NOC Patient bathing

[sheridan7679]

Is it appropriate to insist that a patient receive a bath during the night shift to save the day shift some work and to suit the schedule of the hospital, or is the patient's rest more important?

[zambezi, BSN, RN]

We usually do our baths for vented patients in the early morning--around four or five. X-Ray comes around four to five in our unit...the docs like our first and second day hearts sitting up in a chair for their xray so we get them up anyway. I usually offer them a bath...if they want to, great, if not I let them snooze in the chair and then get them back to bed. For our non-surgical, non-vented patients...I usually ask them if they want a bath when lab or x-ray wakes them up and if they say no I let them sleep. I usually tell my patients about the early wake-ups the night before just so they know the plan. I hate having to wake people up, I try to group all my care so they get some sleep but the frequent monitoring wakes them up anyway!!

[Tweety, BSN, RN]

Not alert and oriented patients. If they are confused and don't know what time of day it is, or are comatose, the night shift should help out.

[Blackcat99]

Does anyone remember in the "old days" how all LTC residents were awakened and dressed around 4am and put in their wheelchairs for the convenience of day shift? All the residents would "snore" through breakfast. I am hoping this isn't done anymore.

[BeenThereDoneThat74, MSN, RN]

I quit working night shift a number of years ago at another hospital where I worked med-surg when day shift started demanding we do a certain amount of baths to help them out. It was the straw that broke the camel's back for me, dealing with their rotten attitudes every morning, and always getting management to dump more on us 11-7 staff. I had enough trouble caring for up to 14 patients-- no nurses' aides-- and an extremely lazy co-worker. Bleh! :angryfire BAD memories!

I hear you loud and clear. That was essentially my med/surg experience as well. The day shift ruled the roost, and the lazier they got, the more baths were thrown to nights- regardless of how many aides were on. 46 bed unit, some nights 2 aides and 4 nurses. Aides drew bloods too. We were required to do 2 baths per district (8 baths). One night, with the above staffing, the nurses made an exacutive decision: we told the aides not to draw the bloods, because there was not enough staff, and obviously the baths were priority!! I can't believe we didn't get nailed for that!!

They complained no matter what (the Day aides, that is). They complained if we counted an incontinent as a bath (they would only have to re-do them anyway). They complained if a self-care actually agreed to get up and bathe themselves. They complained if one patient had a private duty (and then we would do one less). That's still one less for the staff anyway! We couldn't win! BTW this was an orthopedic floor, where we NEVER got a break at night (but the day staff always did- I worked days for a while too). Patients DID NOT SLEEP (I mean it) Call bells, pain meds, bed pans-ughhhh! Not to mention ALWAYS less staff, and post ops and ER admits any time of the night!! I have to stop, as this is bringing back awful memories

[LTC_LPN]

After all everyone knows those lazy night shift nurses get paid more and do less, at least make them bathe the patient

At our nursing home, according to the law, we have to comply with the resident's rights. If they want to take a bath at 4:00 am, then we'll give them one. But I'm not about to wake a sleeping resident to ask them if they want to take a bath at that time! On our 11-7 shift, we have a "shower/bath list" of specific residents that are to be bathed/showered on our shift. These usually begin at 5:30 or 6:00 am. Of course, we do have quite a few "early risers", those who get up normally around 4:30 or 5:00 am, without any prompting. These people we usually bathe early, per their request, so they are ready for the day ahead. Each shift has a bath list, with residents who prefer to be bathed at those times. We respect the resident's rights: if they don't want to get up, we don't make them. If they don't want to shower/bathe, again...we can't make them, but we do encourage them, and chart well when they refuse.

I myself have worked 11-7 for a couple of years now, and I still can't understand why night nurses get the "lazy nurse" rap. Just please consider for one moment that all nurses are not alike! I have never slept on the job, never ignored my call lights, and I appreciate and help my cna's. It's sad that the rest of us "good nurses" get the bad rep like some of the others......:angryfire

[PJMommy]

After all everyone knows those lazy night shift nurses get paid more and do less, at least make them bathe the patient

Amen. Everyone knows we are the "relief" workers who just look for ways to fill up hours until the busy day people come back. :) We surf the web and occasionally go tuck the covers in around a happily snoozing pt. :rotfl:

To answer the OP, in my ICU - sedated, ventilated pts get NOC baths & awake, alert pts get day baths. And even that doesn't happen sometimes....the main goal is to keep them alive so if we are too busy to do a bath because the pt's pressure is tanking, then so be it. Personally, I'll take alive over clean any day. I'm much happier to report to the day RN that the pt is alive, stable and dirty rather than unstable and clean.

[pickledpepperRN]

We usually do our baths for vented patients in the early morning--around four or five. X-Ray comes around four to five in our unit...the docs like our first and second day hearts sitting up in a chair for their xray so we get them up anyway. I usually offer them a bath...if they want to, great, if not I let them snooze in the chair and then get them back to bed. For our non-surgical, non-vented patients...I usually ask them if they want a bath when lab or x-ray wakes them up and if they say no I let them sleep. I usually tell my patients about the early wake-ups the night before just so they know the plan. I hate having to wake people up, I try to group all my care so they get some sleep but the frequent monitoring wakes them up anyway!!

This is our attitude too.

I always let alert patients know what time we will draw labs, do X-rays, and so on. I tell them if they are awake to please turn on the call light so I can listen to their lungs, ckeck pulses and so on. I always offer a bath either in the evening or during the night. If a patient says "no" that is that.

Why should a patient be awakened because they need mechanical ventilation? (comatose patients always get their bath)

Open heart patients have to be sitting up with the CXR in the viewer before breakfast arrives at 7:00 am. Most are glad to have their bath & clean gown first. We watch them eat while giving report.

[CCU NRS]

Are we assuming these are alert and awake patients? (As opposed to tubed/vented/unconscious when it may matter less when the bath occurs?)

If it's an alert/awake patient, it's ridiculous.

I will say when I worked at the nursing home, it wasn't unusual for me to give an early morning bath while I was ending my shift, then lay the resident back in bed until breakfast.

I concur, awake alert people should not be awakened to bath, however if they are having trouble sleeping sometimes a little activity and a soothing bath may assist with sleep

[wonderbee, BSN, RN]

On our med/surg unit where I work nocs, the DON told me that noc bed baths were on an as-needed basis, ie., the incontinent or diaphoretic patient. Somehow, the day staff got the idea that we are supposed to bathe all the total care patients. Our 4am rounding consists of VS, drawing labs/ekgs, refreshing waters, patient cleanup and room cleanup. All it takes is a couple of patients needing assistance to the bathroom, a couple of tough sticks, and boom, you're behind.

I want to deliver my patients to the day shift as reasonably clean as possible but don't expect full bed baths unless it was a necessity.

[merricat]

I suggest someone make rounds at the administrators homes about 0300, and make them get up and bathe, after Q2h vitals and use the same lukewarm water that we have at NOC.

i love it! thank you!

[lovingtheunloved, ASN, RN]

I work in LTC. The ONLY time it's okay to bathe a patient during the night is if they have had a severe incontinece episode, or they've sweated so much you have to do a bed change. I work days. I would rather have a heavier work load than have my residents who already have sleep disturbances disturbed.

[lovingtheunloved, ASN, RN]

I work in LTC. The ONLY time it's okay to bathe a patient during the night is if they have had a severe incontinece episode, or they've sweated so much you have to do a bed change. I work days. I would rather have a heavier work load than have my residents who already have sleep disturbances disturbed.