Refusing to change/toilet pts

Tenebrae, BSN, RN · Sep 2, 2017

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"

I was going to add my answer but realised that Glycerine nailed my answer in a nutsheel

new gal · Sep 3, 2017

I certainly have compassion for the patient lying in poop. It's not that I don't want to get my patient comfortable... it's 15 minutes, that I don't have to give. I am charting, passing a gazillion meds and collaborating with physicians.
This is when I direct my CNA to perform the duty. Please do so and realize that I can do YOUR job, but you cannot do mine.

Absolutely! I am not an RN but I have worked as a CNA for a while and in my facility I have a high regard for the LPN's and RN's that work there, however there will be a time or two with a certain RN that has denied Pt care (something I was not able to due because of it not being in my scope). She is not there anymore. Getting back to point, half the battle is really knowing your staff. The RN's have rushed out of a residents room, while passing me in the hallway and directing me to change or toilet. I dont bat an eye, cause I see how busy the nurses are on my floor, but they always always help when they can. Considering a lot of the stories I hear, I am very appreciative of the nurses I work with.

SaltySarcasticSally, LPN, RN · Sep 3, 2017

This is thankfully one problem we don't have at my hospital. Or at least on my floor it isn't.

If a PCA needs help with a total bed change etc, I try to complete certain nursing tasks at the same time like skin checks or dressing changes in places its hard to do solo. If my PCAs are totally underwater, I will take the pts to the toilet and chart in their room while they are doing their business in the bathroom.

Of course it doesn't always work that picturesque but I think all of us having the attitude that we are co-workers and not above each other really makes work easier.

It helps that most of us RNs were PCAs at some point....

purplegal · Sep 3, 2017

While I can understand some of your thinking, if a nurse is taking the time to find a CNA to do a task, it is not necessarily because he or she is refusing to do the task. The nurse most likely needs to move on to something else, if possible. If I take the time to find the CNA to do the task, or put on the call light for one to come in, it's because I have some other nursing duty that needs to be completed. At the same time, if the CNAs are nowhere to be found (as they are busy helping another patient) or no one answers the call light in an appropriate amount of time, I actually will take the time to help the patient out. When I'm having a good night, I do spend some extra time with patients, if possible. I take them to the bathroom after giving their medications, just to help both the patient and the aides out. But if I did that with every patient every day (I have upwards of 20 patients), I would get so far behind that other important nursing tasks would get completed way too late or not at all, and I would end up staying excessively over my shift (remember, we need to get home and rest, too). Thing is, the nurses who are asking you for help are probably doing more of the aide work than you realize. I know I am. They just aren't sharing that with you. And it seems like they're asking for help more than actually helping because those are the times that you are aware of, or notice. But the VP is right, you most likely have no idea how busy we are.

Now, if a nurse is not toileting patients because she is playing Candy Crush, that's another thing. Either she's not completing nursing duties that she should be doing, or she really is not busy. Regardless, refusing to help out, after getting done with Candy Crush, is wrong and they should be reported. I know that if I'm the one at the nurse's station, and I'm the one to first notice a call light going off, I will go and answer it, especially if I am caught up with assessments and am not waiting for a phone call.

Accolay · Sep 3, 2017

My experience tells me that there are always lazy people in all types of jobs. I agree that if a nurse outright refuses to clean up The Stuff that it's a management problem. If management doesn't attempt to fix this, then it's time for a new job.

I will say though that before becoming an RN when I went from my nursing assistant job at a nursing home to a nursing assistant in the hospital, I knew that my job was absolute cake- less than half the work, basically almost zero responsibility compared to LTC with at least a $4/hr raise. It was good times and easy to stand out as a good NA. Nursing assistants don't know how busy nurses really are and don't know how much a good or bad nursing assistant can make or break your shift.

But in saying that, I will always help clean up as I believe it's my ultimate responsibility to make sure my patient is clean and dry, and I'll find a nursing assistant to, well, assist. If I can't do it myself right then I'll delegate as able. If the nursing assistant finds poop first, they usually will ask me to give them a hand. Teamwork or something, they tell me.

neuron · Sep 3, 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?

I think it all comes down to responsibility. It is not the nurses responsibility to toilet/clean patients (meaning soiled undergarments), when the CNA or PCA is on duty. They 'can ' do it, but it is not their primary responsibility. A nurse has to be on alert for emergencies. There is more liability

beekee · Sep 3, 2017

We all know THAT nurse who refuses to do toileting/changing. When I was new, I basically had to delegate just about anything I could because I was so slow. As I get more efficient, I try to do as much myself as I can muster. I hope the aides I work with don't think I'm dumping on them, but I'm sure it may seem that way from time to time.

I'd suggest spending less time worrying about what others are doing (or not doing). It's only going to make you annoyed with your job, coworkers and patients. Instead of thinking that nurse is playing candy crush instead of taking his patient to the bathroom, think, gosh, that poor nurse is taking a break while waiting for a doctor to call him back because that's the only time he has to decompress a little. Instead of that nurse delegates every freaking little thing, think, that's great that that new nurse is taking her time to make sure she gets stuff right. She's going to be a great nurse! It may not be true, but it'll save you from some headaches.

Accolay · Sep 3, 2017

I think it all comes down to responsibility. It is not the nurses responsibility to toilet/clean patients (meaning soiled undergarments), when the CNA or PCA is on duty. They 'can ' do it, but it is not their primary responsibility. A nurse has to be on alert for emergencies. There is more liability

Yeah, I dunno...If you're cleaning some poop and there is an emergency then stop cleaning the poop and take care of the emergency. I think it also sometimes comes down to work ethic. Even if it is per se the NA's job responsibility to do that, the RN is still accountable. Like if the family comes in and their person is soiled, and may have been sitting in it for a long time, they're not going to be seeking out the NA to find out what's up. Or if you're getting report from your fellow RN and the patient has dried poop under them, that isn't right. You can always sympathize with an RN that had a crap NA, but still doesn't change the fact that it's the RN's deal to make sure it gets done.

If an RN isn't doing anything as in the example put forth, then they can definitively clean up some poop for their patients.

I think we need to differentiate between hospital and LTC here though. Definitely more of the NA's deal in LTC.

oceangirl1234 · Sep 3, 2017

We don't have CNA's on either unit that I work on. We do all of their care...including toileting. Some great discussion on this thread. Would i refuse a human being some basic dignity by helping them to the toilet or changing them when I have the time? Absolutely not. But, prioritization and delegation exists for a reason.

Julius Seizure · Sep 3, 2017

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.

Guys, we found NOADLs!

KeepinitrealCCRN · Sep 3, 2017

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?

well since you responded to my post i assume you are feeling some type of way about it and if you must ask then sure i will give you some examples from your own post. it is not so much a hard to hear truth that CNAs cannot do certain RN duties that is just a fact. then in your next sentence you again say "that only an RN can do.", we got it the first time. then you continue on with listing all of the things you can do that a CNA cannot, again we all know. if 3 times wasn't enough you ended the paragraph with "there is so much they are not able to do". so since you asked me specifics there you go. you do not have to outwardly say something but when you say things like that multiple times and bold or capitalize certain words it comes across a certain way.

JKL33 · Sep 3, 2017

well since you responded to my post i assume you are feeling some type of way about it and if you must ask then sure i will give you some examples from your own post. it is not so much a hard to hear truth that CNAs cannot do certain RN duties that is just a fact. then in your next sentence you again say "that only an RN can do.", we got it the first time. then you continue on with listing all of the things you can do that a CNA cannot, again we all know. if 3 times wasn't enough you ended the paragraph with "there is so much they are not able to do". so since you asked me specifics there you go. you do not have to outwardly say something but when you say things like that multiple times and bold or capitalize certain words it comes across a certain way.

I included details because I was under the impression that the OP was inquiring about possible reasons for the observations she has made, and I did not have information about the OPs knowledge of the nurse role. Also, since the OP does not work with me I did not expect her to know the kinds of tasks I might be engaged those few times that I need to ask for assistance.

Here are some more examples from my own post in case you overlooked them or simply hope to be able to purposefully mis-characterize the spirit with which I wrote:

I want to be 100% clear: I have ZERO respect for RNs who, even when they find themselves with a bit of downtime (increasingly RARE), do everything they can to avoid these tasks simply because (they say) "it's the CNAs' job."
It is certainly not beneath any RN to provide care of any type to a patient.
CNAs/techs are trying to help so many nurses and patients, and I appreciate their help very much.
I've tried to request their help as sparingly as possible

So, I bid you well; your take on - and comprehension of - what I said, is duly noted.