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.
I work as a CNA and currently am in nursing school, and I cannot think of a time at my facility when the nurse asked me to do something (toilet or change a patient) and I felt as though she should do it herself. On my psych unit we have one nurse to 40 patients and 4 CNAs. My nurse is busy, skips her breaks, and stays sometimes over 2 hours after shift to finish charting. It is my job to do what I can to help her so that she can do what I cannot.
Same here when I was an extern. I never once had a nurse ask me to do something just because she didn't want to do it. I have witnessed it out of RNs at my current job; however it is far removed from my extern days at another hospital and the environment is different, as are the expectations of the patients, family members, and Disney-fied, Studer-ized senior management whose jobs are being threatened because the reimbursements aren't coming in, because whoever completes the patient surveys didn't feel that we ALWAYS did EVERYTHING in the exact way and exact time they wanted us to.
I'm sorry if you can't get what you need done because workload is high, but it is not other CNAs responsibility to provide care when you are the designated caregiver and there's no way you can argue around that.
No, really. It literally is. I don't have to argue at all about that. Read your job description. I'm willing to bet that any accredited facility specifies that your duties are performed under the direct supervision and direction of a licensed nurse. That doesn't mean you're a slave but it does unfortunately mean you should do what is asked of you, and if you have any questions or criticisms of those supervising you, they should be shared with the director of your unit, or whoever hires and fires you. I mean, if my director is told by the CNO to audit 20 patients for telemetry lead placement and the director brings me, an RN, the audit sheet and asks me to do it, then goes to her office and engages in a personal call for two hours....what choice do I have unless I'm willing to go over her and discuss my duties versus hers? What do you think the CNO's answer would be if I raised this issue? Think I'd work there very long if I bittered up and refused to do it more than once? Same thing. Actually it's even more critical for UAP to do what a nurse asks of you or explain why you can't, since the delegation is proper and it's in the best interest of patient care.
Also, I don't consider RN school "significantly" greater education than a CNA. ADN is a two year degree that doesn't required hard math or sciences.
Eek! Have you taken physiology. And micro. And pharmacology yet? Maybe you're a genius. I survived law school prior to taking the courses I mentioned, and I still feel that these are "hard."
Specializes in Cardiac, Transplant, Intermediate Care.
Nursing and healthcare is a game. I get to work, meet in change of shift huddle, then my co-workers play games to see who can get out of taking a higher acuity patient or admission. Then we get report and learn about how busy the shift before was- even though they didn't miss the pot luck party in the break room. We inherit things they were just too busy to do. Then we hit the floor running and may get a post-procedure on frequent vitals, new admission, etc- and scramble to find CNAs to do their jobs so we nurses can do our jobs.
I was a tech 15 years before becoming a nurse and it has afforded me the privilege of having techs say to me "I'll do whatever you need because you're my favorite nurse."
I've always felt uncomfortable with this idea. I mean, it's wonderful that some techs and nurses have such a sense of camaraderie that the techs are happy to help with whatever is needed. But on the flip side, techs are responsible to help assist patient's even if they don't like that particular nurse. It isn't right or okay for a tech to refuse to assist or to avoid work because they don't like a particular nurse. In the same vein, it isn't right for nurses to let personal differences between staff affect THEIR care of the patients, either.
Its about taking care of the patient, not about if the nurses and techs are friends.
We have a thing at the facility I work at where all members of the staff answer call bells. If they aren't able to help, they find someone. I will help my CNAs clean up a resident, pull them up in bed. Whatever they need as long as I'm not in the middle of another task. They all know I will help them so when I do ask them for help, they are more than happy to help out.
At the end of my most recent shift, I needed help to get a patient off a bedside commode, but the aide didn't come because she was giving report. The nurse I was going to give report to came to help me. I've heard stories like the OP's a bunch of times. I've experienced stories like mine too often to feel as sympathetic as one might wish. Every aspect of keeping a patient safe and comfortable is part of my job. Doing your job for you is not. I learned an important lesson as a patient. I want to be nice, and I want to be heard. If you make me choose, I will be heard.
I absolutely help toilet my patients when I can. However, I have RN tasks I'm trying to work through. Recently my facility turned vitals over to the nurses. They figured it'd be beneficial to the nurse and free up the tech to potty patient and respond to call lights. Wanna guess how it is working out...I'm doing vitals while running all over pottying patients and trying to get assessment done on 6 patients and meds passed. The tech is nowhere to be found. I usually find them in the break room ignoring call lights while they eat breakfast. While it's incredibly frustrating to have that nurse...as a nurse it's even more frustrating to have that tech. I can do your job but you can't do mine. You may have no idea what I'm dealing with. 15 minutes into my last shift I was sending someone to critical. Sorry I couldn't take time to potty a stable patient. Her BP in the 60s trump potty. Have you had a conversation with the nurse? I'd advise going to nursing school so you can see it from the other side.
My unit doesn't have CNAs and the hospital is doing more to reduce the amount of CNAs on all units. Sooooooo nurses will have to do it and CNAs will have a hard time finding a job. Lose lose situation for all involved except the company writing the checks
Specializes in MICU/CCU, SD, home health, neo, travel.
OK, here's my POV. If, during initial rounds, for instance, I would find a patient lying in poop but otherwise in no distress, and the poop wasn't all over the bed, I might tell that person I'd be right back to help get them cleaned up, *or* ring for my tech if there happened to be one (I didn't always have one!). If it was a total mess, of course I'd have to attend to it right away and the rest of the rounds would wait a bit. It kind of depended on how many patients I had too--bear in mind that I usually worked in critical care/tele/stepdown, so no more than 5 generally. I often, though not always, found that family members, if they were present, were surprisingly willing to help!
But there's a story attached to this. Several years ago when my father was in the hospital one of us stayed with him constantly because he had dementia. We tried to do pretty much everything for him without calling for assistance. He was very weak and required assistance to the BSC, which my brothers could do but I couldn't without help because I am quite a bit smaller than they are. So this one particular day, his nurse was a guy who, years ago, had been a nursing supervisor at a hospital where I was new grad and had chastised me one night for "expecting techs to do things which i could do myself" such as changing patients or helping them to the toilet (never mind I was still trying to figure out then how to do my job and was still always behind!). I recognized his name but he didn't recognize me after 25 years. At one point I rang for someone to help me get my dad to the BSC and was told someone would be there shortly, but no one showed up. meanwhile, this nurse was outside the door in our pod, I heard him chit-chatting with another nurse, and I heard his phone go off....but neither he nor anyone else showed up. I rang again 5 minutes later and it ended up almost being too late before a tech showed up. She apologized, saying two of the techs on the floor had called in. She also ended up having to clean the floor as Dad was in such a hurry. Think I was mad at that nurse? You bet! It would have taken just a couple minutes of his precious chatting time! I almost said something to his charge nurse but didn't. I did, however, leave his name out of the thank-you note I sent to the floor, where I mentioned the other nurses and the techs by name. I know, little revenges aren't nice.
When my Dad was sick, and then when I was, I saw both sides of this conundrum, but both examples were exceptions. Despite my previous little rant, most of what I saw, and most of what I encounter at work, is nurses and aides working together to get a tough job done. But a thing I tell new nurses--even the ones I knew first as aides--is that the aides will test you. Even the ones who don't know they are doing it will evaluate whether a new nurse is going to be part of the solution or another of their problems. A rare few will want to see if they can get you to do their jobs for them, but even the best won't respect you if you act too good to do the icky stuff. Whatever else you can say, Code Browns can be an effective exercise in team building.
almost said something to his charge nurse but didn't. I did, however, leave his name out of the thank-you note I sent to the floor, where I mentioned the other nurses and the techs by name. I know, little revenges aren't nice.
Revenge is a dish best served cold. I would've said something to the charge nurse AND mentioned the incident in a letter to the CEO of the hospital AND said something to the effect of "Thank you to X,Y but NOT Z" in my thank you card. I have a manager who's exactly like that - will chew you out (in front of everyone) if you didn't do something, but when it's time for this person to answer a call light, you'd have better luck winning the lottery. There are simply people out there who enjoy putting others down but won't hold themselves to the same standard.
redhead_NURSE98!, ADN, BSN
1,086 Posts
Same here when I was an extern. I never once had a nurse ask me to do something just because she didn't want to do it. I have witnessed it out of RNs at my current job; however it is far removed from my extern days at another hospital and the environment is different, as are the expectations of the patients, family members, and Disney-fied, Studer-ized senior management whose jobs are being threatened because the reimbursements aren't coming in, because whoever completes the patient surveys didn't feel that we ALWAYS did EVERYTHING in the exact way and exact time they wanted us to.