, but in said write up, include a short history that this is the second time you've brought this to the management. Make sure you forward your write up this time to whoever is above your boss. Not saying be confrontational about it, but........just use the chain of command to your advantage.

While this is going on, YOU MUST remain professional with said CNA. If you begin to let your feelings about them be known, they will cry wolf and claim they are beign targeted and picked on. You should offer assistance/education and make sure the problem is that the CNA is not motivated before the 2nd write up also.

[Magsulfate, BSN, RN]

Trauma-- if the title is wrong, sorry, I was still so upset when I wrote this to be able to come up with a good title. This one was the first one that came to mind.... :) next time I'll think a little harder :)

In my 6 year career, I have NEVER walked into something like this. Ever. These CNA's had a total of 7 patients to care for, at night. Which means, no feeding, and a majority were asleep. Most of them have foley catheters, however my patient did not. Of her patients only ONE of them was clean. ONLY ONE. And this was one hour after shift change.

Now, I can understand how some patients will poop right at, or just before shift change. There is nothing you can do about that. It happens. That's alright, and everyone deals with this as a fact of life. However, when the poop has dried rings around the patient's butt, or it has mixed with the urine and traveled up to the patient's HAIR, along with the rest of their bed, it happened quite some time ago.

I will be nice to her, even though inside I will be feeling like this :angryfire And I will be following up to see if anything happened to her or the nurse. If nothing happens, I'll be forwarding a copy to the person above management, and the person above that.

It did make me feel better to hear from everyone about how terrible this is, and I have had a chance to calm down. I think I just wanted to make sure that everyone else would be outraged too... I don't know. My heart went out to the cute little old man,, oh man, my heart broke for him. I had never felt that way before...

[classicdame, MSN, EdD]

The RN was certainly culpuble as well as the night charge who obviously did not make rounds.

[CoffeeRTC, BSN, RN]

I have seen both sides..sometime pts soil right at shift change or right after they were just changed on rounds. That is a different story that what the poster just mentioned. You can tell what is fresh and wat isn't.

So..getting back to the nurse responsible in this picture.....you were the charge so I'm guessing you didn't have direct pt contact with these people? What was that nurse assessing the entire shift? I'm willing to bet that the nurse had way more pts than the CNA and probably didn't get a chance to peek in on her stable pts as much, but still?????

[rn2bnwi, BSN, RN]

I agree that the Rn or Lpn shares some responsibilty . I do agency cna work both in acute and longer term , I go all over and the case loads for some night shifts area absolutely ridiculous... but there is one crazy LPN that i think does it right. She has 60 pts usually on 2 1/2 wings and i have 24 on one wing that im dong direct care for. regualr Cna's at her facility warned me that she does it and ive seen her mark it but never had her mention it to me. but she comes at the beginning of the shift takes my 'duty' list for each pt looks it over adds to it . then throughout the night she randomly chooses pts and marks what direction they are turned. so she can tell if they are being skipped on rounds. she really can't go in every pts room to check on those things given her insane load but that is one way she stays on top of it.

[RN1982]

Trauma-- if the title is wrong, sorry, I was still so upset when I wrote this to be able to come up with a good title. This one was the first one that came to mind.... :) next time I'll think a little harder :)

Sorry, I was being a bit touchy. Just started taking the pill and I'm having crazy mood swings. Anyhow, the RN is just as responsible as the CNA. My mom's friend was staying at a rehab facility that accepts trach patients. I guess the CNA that took care of my mom's friend was abusive towards her and other residents. Another friend of my mom's raised holy hell at the facility because of the aide and thankfully she was fired. My mom's friend was scared of the aide so much so that she was in tears. People like that don't deserve to work with patients.

[fuzzywuzzy, CNA]

That's awful. What was the CNA doing all night? A few months ago first shift angrily told us that 7 people were laying in brown rings when they got there in the morning. There is no excuse for that. I've seen posts on this website complaining about those who think that night shift sits around doing nothing. I understand that not everybody sleeps at night, but seriously... if most of your night is anything like the last hour of my 3-11 shift, you should still be able to change and turn people. And if I can keep my 10 people clean, dry, and turned in addition to a meal, a snack, HS care, toileting, showers, etc. then you should be able to keep your 15 in the same condition overnight. And yes, the nurse was also at fault for not pay attention.

[Magsulfate, BSN, RN]

I have seen both sides..sometime pts soil right at shift change or right after they were just changed on rounds. That is a different story that what the poster just mentioned. You can tell what is fresh and wat isn't.

So..getting back to the nurse responsible in this picture.....you were the charge so I'm guessing you didn't have direct pt contact with these people? What was that nurse assessing the entire shift? I'm willing to bet that the nurse had way more pts than the CNA and probably didn't get a chance to peek in on her stable pts as much, but still?????

I was the day shift charge, but had two patients myself. One of which was the one in this condition I described, at 8am (one hour after shift change). I don't know what the RN or CNA did all night, but from the looks of it, atleast for the last 6 or so hours of their shift, they were not cleaning patients.

[NurseyPoo7]

The RN was certainly culpuble as well as the night charge who obviously did not make rounds.

At my hospital, the night charge has her own group of patients. How can the night charge be responsible for the 30 patients we can have on our unit + do meds/assessments/ADLs for her own patients?

[Christie RN2006]

That's awful. What was the CNA doing all night? A few months ago first shift angrily told us that 7 people were laying in brown rings when they got there in the morning. There is no excuse for that. I've seen posts on this website complaining about those who think that night shift sits around doing nothing. I understand that not everybody sleeps at night, but seriously... if most of your night is anything like the last hour of my 3-11 shift, you should still be able to change and turn people. And if I can keep my 10 people clean, dry, and turned in addition to a meal, a snack, HS care, toileting, showers, etc. then you should be able to keep your 15 in the same condition overnight. And yes, the nurse was also at fault for not pay attention.

I agree that there is no excuse for leaving your patients in that horrible of condition, but be careful how you word it. It is not just a "night shift" problem, I have come in many times in the evening to find my patients in horrible condition. One time I had a pt with urine up to her hair... Like I said, just be careful blaming all of night shift... how you worded the last part of your post made me feel like as a night shifter, that I was being attacked. Instead of blaming things on a particular shift, why don't you blame it on the trouble makers? There are trouble makers on every shift!

[Magsulfate, BSN, RN]

I agree that there is no excuse for leaving your patients in that horrible of condition, but be careful how you word it. It is not just a "night shift" problem, I have come in many times in the evening to find my patients in horrible condition. One time I had a pt with urine up to her hair... Like I said, just be careful blaming all of night shift... how you worded the last part of your post made me feel like as a night shifter, that I was being attacked. Instead of blaming things on a particular shift, why don't you blame it on the trouble makers? There are trouble makers on every shift!

Yes, and I already apologized for that earlier in the thread. Sorry, again. As I said before, I was so completely beside myself when I wrote this that I didn't think about it. It was on the night shift, and that was what I was thinking about at the time. I KNOW that not every night shift person is like this. I am not blaming all night shifters. I worked night shift for 2 years myself and I never left anyone like this. I also work day shift now and have never seen anyone left like this. As a matter of fact, I said in my first post that in all my nursing years, I had NEVER seen a patient left like this. SO, sorry if you feel like I am blaming all night shifters and saying that they all do this. I am not.

I am not blaming all night shifters, I am blaming this certain CNA and RN on the night shift at my facility. I just re-read my first post and I don't see where I am blaming all night shifters. The title might seem a little misleading, but again, I already apologized for that in a previous post to Trauma.

[nrsang97, BSN, RN]

I didn't get the idea that the OP was saying ALL night shifters were bad. Just this one bad apple of a CNA who left all her patients a mess. We have all walked into a mess on our shift no matter what shift it is.

I would have done a writeup as well. The night shift RN is responsible too. How do you not go into the room all night, and come on the smell of stool and urine had to be strong.