Refusing to change/toilet pts

[ShockMe]

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?

[ComeTogether, LPN]

What you don't understand, because you can't unless you become a nurse, is that many times we absolutely do not have the time.

I can put someone on the toilet, take them off the toilet, help with a boost/reposition/transfer all day long, sure I"m a team player.

However, there is no one but me to complete the tasks and assessment/monitoring that I have to do. I can't take the time to toilet someone who I can't leave alone and I can't take the time to change briefs, either.

You don't see 70% or more of what the nurse is doing or what is happening in her brain. My CNAs have 12 patients each. I have 30. I have meds to pass, skin checks to complete, blood sugars to obtain followed by insulin to give. Then I have to document it all. I am ALWAYS at work at least an hour longer than any of my CNAs, and that's okay because it's my job.

Unless you can go medicate my patients and do my assessments, I need you to help me do the things you CAN do, and that is patient care.

If nurses are delegating out of convenience, that's a different story, but most of the time you just don't know what you "don't know"

[ComeTogether, LPN]

I do know the type of nurse you speak of, OP and unfortunately you will come across nurses who truly think anything not requiring a licence is indeed not their job. The only thing you can do is try to "play the game" and carefully word your response and communicate with your nurses. "I'm going to room 23 to change mrs. jones, if mr. black rings could you put him on the bed pan? He really needs to go" Show appreciation and be a valuable asset and it will go a long way. You will still have nurses that don't want to help, but it will be few and far between.

What you don't understand is how many things can go wrong if we aren't on our toes every second. It's not uncommon to find us at the nruses station charting while we wait for a call from the doctor, but that doesn't mean we're not working.

Its hard to give you insight without knowing what it is you do and whether or not you are the CNA, the activity person or a security guard but there you have it.

[kcochrane]

Are there nurses who refuse to change or help with patients. Sure. As a supervisor I will correct nurses who state "I didn't go to nursing school to wipe butt". Perspective is very important. As a CNA, I thought LPNs weren't busy. As a LPN I though RNs weren't busy. As a RN I thought supervisors weren't busy. As a supervisor I thought nurse managers weren't busy. I was wrong. I still help toilet people, answer lights, etc. If I don't its because I am busy, and it may appear that I'm not. I've seen the nurse that looks for a CNA for 15 minutes to get water for a resident, when in fact they could have done it themselves in less time. I've also seen most times where CNAs leave on time and nurses are still charting. If a nurse is flat out refusing and not truly busy with something else, that needs to be addressed by the manager/supervisor.

[KeepinitrealCCRN]

wow. to answer the OPs question all you have to do is read this thread of responses. unfortunately, there are many nurses who think cleaning a patient is below them as seen by multiple responses here. it is also the nurses responsibility to make sure the patient is clean and not the CNA. there are lazy CNAs and there are just as many lazy nurses. In an emergency sometimes the patient may have to wait or the task is delegated to the CNA, but never cleaning a patient as a nurse is unacceptable. i always treat my patients as if they were my family and it makes me upset the way some nurses think they are above CNAs.

[JKL33]

wow. to answer the OPs question all you have to do is read this thread of responses. unfortunately, there are many nurses who think cleaning a patient is below them as seen by multiple responses here. it is also the nurses responsibility to make sure the patient is clean and not the CNA. there are lazy CNAs and there are just as many lazy nurses. In an emergency sometimes the patient may have to wait or the task is delegated to the CNA, but never cleaning a patient as a nurse is unacceptable. i always treat my patients as if they were my family and it makes me upset the way some nurses think they are above CNAs.

And I literally have no idea what your sense of superiority has to do with the replies on this thread. There is not one "not my job" type of reply here. I'll go back and review in case I missed one. Pray tell, which multiple ones of us are you referring to?

[JKL33]

There is a nurse I am working with tonight who refused to clean her pts up and she's been sitting at the desk playing a candycrush-like game on the hospital computer. Another nurse tonight took a pt to the BSC, found the CNA (doing vitals), asked her to dump it because "its really gross." Then she came back to the nurses station and shot the breeze with another nurse from another floor.

Unacceptable. That is simply shameful behavior as reported.

Management will have to help with this. I hate it when they suddenly "empower" us to "have conversations" about problems like this with our coworkers. This, as described, is purely a personnel/management issue, and it is not up to other coworkers to figure out how to make these types of people do their jobs instead of playing Candy Crush.

I suggest careful diplomacy when approaching your manager, and I wouldn't do it without at least directly and kindly and professionally asking the offending RN for assistance.

[MinneNurse, BSN, RN]

I have seen both sides of this as a nursing student and previously as a CNA, so I understand where you are coming from, but now as a RN I have an whole new perspective on this situation. I am not defending the nurses sitting at the desk playing games on their phone, but I will say that just because a nurse is sitting at the desk and possibly chatting, doesn't mean she or he isn't catching up on what is probably a tremendous amount of charting they have to do. As a newer nurse I sometimes struggle with delegating tasks because I know the aides on my floor are always busy and if I am going into the room I could do it myself, but when you have 4 patients who all need their 0800 meds, taking each and every one to the bathroom and getting vitals can really set you back significantly in your shift. I have found myself staying for quite a while after my shift to get caught up, or missing my opportunity to take a lunch break because I am behind on meds/etc.

As others have mentioned, part of being an RN is using your nursing judgement to appropriately delegate tasks. If I have 2 patients, one wanting pain meds immediately because they are in pain, another wanting to be taken to the bathroom immediately, both are equally urgent and important. The difference though is the RN can give the pain meds while the CNA cannot, so it would most appropriate and fair if the toileting be delegated to the CNA so that the RN can give the pain medication and both patients are cared for. And just because a nurse delegates a task to a CNA and then goes up the nursing desk instead of going into another patients room, that doesn't mean they aren't doing something that only a nurse can do and that takes priority. As others have mentioned, nurses have to page physicians, enter in new orders, complete admission/discharge charting, assess labs/imaging and run protocols, check IV medication compatibility, update charing and write notes, document education, etc. Everything I physically do, I then have to chart it and I know personally that if I do not chart it soon after I will probably forget to chart it later.

I would also like to add that these tasks you are mentioning: toileting, changing, and emptying bedpans/commodes are tasks RNs are taught and encouraged to delegate in order to allow them time to complete tasks that only the RN can do. And although they are within the parameters of our scope and job description, they are also within the parameters and scope of the CNA job description and for at the least where I am employed, the duties which our CNAs are hired to do. If these are not tasks you feel comfortable doing or want to do, I would suggest looking into a different positions.

If you are comfortable completing the tasks but are just busy with other patients, then my suggestion is that when you are asked to do XYZ for a patient, let the nurse know that you are currently completing XYZ tasks for another patient(s) and you will complete the task when you are finished or they can ask another aide (if available). If they have the time, maybe they will elect to complete the task themselves, if not, you will get to it when you are able to. I have to do this on a daily basis when approached by aides/patients and family members/other staff/etc with things the patient needs.

If you are overwhelmed by the amount of tasks being delegated and you cannot complete them in a timely manner, maybe bringing these concerns up with your immediate supervisor to see if additional staffing/other strategies could be implemented.

Best of luck to you!

[TriciaJ, RN]

In every single walk of life there are people who are happy to receive a paycheque without doing actual work. This is a function of weak management. Unfortunately, some nurses engage in this too. It's a performance issue.

On another note, in the most recent BON newsletter that I received, the disciplinary action section has a new category. Several CNAs have been disciplined for "not following the plan of care as directed by the RN". They never clarify what exactly that entailed, but I think it's what used to be called "insubordination". It's a crappy workplace where anyone can get away with not doing their job properly.

[meanmaryjean, DNP, RN]

I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.

That escalated quickly.....

Your response to a legitimate question is to 'report' someone? Very telling.

[Dakeirus]

What the hell?

Why do you think I went to an expensive college to get my BSN? I deserve better than to clean up somebody else's poop. It's too nasty.

[iluvivt, BSN, RN]

Here is the bottom line:If nurses are refusing to help their patients because they believe it is beneath them then this must be brought to the attention of management to deal with. If nurses are responsibly delegating so they can do all of the RN functionsl that UAPs cannot do then the UAPs need to just do what they are hired to do . I say just do it because that is one of your assigned duties and be grateful that you are employed. I personally don't find it an unpleasant task at all but it is very time consuming and it is my duty to manage my time and delegate as I see fit since RNs supervise UAPs and have most of the liability.

[kakamegamama]

I am sorry you are confused. I have already told you my job. Please stop asking for personal details. That is NOT what this topic is about. If you continue to prod for irrelevant and personal information I will have to report you.

Hmmm.....maybe I misread some responses, but I've not seen evidence of anyone asking for personal information, or irrelevant. If you are on a committee tasked with determining nurse-cna working relationships, delegation of tasks, abuse of CNAs, or something could help give you better answers. Why did it escalate to a threat to report? (You don't have to answer me, but answering yourself might be helpful.) I sense a bit of underlying hostility.......