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?

[BuckyBadgerRN, 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.

Ohhhhh, it's going to get GOOD now! Off to read pages 2-8. Nursing student gonna get SCHOOLED!

[Wave Watcher]

I have learned so much from giving a bed bath. I have learned and found: compassion, trust, love, how to make conversation in some of the most awkward/embarrassing times for the patient, respect, being a servant of the heart, time management, some of the greatest historians have told me their stories, peace in a quiet room with nothing but the movement of water, laughter, a sense of humor, sadness, an appreciation for being able to cleanse myself without help, I have found God in those moments of washing a patient who has just passed.....I have found privilege. Privilege to be in the presence of those who invite me in...a stranger, someone they barley know. I am thankful for each patient I have helped in their moment of helplessness.

[BuckyBadgerRN, ASN, RN]

I spoke too soon. Getting to page 2 is where things really heat up.

To the OP, if you have never learned basic care in school, your school is doing you a HUGE disservice, not only to your skills but also to your attitude. A goodly number of your patients will be total cares, and if they are on tube feeds, that's when the fun begins! A big part of nursing often overlooked by the medical team is skin care. Skin condition and maintenance is nearly completely nursing's domain, including oral care.

We are also responsible for preventing deconditioning. Deconditioning can happen with only one day in a hospital bed, especially for those patients whose independent ambulation was compromised to begin with, such as those who use a walker. Basic care is getting them up to meals if their reason for admission does not contraindicate it. Often, this takes a lot of teaching, persuading, cajoling, and reassurance to the patient, not to mention pain management.

THESE THINGS ARE A NURSE'S JOB. Your current instructor is only half-preparing you for your future job.

You should demand more from yourself.

I think OP was raised with the "everyone gets a medal just for participating" idea. She should be rewarded for just showing up and looking cute in her school scrubs.

[LoveNeverDies]

Graduated in May and I can attest that some Nursing schools are still teaching students their fundamentals in pt. care. (As it should be) If I would have left a patient dirty, went to get an aide to do the work, or said those words, I would have been failed for my clinical. I am now a nurse in an Intensive Care Unit. Guess what? I do ALL of those things for my patient, as we do not have aides on my floor. Guess what again? If I answer a call light for another nurse and their pt needs cleaned up, I do that too, unless my pt's are both circling the drain and I cannot do anything more than give them a quick wipe up. Then I will grab their nurse. Why? Because I can not fathom allowing someone to lie dirty in a bed, be slouched in a horribly uncomfortable position, or have to wait to go to the bathroom in the time it takes me to hunt down their nurse who is probably busy also. I am a Nurse, and I can do everything an aide can do. I hope your view on this changes before you become an RN.

Oh and OP, word of advice, I would take down your picture off of your about me IMMEDIATELY. We have Nurses from all over here, and I am sure if you popped up to work or an interview that this post would be crammed under your directors door before you even made it out of the building.

[BuckyBadgerRN, ASN, RN]

you are purposefully misconstruing her post. her assignment on that clinical day did not include hygiene, presumed to have been learned already and its repeat would be a waste of clinical time.

In strolls a classmate to save OP! Total well-being/care of your patient is part of your EVERYDAY assignment!! I weep for the future if yours and OP's attitudes are what we can expect from current nursing students/future nurses. The real world is going to hit some people hard. Between the eyes. With a chair.

The only thing that is a waste of time in clinical is sitting on your backside complaining that some lowly CNA is refusing to do her job and needs to be punished.

[missmollie, ADN, BSN, RN]

After reading your post about not doing a CNA's job, I knew what was coming. The important thing to realize, OP, is that nursing is about the care of a patient. You should be taught to keep your facial expressions neutral so you don't upset the patient, to respect and protect their dignity. Sometimes this will require that you change their bed or brief, or that you provide a bath so others don't wrinkle their nose.

CNA's do not have separate job duties. They are there to assist the nurse within their scope of practice. If it is in the CNA's scope of practice to provide the care, it most definitely within the nurses' scope as well.

I know this thread is probably not what you were expecting, but please consider it a learning experience. Better here than in clinical. You are there to care and nurse the patient. I often get the best assessment data by providing basic care and talking with the client during that time.

Next week, at clinical, take on the role of CNA as part of your nursing duties. It may change your whole perspective on what's important.

[Quest5, BSN, MSN, RN]

I'm saddened to think that you missed the lessons inherent in your clinical assignment. Yes, you are a nursing student but the fundamental lesson any healthcare student must learn is that it is a team effort. There is no description in a nursing report at change of shift of who did what. You made assumptions, but others have commented on the possible reasons for what you saw.

As others have commented, many diseases will cause the sufferer to have an odor, including renal, liver, advanced cancer and psychiatric disease as well as medication side effects. Experience of these odors teaches us to recognize disease, sometimes before it is clinically evident in laboratory results. Bathing a patient goes beyond removing sweat and grime, as it teaches us to respect the skin, to see telltale signs of pressure before it becomes a decubitus, to check for perfusion and healing. Such experience relates directly to learning the skills of assessment, the RN's first responsibility in the nursing process.

When you get to your class on leadership you will learn that as someone in a position to delegate care to others, you must be able to evaluate whether or not the person to whom you have assigned the task can do it correctly. You are indeed a nursing student and as such you are in a position, through lectures and very limited clinical exposures, to learn what it takes to deliver and delegate care properly. Without personal experience of what is involved in a full bed bath, you cannot expect to effectively delegate these tasks. It surprises many new RNs that a correct full patient bath and full bed linen change can be done by an experienced CNA in an amazingly short time. By learning that level of care, what it entails, and what is involved is a critical lesson for every future RN. Experiences providing the simplest care are not a waste of your clinical time; it directly teaches the knowledge and skills needed by the RN to effectively plan care and ensure its efficient delivery.

What grieves me most is however, is that the patient's bath was a not fully appreciated by you as an opportunity to learn gentleness of touch and the use of self in the nursing process. You did not realize, assuming you did bathe the patient, the subtle effect of a task intended not only to clean the patient, but to promote patient comfort. Patients who cannot communicate openly will often settle and sleep after a bath. It has benefits for both the caregiver and the recipient. Ask any experienced RN if s/he recalls the first, and most recent time, a patient expressed gratitude for the simple act of bringing true comfort just by touch. It is a powerful experience and the bath provides the opportunity. The next time a clinical patient needs a bath, accept the chance to learn from the experience, keeping in mind the bath is not about your comfort, but your patient's. Your nursing education will have greater depth and meaning if you can learn to connect to patients through comfort measures and ultimately, your delegation decisions, when you begin professional practice, will be rooted in reality.

[mrsboots87]

We are also given specific assignments for the day. But we are also expected to help around the u it in general with the "CNA work." I highly doubt then the instructor gives the daily assignments that they specifically say the OP CANT do basic care for patients. In my clinical, our assignments are priority and we are expected to get them done, BUT we are also expected to help. As in, bed baths, vitals, accuchecks and such. By the OP saying "my patient" as in ONE patient, there is no reason there wouldn't be time for basic care. I have one patient and unless I plan to round on them q15min, there is plenty of time for things other than assessment, meds, and skills. And it makes the clinical facility look terrible if they have perceived "lazy" students. They don't care that the student wasn't specifically told to provide basic care. They will just remember that the student didn't. The. Urging world isn't that big and word gets around. Facilities may not prefer students from program A because they weren't taught prioritization, time management, and basic care.

OP I feel truly sorry for you that you are in a program that promotes this uppity attitude towards your "stinky" patients.

Also consider this, my mother was in the hospital for over a week once. Due to her illness and procedures done while there she could only have bed baths. I don't care how good you are at bed baths, nothing beats a shower. My mom would have fallen under the "stinky" category. The nurse or aid helped her bath every evening, but hair is washed and that begins to smell. She was I'll and sweating and overall just smelled off. If a nursing student came in who was too good for patient care because it wasn't part of their assignment for the day, myself and my mother would have refused the student providing any care. You would have had the joy of getting a new patient. And of course to pass meds and practice safely as a student, this would mean a whole new care plan. Plus, it would not look good to management that you weren't providing basic care because it wasn't your job. The basic care is intentionally left not because aids and techs are lazy. It's because they are overworked, and it is saved as a learning experience for you.

In fact, I just aided my NURSE in bedpans, bed baths, foley bag emptying, and peri care on her various patients today. The actual NURSE was doing these tasks. Even though she had some aids, but they were busy and she was in the room when it needed done. I was also sent off to help other patients with care. I did my assessment on my patient. Passed her meds all day and she had many every couple hours. I had to redo a complete patho for my care plan that I messed up, had to do my narrative documentation (requirement by my instructor) and helped with wound care and did an IV insert. It was a busy day, BUT I only had one patient so it was more than manageable and I met all my assigned objectives for the day.

[Leonardsmom,LPN]

While I am a pre-nursing student right now and can't speak from personal experience in a clinical setting, I can speak from the perspective of a CNA for over 7 years and working with many nurses during that time. As a nurse you are trained and able to do everything that a CNA is able to do which includes basic care that a patient may need. Having or conveying the attitude that providing basic ADL care for a patient is beneath you because you are a nursing student and having that attitude once you are a nurse is not going to get you far and will not give you the respect of the CNAs that are working with you. While I don't expect a nurse to do my job for me, when they are able I do expect them to help. The nurses that I respect the most are the ones that help out on the floor, they will get a patient a glass of ice water, or help them to the bathroom when I am tied up with giving care to another patient. They are the ones that will help a patient onto the bedpan when the patient asks them when they are in the room giving them meds, instead of turning on the call light adding it to the over 4 call lights that are going off at the same time, or come looking for me in a patient's room to tell me that room such and such needs ________.

I have had nurses that have refused to help me with repositioning a patient in bed, or help transfer a patient that requires two people when I have not been able to find another CNA because they are helping someone else. Those nurses have very little of my respect, and they are definitely not the type of nurse that I eventually want to be. If your program is training you to have this type of attitude they are truly doing you a disservice.

[Red Kryptonite]

Also consider this, my mother was in the hospital for over a week once. Due to her illness and procedures done while there she could only have bed baths. I don't care how good you are at bed baths, nothing beats a shower. My mom would have fallen under the "stinky" category. The nurse or aid helped her bath every evening, but hair is washed and that begins to smell.

I'm assuming you meant to say hair is not washed. Well why the heck not?! Because you're right, unwashed hair will begin to smell. Seriously, throw a disposable chux under her head, squeeze warm water out of the washcloth on her hair a few times, grab your bottle of no-rinse and go to town! I can usually get it lathered up pretty well that way and then remove the chux, wrap their head in a towel, and then complete the rest of the bath. Then once the sheets are changed and they have a clean gown on, you can remove the towel and comb or brush the hair. It makes a huge difference and I've rarely had a patient or family not express gratitude that we did that.

[Red Kryptonite]

The nurses that I respect the most are the ones that help out on the floor, they will get a patient a glass of ice water, or help them to the bathroom when I am tied up with giving care to another patient. They are the ones that will help a patient onto the bedpan when the patient asks them when they are in the room giving them meds, instead of turning on the call light adding it to the over 4 call lights that are going off at the same time, or come looking for me in a patient's room to tell me that room such and such needs ________.

I have had nurses that have refused to help me with repositioning a patient in bed, or help transfer a patient that requires two people when I have not been able to find another CNA because they are helping someone else. Those nurses have very little of my respect, and they are definitely not the type of nurse that I eventually want to be. If your program is training you to have this type of attitude they are truly doing you a disservice.

Sing it, sister!

[ruralnurse84]

They probably said that because that is what is typical of a nursing student, even an RN student and it is actually a good idea to bathe your patient because as the nurse you need to be able to do everything, including the "CNA's job", so ya you are kind of coming off a little uppity. Also if you bathe your patient you are able to do a better head to toe assessment because you are able to visualize their entire body. Sometimes once you are employed as a nurse you may not have enough CNAs around and you will have to bathe your own patient. Don't get annoyed at those with experience letting you know why you, the student, should be bathing your patient. I am rather surprised that your instructor does not have you do total care. Until I was up to 4 patients during a clinical shift during my second to last quarter, we did total care on our patients.