Refusing to change/toilet pts

Meowzers · Sep 8, 2017

Current CNA/Future RN here.

I work with a couple of nurses who flat out will not do any ADLs and will page a CNA every time to do it, no matter what. Thankfully, most of the nurses I work with are extraordinary and are the type of nurse I aspire to be when I am done with school. They help when they can and will do ADLs or vitals when they can (and for larger or harder to move patients, it is usually a team effort between me and them). Not to mention that assisting in ADLs helps you better assess and monitor your patient's movement, skin issues, etc. When they are too busy (behind on meds, need to start blood, etc.), they say so, and are appreciative of the help, just as I am appreciative of their help when I am swamped (we tend to be short staffed on the CNA side more often than the RN side on my floor).

Bottom line is it's all in the ask, in my opinion.

"Hey, can you come change pt in XX room? I would but I have to start this IV. Thank you!" is vastly different from "Hey, pt in XX needs changing now."

Everyone likes to feel valued in their work, and no one likes to feel like they are being taken advantage of or purposely made to feel like they are lower on the food chain. Some RNs have a tendency to treat CNAs this way, which is why I am enjoying working as a CNA before I become a nurse so I can appreciate both sides. Thankfully, the RNs with that attitude seem few and far between at my hospital, and I am grateful for them! I also work with a couple of CNAs who always make themselves look busy, but never actually do anything, and leave it all to the nurse, then gripe when someone asks them to do their job. All i can say is that both the RNs and management have noticed this behavior.

Sour Lemon · Sep 8, 2017

"Hey, can you come change pt in XX room? I would but I have to start this IV. Thank you!" is vastly different from "Hey, pt in XX needs changing now." .

As a new grad, I fell into the trap of thinking I needed a bottle of wine, chocolates and an eight-page poem about why I couldn't "do it myself" before I dared to ask any CNA for assistance. I no longer feel the need to over-explain or apologize, though.

When my manager or directer assign a task to me, I don't get to demand an explanation as to why they can't do it themselves and then decide whether or not they deserve my help. If I'm able to do the task right away, I do it. If I'm not able to do the task right away, I let them know I'll get to it ASAP. If there's some reason I can't do the task, I initiate a polite, respectful discussion about it.

Asking nicely doesn't mean begging.

Meowzers · Sep 8, 2017

As a new grad, I fell into the trap of thinking I needed a bottle of wine, chocolates and an eight-page poem about why I couldn't "do it myself" before I dared to ask any CNA for assistance. I no longer feel the need to over-explain or apologize, though.
When my manager or directer assign a task to me, I don't get to demand an explanation as to why they can't do it themselves and then decide whether or not they deserve my help. If I'm able to do the task right away, I do it. If I'm not able to do the task right away, I let them know I'll get to it ASAP. If there's some reason I can't do the task, I initiate a polite, respectful discussion about it.
Asking nicely doesn't mean begging.

Totally did not mean it to come off that way. Over explanation and begging are definitely not necessary for delegation. Was just trying to make a point about communication between co-workers - it's hard to translate when it is a rhetorical situation and knowing someone's work ethic/personality is key to understand the hows and whys of that kind of communication. This happened to be the first examples that popped into my head, maybe not the best ones. As you said, polite, respectful conversation is always key.

Firebabe26 · Sep 10, 2017

I have conquered this on my floor. We had an RN who would come out of the room after doing her initial assessment and find the CNA to toilet a patient. Not cool. On our floor, we are now rated based on call lights -how long they ring and if they go into "overtime" , i. E. Are longer than 3 min. Every RN and CNA are now held accountable for the length of call lights. This has been a game changer. As an RN I will at least help a patient to the bathroom ,then finish my charting while I am waiting. If I get done charting, my CNA will come in and help the patient back to bed. I never had a problem with my CNAs helping me because of this practice of mine. They know I have their backs. I help them when they are behind too. It is a team. If we have a heavy, bigger patient that cant or wont roll, we BOTH clean them up. Or myself and another RN will. ( gasp!) I dont expect my CNA to do it by themselves. Thats how injuries happen. Btw, That RN who would look for the CNA -she was written up and now she is much more of a team player. And we haven't lost a CNA in over a year. They love our floor!

G019, BSN, RN · Sep 11, 2017

Ultimately I think it's where you work. I've had some nurses although they were kind, run me ragged. I have a hard time saying no. Unfortunately I was use to not having a lunch/bathroom break despite time being deducted from my pay. I gave 100% every shift which leaving me physically exhausted to the point that the heavy workload affected my school.

When I started my nursing program, I took an opportunity to work on another unit and I'm happy so far. A handful of the nurses on my unit were former techs on the same unit. That says a lot to me.

I know my role as a tech. I chose to be in this role to learn things the textbooks cant teach. Until the day I pass NCLEX, I know I'm not liable for a patients life. I'm here to help them out making sure they have what they need to do their job because they have to deal with the angry Pt/families, laboratory, providers, and other policies that are out in place all the time. I also know if it's been a crazy shift and I haven't had a chance to go to lunch/bathroom, I can inform my charge nurse and with certainty they have no problem with that.

gcupid · Sep 11, 2017

I have no issue with helping CNA's, but I'm usually seen as the slow one because I'rarely clock out on time and other nsg interventions are delayed bc I am doing basic care.

I strongly believe if nursing was male dominated, this wouldn't even be a question on this forum. You shouldn't have nurses doing these tasks. No other 4 year program requires the BS we are required to do. Who wakes up & decides to spend 30-65k on a long education path to walk into work being treated like a slave and wiping ass with a smile. If' its about assessing patients, assistants could call us in the room when ever they are ready to turn/clean patient if we must look at skin, examine feces, etc.

Anne413 · Sep 11, 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 feel your frustration and thank you for all the hard work I know you do in your job. Every part of the healthcare team plays such a vital role in maintaining wellness of our patients. Every staff member is important. It would be hoped that all staff on a team, from CNA, LPN, RN, etc. could all work together seamlessly and back each other up when someone is particularly busy and could use an extra hand. However, each group of staff within the team has their own priority list and duties that are vastly different from other groups, and, of course, often, only RNs can do certain duties, LPNs have their designated priorities, and so on. If a nurse is sitting, organizing her thoughts in order to start writing her shift notes, would they politely refuse to help toilet a patient at that time? Unless an emergency, probably, as they are in the middle of something that is their responsibility. Then again, if her day is going well and she has the time, how nice to lend a hand and make the personal care aid's day a bit easier. Now I know that every group has "those people" who seem to never lift an extra finger to help beyond the description of their specific job, but hopefully they are in the minority. As far as going and getting a CNA to change the patient, a simple explanation that "I am getting your Nursing Assistant to assist in changing you" would be a perfectly acceptable explanation. As far as if the nurse should/can toilette the patient themselves, depending on the supervision level, length of behavior, clean up, replacing clothing, documentation of the event, assisting back to bed and doing all the other things to make sure the patient is comfortable afterwards, it may very well take a protracted length of time when the nurse not only could, but should, be doing her nursing duties. I've been an aid and I'm now an RN, and I like to be helpful, but not to the point where my work and duties might suffer because that's my license, integrity, and responsibility. People that are generous with their time when possible, creates strong bonds of collegiality and friendship that makes the work environment so much nicer and easier for everyone.

Julius Seizure · Sep 11, 2017

2. CNAs who are not in charge of a patient are not responsible for the care of that patient, however the nurse of that patient is. I couldn't tell you how many times a nurse would ask me to go ask another CNA to help give care to my patients, as if it was not their responsibility. Sometimes that would work but at the end of the day the other CNA is only helping out. It is the nurse's patient and ultimately is it the responsibility of the nurse to participate in helping her CNA with that care.

This reminds me of the staff that see a call light going off and don't get up to answer it because its "not their patient". In a good unit, everyone works together - that includes CNAs helping each other, because every staff member shares the responsibility to care for the entire unit.

And yes, it also includes nurses and CNAs working together - but this doesn't always mean doing the exact same task together. It means every one takes ownership of doing their part to care for the patients, whether their part be passing meds, assessing, toileting, or other ADLs.

Julius Seizure · Sep 11, 2017

1. You are saying "no one said that ADLs are not beneath you in nursing school". But if you asked a professor directly "y know, are ADLs beneath me or are they CNAs work?" what would they say? I know this because it's already been discussed in my school and the answer is that ultimately it is your responsibility but you should delegate 'appropriately' (never once has anyone said anything resembling " as much as possible".

This brought back memories! There have definitely been shifts where delegating "appropriately" DID mean "as much as possible" because that's what it took to get all the patients cared for! All hands on deck, as they say - and everybody wishing we had more staff...

Julius Seizure · Sep 11, 2017

Well, I just want to learn to delegate "appropriately". My goal is not to see how much the CNA can do for me, but maintain the standard, I guess. And use situational awareness in that regard.

Excellent goal

Julius Seizure · Sep 11, 2017

I never understood the concept of ALWAYS being too busy to do something. I worked on a super busy medsurg floor for over 2 years and I could always make time for whatever I wanted to.

My first thought was truly, "hmm I wonder what wasn't getting done that you had so much extra time".

Could be totally off base, but it is what initially popped into my head.

Julius Seizure · Sep 11, 2017

Bottom line is it's all in the ask, in my opinion.
"Hey, can you come change pt in XX room? I would but I have to start this IV. Thank you!" is vastly different from "Hey, pt in XX needs changing now."

As a new grad, I fell into the trap of thinking I needed a bottle of wine, chocolates and an eight-page poem about why I couldn't "do it myself" before I dared to ask any CNA for assistance. I no longer feel the need to over-explain or apologize, though.
When my manager or directer assign a task to me, I don't get to demand an explanation as to why they can't do it themselves and then decide whether or not they deserve my help. If I'm able to do the task right away, I do it. If I'm not able to do the task right away, I let them know I'll get to it ASAP. If there's some reason I can't do the task, I initiate a polite, respectful discussion about it.
Asking nicely doesn't mean begging.

Totally did not mean it to come off that way. Over explanation and begging are definitely not necessary for delegation. Was just trying to make a point about communication between co-workers - it's hard to translate when it is a rhetorical situation and knowing someone's work ethic/personality is key to understand the hows and whys of that kind of communication. This happened to be the first examples that popped into my head, maybe not the best ones. As you said, polite, respectful conversation is always key.

Meowzers,

I completely agree with you that polite, respectful communication is absolutely critical. But I also agree with Sour Lemon. What I would change about your phrasing is that I think the only part that is 100% necessary is, "Hey, can you come change pt in XX room?" It isn't "wrong" to add that you need to go start an IV, but it isn't necessary to give a reason that you asked them to do it. Sometimes it might be relevant or useful to say what you need to go do, but explaining yourself isn't a requirement.

That's all. Again, I totally agree that politeness and respect is the main point!