stinky patient pet peeve

[Fruit Sucker]

It really irritates me when we get to the floor, get patient assignments, and go in to see patients that have not been cleaned for at least a day. I'm not talking about diapers that need to be changed, I'm talking the entire patient is stinky and there are techs/cna's standing around. This really grinds my gears.

Do people working as nurses have this problem? If so, what do you do? Can you write up the techs for this?

I had a patient the other day who was stinky as all get out, Foley bag was full, and he was slumped down in his bed. The nurse is busting his butt trying to get all the medications out, and there are techs standing around talking. I say something to my clinical instructor and she says, "sometimes you'll have that, it's a game where they want to see if you'll do it for them." Can't people like this be punished?

[SubSippi]

First, I'll answer your question. Yes, if there is a CNA who is refusing to do their job, this can be reported to the manager, and they can be written up. In my work experience, this sort of behavior has not been the norm.

Anyway.

If you expect to arrive to every shift with each of your patients fresh bathed, fluffed and puffed, with an empty foley bag or whatever else, you are in for a HUGE surprise...and it's not because so many CNAs are lazy and trying to get busy nurses to do their work. Not only can people who are old and sick can start to smell really quickly, but they also refuse baths, and it's very possible there's a reason a bath may have to wait until later in the day. And it takes all of ten minutes for people to slump down in the bed. These issues are having to be addressed constantly through each shift with some patients, and there's not enough staff for people to get a bath as soon as they start to smell or for someone to be standing next to a bed repeatedly pulling the patient back up.

Also...you're a student, and this was your patient. Taking care of their hygiene needs was your responsibility that day, so maybe that's why they needed a bath, were slumped down, and had a full foley bag. Because you hadn't don't it yet. Don't get all uppity before you even graduate.

[RNsRWe, ASN, RN]

can they be "punished"? It would benefit you to start thinking in terms of profesional behavior; people aren't "punished" like small children who misbehave. Are there consequences, repercussions? Absolutely. But not always in the circumstance you currently describe.

If a CNA had refused to perform a task, yes there are consequences to that refusal. But I ask you how it is you know exactly the circumstances that occurred in the hours/days prior to your appearance on that floor for that shift? As the PP mentioned,people can and do refuse baths, or need to be done at odd times to accomodate their own peculiarities. Is this a patient who was bathed the evening before, but once again has become malodorous? Would you then suggest that this patient be bathed qshift? And if so....you should have no problem doing it, since it's now YOUR shift :)

As a student, you are expected to just DO IT. As a nurse, you are expected to delegate when appropriate, and follow up. A considerable amount of the time, that means assisting with ADLs or doing them yourself, depending on the situation, ratios, and care needs for the census.

I recall a student who was incensed that the patient she just picked up had completely wet the bed: incontinent to the max, and the entire bedding was a mess. She made a point of interrupting report to announce that this patient was a MESS, and wanted to know "who was responsible for that patient" in the five minutes prior to her arrival.

It was ME.

I politely informed this student that incontinent patients aren't typically courteous enough to 'hold it' until late enough in the shift to acccommodate the oncoming staff's routine. That that particular patient had been changed and fluffed exactly ONE HOUR prior to the end of the shift. And that he was now HER responsibility, thank you. The last 12 hours were mine, the next four were hers.

I have no doubt he didn't smell very sweet, either.

[smoup]

What time does clinical start? Apart from reasons stated above, some patients just don't get the care and attention of others for various reasons. Sad but true.

[classicdame, MSN, EdD]

I hate this too. Really and truly - several people are passing the buck in this case.

I once had a FAMILY of stinkers. No one wanted to go in the room, not even the MD. So I went in and said the MD said that if people do not bathe then they cannot come to the room as it is an infection control issue. Most preferred to stay home. I preferred that as well. When I told the MD he said "I did not say that". I told him I would swear that he did if anyone asks. :)

[KiggyPupPuff]

In our RN program, routine care (hygiene, feeding, etc) is the student's responsibility on top of ADPIE simply because we don't always have more than 1 patient (due to census). But the CNAs on our teaching floor are very exceptional and efficient; it is HUMBLING and fascinating to watch them do their job with speed, kindness and respect for the patient.

Just out of curiosity, how many patients do you have to take care of in how many hours?

[psu_213, BSN, RN]

As others have hinted--there could be a lot more to this situation than just that this person was neglected. There were mornings (7am) when day shift walked in and they might see night shift just sitting there. Someone might think "boy, night shift has it easy…they…they just sit around. This med cart is not properly stocked--they are pretty lazy too!" What they didn't see is that for 11 and a half hours, night shift was running around like crazy, there were 2 codes, 5 admissions, and all the other stuff that can come up during the night. It's easy to say night shift was slacking based on that one snapshot of what you see when you first get there, but that, in no way, reflects on what happened over the entire shift.

[RNsRWe, ASN, RN]

I probably should throw in there that there are indeed times when a patient could have been bathed, should have been bathed....and wasn't. Sometimes, people are missed, or downright skipped over. I'm not condoning neglect by ANY stretch of the imagination, but it does happen.

If it happens with someone who is normally on top of things and you know it was just a bad shift, we all have learned to deal with it. No one is perfect, and sometimes balls get dropped. "No one died" is sometimes the best way to describe some shifts!

If it happens with someone who routinely "forgets", that's different. There are definitely avenues to take, and that can all be discussed....IF that's what we're talking about. But I'm not getting that sense from the OP.

[Here.I.Stand, BSN, RN]

Staff not doing their jobs can be written up, yes. The professional thing to do is speak to them directly first.

That said, at many places were I've worked with nursing students, the CNAs have been advised NOT to do a.m. cares for the pt--because the pt has a nursing student assigned for the day, and s/he will be providing the care.

Also, just because someone has slumped in bed doesn't mean that s/he has been neglected. The past couple of weeks, I've personally had pts who had severe TBIs.

One was constantly sweaty and squirrely in bed. This was with scheduled oxycodone, a fentanyl pump through his IV, scheduled seroquel, AND was still on propofol. The minute he so much as coughed, his entire body would break out in beads of sweat. He had ripped his mattress with the pin (external fixator) in his heel bone--he had this pin sticking out, and he was digging his feet into the mattress so much that he ripped the mattress. We had a tennis ball stuck on it to cover up the tip, but that would fall off when he got going. He was hugely incontinent (DI--look it up), but our policy is that "foleys are not a substitute for nursing care," and since he didn't have skin breakdown or pelvic injuries or obstruction...no foley. Condom cath wouldn't stay on, so it was diapers and chux only. He'd get himself slid down and get at a diagonal angle in the bed. This poor man could not follow commands or communicate with us. Oh, and our one CNA got pulled from the floor to do a 1:1. I was doing full bed changes and partial baths q 2 hours (or more, if he stooled AFTER changing everything...) BY MYSELF, unless I was able to get another RN to help me. And all the while, my other patient was trying to extubate herself.

My point in saying all that is, someone walking past his room and looking in (student nurse coming on maybe?) would probably think, "Has this nurse been chatting at the desk all day?? WHY is this pt so unkempt?" When in reality I had just done a full bath, fluff & buff, boost & prop, AND given prn meds for pain/anxiety half an hour before.

[Fruit Sucker]

To the people who said that I should just do the CNA's job because I'm a student and I'm being "uppity"...just, no. I am given what assignments I do by my clinical instructor, and washing patients is not among those duties. I'm an RN student, not a CNA student, maybe I didn't mention that. My assignments that I receive from my instructor are assessment, meds, and so on, and if there is extra time I'm expected to be looking things up, not giving bed baths.

I guess I didn't expect so many "oh, just do it yourself" replies. Kind of shows people's attitudes toward students.

[Fruit Sucker]

Also, if CNA's are being told that the students coming in are going to do their work for them, I should find this out. That would cause a big stink with my instructor. I don't know who would do that, it certainly wouldn't be the nurses.

[jifferte, BSN, MSN, RN]

As a nurse with more than 18 years under my belt and a nursing instructor, if I ever found one of my student's patient assignments filthy and said student stated, "I'm a RN student- not a CNA student." Said student would be out of the nursing program lickety split. In my opinion, Veggie's post is symptomatic of the tremendous entitlement issue rearing it's ugly head in schools and facilities these days.