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?

[RNsRWe, ASN, 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.

If I could only hit the 'Like' button about a hundred times.....!

[JustBeachyNurse, LPN]

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.

Exactly nursing fundamentals includes bathing, bed baths, pericare (amazing the skin assessment that can be done during this time. You were assigned full patient assessment including skin), oral care, vital signs, full systems assessment and more. Do you not expose the patient skin to assess skin, heart tones & breath sounds, palpate & auscultation the abdomens? If you refused to do direct care ( including measuring I&O (empty foley, check consumption of meal served) and full skin assessment (takes only a few extra moments to do a bed bath)) while performing assessment it was a guaranteed fail in my program

[Fruit Sucker]

Well, I can't speak to where you went to school 18 years ago, but today's instructors are not teaching students how to make beds and give sponge baths anymore. As I said, I follow the instructions I'm given BY MY PROFESSORS, not by some hospital staff members who think someone else should do their work for them. Nor do the nurses on the unit have time to do CNA work. Maybe this is a regional thing, I don't know. I've heard hospitals in more rural areas don't even have CNA's. But I do know that I go to school to learn, and missing out on inservices, missing meds, and missing actual student duties because I have to do someone else's work is not acceptable.

[JustBeachyNurse, LPN]

Nursing fundamentals including bed changing, bed baths, assessing I&O were assigned by our instructors as a part of the clinical assignment while performing the assessment. Including assisting with PROM & ADLs, toileting, assist with feed. Not just handing out medications and inserting IVs or foleys.

[RNsRWe, ASN, RN]

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.

Wow. Unreal. First, there was no confusion that you're "an RN student, not a CNA student". ALL RNs are expected to be able to properly bathe, ambulate, perform any and all ADLs whether there is a CNA available or not. It is the responsiblity of EVERY RN to not only know how to do these tasks, but in many MANY cases, DO them. It's nice to be able to delegate this when ancilliary staff is available, but it is NOT in the LEAST strange for a nurse to find herself/himself with ZERO aides available. There are still those "stinky" patients that need ten layers of care, but YOU would be expected to do it. No one else to call on the carpet for what YOU will be responsible for doing.

If you are fortunate and do have an aide assigned to your patients, but the aide doesn't have time to (or doesn't "get around to") bathing a patient, whose responsiblity do you think it is to GET it done? Yours. Oh, feel free to write the aide up for poor time management if you like. But the aide is there to assist in getting YOUR WORK done.

People here don't have poor attitudes toward students; they (we) are shocked to find someone who is still in school and expecting others to do for them what they really should be doing themselves.

If your instructor tells you that you are there to learn to be an RN and are NOT expected to handle routine patient care....THAT shocks me. If you're in a Fairy school learning to be a Fantasy nurse who will never encounter situations in which you have NO available aides and are expected to do the job yourself.....you're being sadly misled. To be prepared to work as an RN today, it's a joke to think you won't be doing patient care. Truly.

If a student somehow gets through school without doing the basics (like those disdained bed baths) then that student is in for a REALLY rude awakening upon getting a floor assignment.....and if that new grad then approaches the tasks as beneath her, because she expected to spend her time flipping through the chart......she shouldn't be surprised to find no one is interested in doing her patient care work for her.

[RNsRWe, ASN, RN]

Well, I can't speak to where you went to school 18 years ago, but today's instructors are not teaching students how to make beds and give sponge baths anymore.

At this point, I honestly, truly do feel sorry for you. Switched gears, because I think your instructors are doing a horrible disservice to you!

"Today's instructors", (many of whom post on this forum all the time, btw) DO teach their students all the things you say your "PROFESSORS" do not. That is a real crime. You are paying them for a nursing education, and they are giving you the short-shrift. Oh, and the nurse you were responding to with "I don't know what it was like 18 years ago when you were in school" (veiled put-down)? She IS a nursing instructor, and I would hazard a guess she falls into the category of "Today's Instructors"

When you become a new nurse, and find yourself drowning in floor work....you'll let us know and we'll remind you of this conversation

[JustBeachyNurse, LPN]

Well, I can't speak to where you went to school 18 years ago, but today's instructors are not teaching students how to make beds and give sponge baths anymore. As I said, I follow the instructions I'm given BY MY PROFESSORS, not by some hospital staff members who think someone else should do their work for them. Nor do the nurses on the unit have time to do CNA work. Maybe this is a regional thing, I don't know. I've heard hospitals in more rural areas don't even have CNA's. But I do know that I go to school to learn, and missing out on inservices, missing meds, and missing actual student duties because I have to do someone else's work is not acceptable.

Just curious in the ICU (often no CNAs) who do you think does the foley emptying/I&O's, linen changes, oral care, ADLs, bed baths, pericare, and other fundamental nursing skills? The RN assigned to the patient often with the assistance of another nurse.

These skills were and are taught, assessed, and assigned by nursing instructors/professors in class, lab and at clinical sites as a part of total patient care. This was included in the fundamentals text book as well as the skills lab books & check off sheets.

Quite often the RN is responsible for total patient care in critical care as most often it's nurses only and maybe if lucky a unit clerk on the floor to care for bed bound, critically ill patients.

Something to think about.

[LadyFree28, BSN, LPN, RN]

Wow. Unreal. First, there was no confusion that you're "an RN student, not a CNA student". ALL RNs are expected to be able to properly bathe, ambulate, perform any and all ADLs whether there is a CNA available or not. It is the responsiblity of EVERY RN to not only know how to do these tasks, but in many MANY cases, DO them. It's nice to be able to delegate this when ancilliary staff is available, but it is NOT in the LEAST strange for a nurse to find herself/himself with ZERO aides available. There are still those "stinky" patients that need ten layers of care, but YOU would be expected to do it. No one else to call on the carpet for what YOU will be responsible for doing.

If you are fortunate and do have an aide assigned to your patients, but the aide doesn't have time to (or doesn't "get around to") bathing a patient, whose responsiblity do you think it is to GET it done? Yours. Oh, feel free to write the aide up for poor time management if you like. But the aide is there to assist in getting YOUR WORK done.

People here don't have poor attitudes toward students; they (we) are shocked to find someone who is still in school and expecting others to do for them what they really should be doing themselves.

If your instructor tells you that you are there to learn to be an RN and are NOT expected to handle routine patient care....THAT shocks me. If you're in a Fairy school learning to be a Fantasy nurse who will never encounter situations in which you have NO available aides and are expected to do the job yourself.....you're being sadly misled. To be prepared to work as an RN today, it's a joke to think you won't be doing patient care. Truly.

If a student somehow gets through school without doing the basics (like those disdained bed baths) then that student is in for a REALLY rude awakening upon getting a floor assignment.....and if that new grad then approaches the tasks as beneath her, because she expected to spend her time flipping through the chart......she shouldn't be surprised to find no one is interested in doing her patient care work for her.

Well said.

I just completed a BSN program about two years ago, they are STILL teaching bed baths and ADLS in fundamentals; batching and changing patients is STILL part of nursing care.

I'm in a major metro area, btw.

[RNsRWe, ASN, RN]

Just curious in the ICU (often no CNAs) who do you think does the foley emptying/I&O's, linen changes, oral care, ADLs, bed baths, pericare, and other fundamental nursing skills? The RN assigned to the patient often with the assistance of another nurse.

These skills were and are taught, assessed, and assigned by nursing instructors/professors in class, lab and at clinical sites as a part of total patient care. This was included in the fundamentals text book as well as the skills lab books & check off sheets.

Quite often the RN is responsible for total patient care in critical care as most often it's nurses only and maybe if lucky a unit clerk on the floor to care for bed bound, critically ill patients.

Something to think about.

I was about to write the same post you just did here, LOL.....I've worked ICU, and I was TICKLED when I had an aide available! It was usually one aide for the whole unit, and obviously (ok, obvious to MOST of us) the aide would be running and still get only a fraction of the "CNA work" done.

I asked the aide to help me with the jobs that absolutely required two people: T&P for patients one could not move alone, mostly. But there was SO MUCH patient care to be done--and yes, they sometimes WERE "stinky"--I can only imagine if I said "oh, no CNA? Guess it doesn't get done until next shift..."!!

[heron, ASN, RN]

Well, I can't speak to where you went to school 18 years ago, but today's instructors are not teaching students how to make beds and give sponge baths anymore. As I said, I follow the instructions I'm given BY MY PROFESSORS, not by some hospital staff members who think someone else should do their work for them. Nor do the nurses on the unit have time to do CNA work. Maybe this is a regional thing, I don't know. I've heard hospitals in more rural areas don't even have CNA's. But I do know that I go to school to learn, and missing out on inservices, missing meds, and missing actual student duties because I have to do someone else's work is not acceptable.

If you can't think of anything to assess during that bed bath/linen change, then your professors aren't teaching you assessment, either.

In addition to skin condition, you will get a good look at mental status, ability to follow direction, a quick pass with a steth gives you resp and cardiac and bowel function information, you can note edema, existing range of motion and movement issues, pain, condition of any wounds, dressings, etc.

Is range of motion one of your "student duties"? If so, a bed bath is prime time for that.

Any acute care nurse can add to this list.

Sorry, getting all thin in the nose about punishing CNAs who won't do your work for you is just too arrogant for words.

Have you shared this opinion with your instructor? What did s/he have to say?

[RainMom]

Holy cow... OP, if you have plans to work on an acute care floor, you WILL find yourself having to do bed baths, pericare, oral care, etc. on occasion. CNAs are pulled to other depts all the time, leaving you on your own. (And there is nothing that ticks me off more than a nurse that won't answer call lights or searches for the CNA to toilet a pt!) Your instructor is doing you a disservice & misleading you. Hopefully, for your sake, next semester's clinical instructor gives you realistic expectations. As the nurse, you are responsible for ALL care.

[RNsRWe, ASN, RN]

I wonder where the idea that it's really just hospitals in rural areas that don't have CNAs comes from? I guarantee that would be news to friends of mine working in hospitals in NYC, Boston, Philadelphia, and Houston!