Refusing to change/toilet pts

nursemike, ASN, RN · Oct 9, 2017

I am not sure if this is in the right topic...
I have been working with an increasing amount of nurses who FLAT OUT REFUSE to change or toilet their patients. Is this a thing? Do your hospitals have policies or guidance on this topic?
I've brought this up to a few people unofficially and one answer I got was (from a VP) "the nurse may be too busy and you just don't know it." My thought is "If you know they are soiled or ask them to toilet them, why are they taking the time to find a CNA and not just doing it?"
Years ago someone was talking to a group and the toileting issue came up (different hospital) and this person asked us rhetorically how WE would feel if our nurse was in the room and we were soiled and they would not change us? Or if we asked to go to the toilet and they walk out and send in a CNA? I know I would feel pretty small.
Suggestions, comments, HELP...? Anything?

Looking back through this thread, it occurs to me that I didn't really answer the OP's question. Like a lot of others, I got a bit defensive, and as I am sure is true of many others, part of the reason I tend to get defensive is that I spend quite a bit of a typical shift assisting patients with ADLs--principally with toileting. I generally don't have time to brush their hair, or even do oral care. I will help with a bath, when I can, but the aide may have to wait until I can, and if necessary I'll find time for that oral care, because I've learned that "neuro breath" greatly increases the risk for pneumonia. But as a nurse with some experience, I have to admit that I "test" the aides a bit myself--not in the sense of seeing how far I can pushing, but in seeing how far they will go.

So, to the OP, first let me say, I don't mean the term "aide" to be in any way demeaning. Different facilities use different titles for what is essentially the same job, and many of the ones I work with, including some of the best, are not actually CNAs. I suppose "nursing assistant" might be more PC, but "aide" is quicker to type. Where I work, their official title is Clinical Associate, and I call them CAs, like everyone else.

Now, it's a fact of life that a good aide males my job a lot easier, and I value that. But the more important fact is they make my patients' lives easier. The job itself is inherently task-oriented, but when we refer to a novice nurse as task-oriented, it isn't a compliment. We all have so many tasks to do that it's hard not to get that way, at times, but good nurses are patient-centered, and good aides are, too. Part of my job, in the case of that aide who was too busy with report to help me with a patient is to educated her that patient safety comes first, patient comfort is a close second, and everything else is a distant third. If she gets that, she'll have my respect, and if not, she won't. Either way, if I call for assistance or delegate a task, it will be for a good reason. A good aide will come to see that for herself, and a bad one will be told so, firmly.

I think, for the OP, the best approach to dealing with the sort of nurses she (I'm guessing from the avatar) describes is to win the respect of nurses like me. You aren't really in a position of power to enforce appropriate behavior on nurses, and going to management isn't likely to help. Bluntly, nurses are harder to replace. Then again, the kind of aides nurses and nurse managers want to keep ain't exactly a dime a dozen, either A common theme on this thread, it seems to me, is that most who've posted don't respect the nurses who are "too posh to wash," and so get a little testy if we feel we're being lumped in with them because we do delegate--appropriately. And life can be pretty unpleasant for nurses who aren't respected by his or her peers. The balance of power, if you will, can shift quite a bit when there's a conflict between a valued aide and a useless nurse. It may appear, at times, that managers live in a world far away from the floors we work, but most actually do have a pretty good idea of who are respected members of the team, and who aren't, and the latter usually aren't around very long.