"We don't clean patients, we are a procedural area"

[Tait, MSN, RN]

I was thinking about an issue that has recently come to my attention as I have been working day shift for the past few months. In addition to noticing that my IV poles and pumps never seem to come back from CT/Xray/what have you, there seems to be a rash of nurses who believe that if a patient is in dialysis and has an accident it isn't their responsibility to clean them up. I was really surprised to come across this so frequently when I started days. After talking to a few of my techs I realized it was happening even more than I was even aware.

It is hard for me to decide if this is a case where we should start UO'ing (unusual occurrence reporting) this to get a paper-trail on the incidences, or if there is too much "he said she said" involved. The times we have confronted other departments we have gotten the "We don't do patient care, we are a procedural area" speech. Give me a break, we all do patient care, it isn't limited to the patient's room and home floor!

Thanks for listening, bored overdue momma here just thinking on work stuff.

Tait

[frann]

I'd talk to there manager. I'm in procedural area. Can't imagine letting a patient leave my area soiled. We are a team. that is basic care.

[OhioCCRN, MSN, NP]

I noticed that during Clinicals...

oh and the NP who will go trolling down the hallways looking for you to give the PT a bedpan, when Its.right.there.... it takes 2 seconds! end result? newly dyed sheets:uhoh3: (super unrelated...sorry!!!)

[0402]

I was quite astounded the first time I had a pt getting dialysis in their own room, and the nurse hunted me down to tell me that the pt had a BM, so I could I please get her cleaned up. It was a 2 person job, and when I started, the nurse pushed herself into a corner, so I had to stop and go get the tech, as I was obviously getting no help there. I was much happier two days later when the RN found me to ask me to get the linens together so that WE could clean up the pt.

[MJB2010]

Actually as a Dialysis Nurse I can tell you in our facility we do not have the staff nor supplies to clean a patient. We have no wipes, no gowns, no briefs, no shower, nothing! We our told by our medical director to send the patients back, they are not willing to staff for that. Just a bathroom and TP. Our facility staff is skeleton crew always (cost thing) and I am the only RN for 12 patients. We have 2 dialysis techs there with me. So 3 of us on the treatment floor, and we are doing the cannulating & vital monitoring, and I am doing all the assements, meds, interventions myself. Patients on dialysis can code at any moment, we need to monitor them constantly. If a needle slips they can bleed to death in under a few minutes. You can not take your eyes off of them. We really can not spare a single staff member. Rarely do we get an uninterrupted break even. And many of our patients would need 2 staff members to roll, lift, or move. And if we could spare them for a few minutes (which we can't) we have nothing to clean them with and nothing to dress them in after. And during shift change when patients are coming off and on we are all running. For the most part our patients are well cared for but we have one facility in particular in which the residents are often sent to us sitting in soiled clothes, covered in vomit, or not clean. It is obvious that this didn't happen on the ride over (which they always try to claim when we call them on it). I would never make a patient sit like that for their 4 hour treatment. If they are not in clean dry clothes, I am sending them back to be cared for so they can be treated while clean and comfortable. I worked in a hospital I know how busy you are, but please treat the patients as you would want to be treated.

I feel I should mention this is a chronic facility. Most of our patients come from SNFS and ALFs.

[Tait, MSN, RN]

Actually as a Dialysis Nurse I can tell you in our facility we do not have the staff nor supplies to clean a patient. We have no wipes, no gowns, no briefs, no shower, nothing! We our told by our medical director to send the patients back, they are not willing to staff for that. Just a bathroom and TP. Our facility staff is skeleton crew always (cost thing) and I am the only RN for 12 patients. We have 2 dialysis techs there with me. So 3 of us on the treatment floor, and we are doing the cannulating & vital monitoring, and I am doing all the assements, meds, interventions myself. Patients on dialysis can code at any moment, we need to monitor them constantly. If a needle slips they can bleed to death in under a few minutes. You can not take your eyes off of them. We really can not spare a single staff member. Rarely do we get an uninterrupted break even. And many of our patients would need 2 staff members to roll, lift, or move. And if we could spare them for a few minutes (which we can't) we have nothing to clean them with and nothing to dress them in after. And during shift change when patients are coming off and on we are all running. For the most part our patients are well cared for but we have one facility in particular in which the residents are often sent to us sitting in soiled clothes, covered in vomit, or not clean. It is obvious that this didn't happen on the ride over (which they always try to claim when we call them on it). I would never make a patient sit like that for their 4 hour treatment. If they are not in clean dry clothes, I am sending them back to be cared for so they can be treated while clean and comfortable. I worked in a hospital I know how busy you are, but please treat the patients as you would want to be treated.

I feel I should mention this is a chronic facility. Most of our patients come from SNFS and ALFs.

Your situation I can definitely understand. It sounds like you run very short staffed and patient safety in this situation is priority over ADL's.

It is areas of mine, a large staffed hospital, that should have no excuses let alone telling a nurse "it isn't my job" to help a patient. They have the supplies, they have the staff, and if not then for crying outside just tell me so I can understand!

I am not impervious nor oblivious to the chaos that is all departments, nor do I turn a cold heart to those who really don't have the resources. Perhaps I should ask to shadow dialysis for a day or two and see how it works, maybe that would shed some light on the issue.

[MJB2010]

I must mention when I started working in dialysis, having come from a hosptial, I was horrified by the fact that we send them back. You should try to shadow a day there is a lot more too it than you probably think. It is really interesting, but takes a lot of constant monitoring.

[Grumpygs, MSN, RN]

I've actually had the dialysis nurse (small community hospital - dialysis done at bedside) tell me after dialysis was completed that the patient had thrown up during dialysis. I found the patient soaked in her own vomit - and the clean linen cart was LITERALLY right outside the patient room. I understand that the dialysis nurse may not be able to leave the patient during the procedure, but to simply leave them 'dirty' seems so wrong...

[StNeotser, ASN, RN]

Thanks for the insight MJB2010. I always wondered why people got sent back poopy.

[Crux1024]

This is upsetting. People sometimes forget (or dont care) that the whole reason that healthcare jobs exists are to take care of others. When you focus more on completing the task instead of the person thats sitting in urine or feces or vomit for hours...well, its time to reevaluate why you come to work in the morning/evening/night in the first place.

[MJB2010]

This is upsetting. People sometimes forget (or dont care) that the whole reason that healthcare jobs exists are to take care of others. When you focus more on completing the task instead of the person thats sitting in urine or feces or vomit for hours...well, its time to reevaluate why you come to work in the morning/evening/night in the first place.

I would never leave a patient sitting like that. And I agree with you completely. Saftey is the priority (not necessarily the task) and I don't even feel like we have enough staff for that most days. With the dialysis machine pulling blood from one side and pushing blood back in the other, the rate at which someone can bleed out is very quick, you cannot take your eyes off of them. I assure you, we (the staff) care a lot about our patients. we get to know them and know their families. We see them 3x's a week.

The facility I work for has staff meetings all the time, they are NEVER about the patients or patient care, only the bottom line. How to save a buck. How to cut costs. Our supplies are shrinking and getting cut back. No more bandaids, just use tape. No more 4x4-use 2x2. No more plastic tape, make sure you only use x amount per patient. It is absurd. Medicaid and Medicare are no longer reimbursing the full cost of dialysis treatment so the facilities are scrambling to cut costs everywhere. I fear it is only going to get worse too.

[netglow, ASN, RN]

I was quite astounded the first time I had a pt getting dialysis in their own room, and the nurse hunted me down to tell me that the pt had a BM, so I could I please get her cleaned up. It was a 2 person job, and when I started, the nurse pushed herself into a corner, so I had to stop and go get the tech, as I was obviously getting no help there. I was much happier two days later when the RN found me to ask me to get the linens together so that WE could clean up the pt.

Yea, this I observed in clinicals too. Funny, I helped with the tubing etc. repositioning. But was called to deal with a BM later with no return help. I was even told that the dialysis nurses are only responsible for dialysis, nothing else. I also had a friend tell me when she started (luckily) in acute care that if the patient begins to crash, all they do is inform the regular RN, and this, via phone from away in the dialysis room! So she ran like a chicken (with a full bladder) - prior thread reference there... over to dialysis room only to find that this nurse had no pyxis privs. and just stood there and said look as she pointed to the monitor at her emergently elevated BP. What a mess.