Prioritizing AM care (longish)

Published

Hello all,

Can anyone give me any suggestions about the best way to fit in getting patients washed up in the morning? I work on a med-surg floor with 4 patients, and nurses assign two or three of these to PCA's for AM care. Usually the one or two that don't get assigned to PCA's just need assistance with ADLs--often they are ambulatory, or at least can move easily in bed. I am new to practice, and I am feeling like the patients I am assigned to for AM care are getting the short end of the stick.

Here is what I am currently doing:

Ensuring that patients have everything they need to get fresh in their room when I first go in to assess. If they don't, I get it for them--linens, gown, washbin, toothbrush, toothpaste, soap, etc.

Then, IDEALLY, here's what I do--once I finish all meds and assessments, I return to those rooms, fill the bin, change the linens, hep lock the patient, get them generally set up. Then I help them wash unreachable areas, then I give them their privacy and go on my merry way.

Here are problems I'm running into--usually there is something else that is going on that needs to be addressed. Multiple patients having pain issues, maybe a low blood pressure, someone needs blood or electrolyte replacement. Call lights are going off, and one patient needs to go to the bathroom, another is nauseas, etc. If I don't encounter anything that needs to be addressed before AM care, then the other thing that I'm struggling to find time for is getting my documentation done. When the time seems to be flying by, and I've been been running all over, I've taken to prioritizing getting back to the patient to get them cleaned up before I get my documentation done. Then I'm documenting my 8am assessment at like, 11 in the morning.

Then, when all is said and done, I'm reallly sucky at actually getting patients cleaned up. I don't usually do a full bedbath on these patients because they are more able to do it themselves--I change their sheets of course, and help them with what they ask for as best as I can. But then I leave, and sort of leave it up to them to take care of reachable areas, their face, teeth, etc.

I don't know if that's enough. At the end of my shift the other day a patient's husband was in the room and asked me if his wife was ever going to get cleaned up--I think she had told him she hadn't gotten to shower (she has critically low platelets, and I told her I thought a shower wasn't a safe idea). I didn't want to be like--"don't you remember when I washed up your back, changed your sheets, helped you get set up this morning?"

I'm not blaming her--I would rather take a shower too. But I'm new at this, and wondering if my approach is actually not acceptable. If it isn't, does anyone have any suggestions about how to manage this better?

Thanks!

Up Vote Up Vote ×
Specializes in Emergency Department.

When i was on surgical floor the techs did all the am care. The RN would help when they got their work finished. Perhaps your unit should hire another tech

Up Vote Up Vote ×
Specializes in Med-Surg, ED.
Hello all,

Can anyone give me any suggestions about the best way to fit in getting patients washed up in the morning? I work on a med-surg floor with 4 patients, and nurses assign two or three of these to PCA's for AM care. Usually the one or two that don't get assigned to PCA's just need assistance with ADLs--often they are ambulatory, or at least can move easily in bed. I am new to practice, and I am feeling like the patients I am assigned to for AM care are getting the short end of the stick.

Here is what I am currently doing:

Ensuring that patients have everything they need to get fresh in their room when I first go in to assess. If they don't, I get it for them--linens, gown, washbin, toothbrush, toothpaste, soap, etc.

Then, IDEALLY, here's what I do--once I finish all meds and assessments, I return to those rooms, fill the bin, change the linens, hep lock the patient, get them generally set up. Then I help them wash unreachable areas, then I give them their privacy and go on my merry way.

Here are problems I'm running into--usually there is something else that is going on that needs to be addressed. Multiple patients having pain issues, maybe a low blood pressure, someone needs blood or electrolyte replacement. Call lights are going off, and one patient needs to go to the bathroom, another is nauseas, etc. If I don't encounter anything that needs to be addressed before AM care, then the other thing that I'm struggling to find time for is getting my documentation done. When the time seems to be flying by, and I've been been running all over, I've taken to prioritizing getting back to the patient to get them cleaned up before I get my documentation done. Then I'm documenting my 8am assessment at like, 11 in the morning.

Then, when all is said and done, I'm reallly sucky at actually getting patients cleaned up. I don't usually do a full bedbath on these patients because they are more able to do it themselves--I change their sheets of course, and help them with what they ask for as best as I can. But then I leave, and sort of leave it up to them to take care of reachable areas, their face, teeth, etc.

I don't know if that's enough. At the end of my shift the other day a patient's husband was in the room and asked me if his wife was ever going to get cleaned up--I think she had told him she hadn't gotten to shower (she has critically low platelets, and I told her I thought a shower wasn't a safe idea). I didn't want to be like--"don't you remember when I washed up your back, changed your sheets, helped you get set up this morning?"

I'm not blaming her--I would rather take a shower too. But I'm new at this, and wondering if my approach is actually not acceptable. If it isn't, does anyone have any suggestions about how to manage this better?

Thanks!

I think I would ask the PCA's to do all the bathing and then spend my time with the assessments, meds, etc. Then when I got those done, I would worry about going back and helping the tech get caught up. I would ask the techs to help with linens and bathroom trips etc, and I would certainly lend a hand as often as possible, but my job demands me to assess, medicate, document etc etc. The techs are there to assist us with tasks such as linens, baths, etc. I had a hard time at first allowing the techs to help me but I've learned that its okay to ask them for help--they are there to assist us!

As far as documenting, I make it a rule to document as I go. It is sometimes hard to stand and write when I know I have about 10 other things to do, but the payoff is that it is done when it is fresh in my mind, I don't forget things and I don't have to worry about going back and doing it later. Its an extra minute that saves an hour later.

Good luck! :)

Up Vote Up Vote ×
Specializes in NICU.

Wow. I didn't usually have more than 3-4 baths a day, even as a CNA and rarely did the nurses give the patients a bath--not because they were above it, but as you said, they are very busy doing assessments, treating pain, educating, etc.

Can the families get involved at all? A lot of times when I'd come in I'd ask if the families wanted to help the patient and often they would. It seems many patients prefer a spouse/mother to help more than nursing staff. I think the family members were frankly happy to have something to do.

Maybe the patients could do more themselves? Sit them in a chair, give them a basin, making their beds while they start on their bath and have them call you or an aide to help them get back to bed.

Confession here. I work in the NICU with total care of the patients and it takes me forever to bathe the little ones. I've got kids and I think it should be easier, but I'd just usually bring my babies in the bath with me and that wouldn't work as well on the job :rolleyes:. I'm hoping to get faster, because until then, I kind of dread bath nights. I'm sure the other nurses are looking at me and thinking, "Man, is that nurse STILL bathing that baby?" I do keep the little ones covered and warm while I do it :).

PS: No harm in reminding the patient why she couldn't shower and that you had cleaned her up that morning.

Up Vote Up Vote ×
Specializes in Med Surg, Hospice.

Geez.. today I 7 baths to do (15 patients total) and one nurse riding my ass because HER patients didn't get washed up first. She doesn't seem to get it that I am BUSY in the morning, and I'll get them washed when I get my paperwork done, blood sugars taken, water and linens passed and after breakfast. I have all shift to do baths, but if hers aren't done by 7:30, she's on my rear end riding. Can't stand working with this one.... her patients are no more important than the other 12 that I've got to take care of.

Up Vote Up Vote ×

Thanks for all the replies! You all have some great advice--and Kylee, I appreciate the perspective from the PCA standpoint. The PCAs on our floor are assigned to 5 patients to wash up--but they do vitals and answer call-lights (nurses answer them too--but definitely give the PCA the opportunity if they have a moment and we are busy). The PCA's work as hard as the nurses (and 15 patients Kylee! I know it's a different setting, but there are only so many hourse in a shift! Sheesh!)

Anyway, I'm glad I posted. I've been feeling pretty lame. Gotta get creative!

:)

Thanks all

Up Vote Up Vote ×
Specializes in Med-Surg, Wound Care.

If I'm going to assess it, I'm going to wash it at the same time! No better way to assess than to wash your patient (obviously you can't wash them all). You see every inch! I usually do am care on the most "needy" patient as long as time warrants.

Up Vote Up Vote ×

we have one tech on our 24 bed unit and are lucky if she does the 5 baths she is assigned, that leaves 3 out of four patients for the nurses to clean up. wish we could get another tech...

Up Vote Up Vote ×
Specializes in Jack of all trades, and still learning.

How does it work in the US? Here we provide all cares. On my ward there is one patient care assistant who assists with turns, taking pts to procedures with or without the nurse, and also helps with general things such as cleaning beds when pts are discharged, emptying linen skips etc etc. So if a nurse, EN (equivalent to LPN) or RN has 5 or 6 pts, we give them their meds, help them with ADLs, attend dressings etc etc. (Although in one ward ENs can't give meds, so the RNs give their meds as well as their own). At night we can have 8 - 9 each with no patient care assistant - no I lie, we share one between about 4 wards.

Up Vote Up Vote ×
Specializes in Neuro, Cardiology, ICU, Med/Surg.

I'm a nursing student working as a PCA on a floor with 19 beds and usually 2 PCA's. I'm new to this job and not very efficient with patient bathing and am usually assigned the patients who need the most care. I also do the vital signs on half of the floor, and several of the patients have been "contact precautions", meaning I need to gown and glove up before entering the room and wipe down any equipment used after going in. I'm generally assigned three patients to do AM care for and then need to work around them eating their breakfast. Also, the PCA's do blood draws at our hospital, so I have to work that in (and I'm new and not really good at that yet). So I get the care done generally for the three by the time morning is done, unless someone has a visitor and asks that the care be delayed until the visitor(s) leave. So my mornings sound a bit like the OP. The nurses do some of their own AM care, though the 2 PCA's on the floor make the work quicker.

Up Vote Up Vote ×
+ Join the Discussion