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

[Tait]

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

[srmoon]

Coming from the LTC standpoint, we always sent a CNA with the pt. to dialysis for ADLs. That way someone is there to clean them up, help with blankets, repositioning, etc. I thought that was common practice.

[JB2007, ASN, RN]

Coming from the LTC standpoint, we always sent a CNA with the pt. to dialysis for ADLs. That way someone is there to clean them up, help with blankets, repositioning, etc. I thought that was common practice.

No it is not a common practice. I wish it was, but the LTC facility that I worked for you was lucky if you had enough staff for the residents that was at the facility.

[AnnaN5]

Interesting that you bring this up because we are currently discussing this issue at our hospital. Our inpatient dialysis unit is staffed with a contract dialysis service so they are not employees of the hospital. They say it is in their contract that they do not have to do tolieting, etc. It is very frustrating when you have a patient go down to dialysis for many hours and come back soiled because in dialysis they told them to just go in the bed. I understand that everyone is busy but it just blows my mind we would tell a patient to just go to the bathroom in their bed so they can sit in it for however many more hours. Sometimes they will put the patient on the bed pan but say it is not their job to take them off so they are sitting on the bed pan for an extended period of time. Which unit do you think gets dinged with a pressure sore or skin breakdown? Not the dialysis unit.

[tyvin, BSN, RN]

Disgusting ... I don't care if you don't have wipes or supplies. You're aware of the problem so do something about it! I know I would actually request supplies be sent with the patient for such emergencies.

I know the attitude; they're going to fight tooth and nail to not have to change diapers. What an excuse for letting human beings sit in **** and filth for hours, not my area ... ... oh so sad. What have we became?

[MJB2010]

Disgusting ... I don't care if you don't have wipes or supplies. You're aware of the problem so do something about it! I know I would actually request supplies be sent with the patient for such emergencies.

I know the attitude; they're going to fight tooth and nail to not have to change diapers. What an excuse for letting human beings sit in **** and filth for hours, not my area ... ... oh so sad. What have we became?

Tried asking them to send supplies, they won't do it. Tried asking them to stop using the dialysis access for labs, they can't seem to do that either. Asked them to keep the catheter dressing clean & dry, NOPE they can't seem to do that either. Ask them not to give bp meds before sending the patient, nope. I feel like I call one particular facility every single shift and all I get is "yeah yeah yeah yeah ok" no results. It has been documented til the cows come home. Every time you call you get someone different, they always say they will pass it on. It is like beating your head against the wall.

Until you walk a day in my shoes, easy for you to judge. You have no idea what our job entails. We do not have the staff to do it. I wish we did. You are preaching to the choir my friend. I was a tech for 5 years before becoming a nurse I have no problem cleaning poo and vomit. I can't risk the safety of all of the patients if someone has an accident. They have to go back to their facility. They do not sit in it for hours. I wish we had more cnas, I wish we had another nurse, you know what they say. You can wish in one hand......

And keep in mind these patients have 14G needles in their arm/leg, so maneuvering them takes more than one person.

[Fiona59]

Our dialysis staff calls the unit to have someone come and do the care. Their logic being they have to be "clean" and doing peri care will contaminate them. Did I mention they get their uniforms supplied by the hospital (and can change when required) and we don't.

There is time away during a run to perform patient care. That's usually when they start checking the next runs charts and pulling the solutions, etc.

[MJB2010]

I think it is a big case of "the grass is greener " syndrome. The day shift nurses think the night shift doesn't do anything, the floor nurse thinks radiology has it made, and apparently everyone thinks that in dialysis we just sit around kicking our feet up refusing to do any work. Not the case, I can promise you that. Everyone thinks that the other department or specialtiy has it made.

[Ruby Vee, BSN]

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.

i would have asked the dialysis nurse to help in a polite, friendly way. if he/she demur (as ours do sometimes) because of "back issues" or "shoulder issues", i express sympathy, refer to my own back surgery and then ask if they'd prefer to clean while i hold the patient. usually the back issues disappear . . . or they find a sudden reason to leave my patient to go check on something else. i've rarely had a dialysis nurse outright refuse to help me clean the patient up, and most of the time now they just expect to help.

and on the same track -- an np or md who happens to find (or leave) a soiled patient may also be asked to help, depending on the situation in the unit and how busy he/she is. a provider bombarded with admits and emergencies, i'll let them slide. but someone who has been spending the whole shift shopping online, facebooking or doing their own research on our dime -- they get asked to help and almost always do. the one time i had a resident refuse to help -- they had made a horrible mess putting in a line right at change of shift, and then disappeared leaving the patient covered in blood and poop and their stuff all over the room -- i went to their attending and asked, ever so sweetly "could you give me a hand, please? so and so is too busy to clean up their mess." never happened again.

of course, i work in a teaching hospital. your milage may vary.

[madwife2002, BSN, RN]

As an Acute dialysis nurse in the past we were not expected to clean up an incontinent patient but I personnally would assist! We had no access to supplies but I was always willing to clean any patients. You do have to worry about cross contamination especially with faeces. In the chronic units if a pt has diarrhoea, and we have to take off dialysis we do clean up the patient but we do not put them back on HD for fear of cross contamination. I do think you get lazy dialysis nurses and techs just like you get lazy people in any walk of life.

[caregiver1977]

From what I am reading here I don't think any nurse is trying to be intentionally cruel to a dialysis patient.

But I feel for a person who is already having to go through all the difficulties of dialysis and then has to sit in their own mess for hours. Even facilities that let patients use a bedpan...sometimes that bedpan doesn't get there in time. I once knew a young man who had dialysis and he said the worse thing about it was accidents/using the bedpan because you are right there with other patients and everyone knows that YOU created the stink. He found it highly embarrassing (I'm just going by what he described, your facility may run differently).

I have a hard time believing that a nurse would try to humiliate patients (maybe a few really bad ones). I believe most nurses are doing the best they can, but I really, really feel for a dialysis patient that has to experience that great embarrassment.

[Tait, MSN, RN]

Tried asking them to send supplies, they won't do it. Tried asking them to stop using the dialysis access for labs, they can't seem to do that either. Asked them to keep the catheter dressing clean & dry, NOPE they can't seem to do that either. Ask them not to give bp meds before sending the patient, nope. I feel like I call one particular facility every single shift and all I get is "yeah yeah yeah yeah ok" no results. It has been documented til the cows come home. Every time you call you get someone different, they always say they will pass it on. It is like beating your head against the wall.

Until you walk a day in my shoes, easy for you to judge. You have no idea what our job entails. We do not have the staff to do it. I wish we did. You are preaching to the choir my friend. I was a tech for 5 years before becoming a nurse I have no problem cleaning poo and vomit. I can't risk the safety of all of the patients if someone has an accident. They have to go back to their facility. They do not sit in it for hours. I wish we had more cnas, I wish we had another nurse, you know what they say. You can wish in one hand......

And keep in mind these patients have 14G needles in their arm/leg, so maneuvering them takes more than one person.

I wonder if my idea of writing up people might be better suited for your situation! If they aren't cared for when they come to you I wonder what their quality of life is like at their facility

[JSBoston]

At my facility, hemodialysis does NOT turn patients, or clean them up. I understand calling us for a prn pain medication, but it's usually the NURSES (not the CNA's) that are called to clean a pt up who had an accident. It's almost a blessing very little urine is produced with HD patients, because leaving my 4-5 other patients to walk down to another floor to clean someone up can be stressful to my time management. It is what it is I guess...