Turning Patients

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I know this sounds cruel but has anybody not turn a morbidly obese patient because they could not get help? I know we are suppose to be the patient care advocates, however, we need to watch for out health first and I am not willing to risk a severe back injury to turn a 300+ person myself! :dzed: I just get sooo mad when I see these patients that are severely obese and are taxing the resources of the hospital staff and health-care system. :mad: Sometimes I think it is all when can do just to make an obese patient comfortable!! Just ranting here but want some opinions from fellow nurses. I'm a relatively new RN and I don't know if I can stay in bedside care if this is the future of our patient care population!:banghead: PLEASE GET SOME EXERCISE AND STOP EATING SO MUCH FAST FOOD AMERICA!!!:hdvwl:

Wow....I let out a giggle to this because I've felt the same and never have said anything. At my hospital we have bari MAX beds that are suppose to turn huge patient but my manager insist that the beds turn the patients but doesn't lift their butt, so technically they can get breakdown. Then my manager rounds just to make sure you're turning these 400 pound patients. I'm like get real! These patient's are on air beds. If they are too big and get breakdown then so be it. Using those lifts take 30 min to get out and maneuver and you still need someone else. They are really useless sometimes.

Tell your lazy (fill in blank) manager to roll up his/her sleeves, get a pair of gloves and help!!!! When they go home at the end of the day/night with an aching back, maybe they will understand. Turning any patient greater than 30 degrees via a turning bed will contribute to breakdown due to shearing action.

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Specializes in ER, ICU.

Just look at all these corn fed Americans as job security and a paycheck! This is a good venue for you to campaign for improvements in your work environment. Keep track of the times you can't turn a patient for lack of resources. Then present your concerns to your boss, risk management, and the CNO. You should also poll your coworkers and see if they feel the same way. I would never try to turn a patient like that myself.

Luckily we have ceiling lifts in all our rooms. We also have three types of specialy beds and can get others, like bariatric.

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Specializes in ICU, Research, Corrections.
I've found myself asking "How big are they" during report when I get a new patient I've yet to have. It's nice to hear that they're so tiny you can turn them and bathe them yourself without any strain lol.

:lol2:

I consider myself lucky if they weigh less than 150 kg for a new admit. I have

been getting so many super morbidly obese patients it's ridiculous. And, that's

why I am getting them in ICU - they are too fat to breathe.

Once upon a time, I had a 500 lb pt who had terrific diarrhea. The unit was

on extremely low census that night. I only had one other person working with

me. I could not leave that pt anymore in all that diarrhea - so just two of us

worked on him. Hey, that's all there was available. I ended up with a intercoastal

cartilage rip - NEVER going to do that again. It's not worth risking my health

over.

Once your back is messed up you are yesterdays news.

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Specializes in icu/er.

hmmm, if i injure my back trying to turn 500-600lbs to where i'm put on injured reserve there is a very high chance that my spot will be filled by another nurse. also, if it comes to the point where i have frequent office visits and rehab sessions that cuts into my work schedule i'm pretty sure i'll be given the boot. then who is going to hire a nurse with a crippled back? now i cant pay bills and the repoman visits me. end result for me will be a etoh dependent disabled male showing up in your er at various times complaining of back pain. wow, i just had a triage flashback!

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Specializes in Dialysis, Hospice, Critical care.

Does anyone know of a study addressing the issue of proper stafing ratios for caring for morbidly obese patients in an ICU setting?

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I had to giggle a little when I read these posts because I have had a few similar experiences. I tend to think to myself how ironic it is that I go to the gym four days a week (every day off) to lift weights and do cardio so that I can be fit enough to perform my job - which would be sooooo much easier to do if they (the supersized pt) would only be so inclined. Seriously!!

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Specializes in ICU/CCU.

The families of these patients are as much to blame as the patients themselves and, at a certain point, they are more to blame. Even at home, many of these patients cannot raise their bodies from a bed or couch (Lord, how many are actually living on the couch, often in their own filth), and someone is BRINGING them enough food to sustain their massive weights. These enablers should stop bringing these people all but the healthiest of foods! in sensible portions! Lock the refrigerator! Throw out every bit of processed food in the house! Remove the television!

It doesn't even stop when the patient is hospitalized. As soon as the patients can eat, the family is bringing crap food from home, so the patient can stuff himself. I had one lady with a BMI of 60 who said she could not eat our hospital's food (she ate only the desserts) and had her husband bring her fast food for every meal. She could barely breath when she fell asleep! She was diabetic! I wanted to smack the man each time I saw him. It was like he was a farmer and his wife was a pumpkin he was planning on showing for a prize at the state fair--how big could he grow her? Ugh.

I still feel pity, but I refuse to sacrifice my health for these people anymore. Time was when I would spend extra time moving all their limbs (in addition to q 2 turns) to make them more comfortable. But I threw my back out once last year just trying to reposition one man's massive leg. I just tell them "sorry" now and that I have to wait for several people to help me before I can do anything for them. If they complain, I explain that my back is my livelihood. As diplomatically as possible I explain to them that if I must choose between supporting my family and turning/lifting them, I choose my family's welfare first.

Also, I will chart "sufficient staff unavailable to turn 400 lb patient" to get management off my back. We have been lectured repeatedly and blamed for our high rate of back injuries. In these lectures we are told that no one nurse may lift more than 30 pounds! That means that to follow our own safety rules it would take 13 nurses to turn/boost one 400 pound patient. That number exceeds the number of nurses on our unit any given night!

The problem will only get worse. America is getting fatter and fatter. Obesity rates are astronomical among elementary school age children. We won't have to wait for these kids to get old before they show up in our ICU. Many of them will have severe complications from diabetes and heart disease before they hit 30. The only solution I see to managing healthcare for this morbidly obese population is in technological advancements since nurses are not going to get any stronger, and staffing levels will not get any better. Soon every ICU room will have a hoist in the ceiling, and every bed will be a bariatric bed/chair. I think I will invest in companies that make bariatric medical equipment.

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Specializes in Critical Care.

Wow I never thought so many people felt the way I did!:rckn: It's not even worth trying to get these patients to change their habits when they don't care about their own health. The "I didn't know a double quarter with extra cheese, super size fries and a diet coke was bad for me" excuse is just pure idiotic :bugeyes: I'm not saying people can't change but they have to be willing to change themselves and families need to put there foot down (or food down) sometimes. :banghead:

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Specializes in MICU, SICU, CVICU, CCU, and Neuro ICU.

Our hospital installed lifts in the ceilings of many rooms in the past few years. The lifts have a 500 lb weight limit. Fortunately, someone was wise enough to install some lifts with a 1,000 lb weight limit in some of the rooms so we can use the lifts on larger patients.

Its sad that we need patient lifts with a 1,000 lb weight capacity.

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Specializes in ICU & ED.

I once took care of a patient who was SMO and couldn't fit in the MRI... The hospital had to send the patient to the zoo to use the MRI for the large animals! The family was really mad at us, insulted...

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Short answer: no. Don't turn or lift people without adequate help. You can't be expected to do things that you can't physically do safely. No one in management or on the medical staff (the other people concerned with preventing skin breakdown) would be expected to turn these people without adequate support. If you can't do it, you can't do it.

Of course, you'll be expected to bring this to their attention, because you're the nurse and they can hold you accountable if you didn't alert them to the obvious facts (which seems to be the usual thing, holding your license to their insufficiencies)...but still. Don't do it.

Also keep yourself in shape, and consider short-term disability insurance or accumulate six month's worth of income in case worker's compensation doesn't work out.

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I am new to ICU but can totally relate with what everyone is saying.

One reason I was so excited to switch to ICU from med/surg was because I could finally perform "excellent" patient care..."At last!" I said to myself, "I won't have to depend on CNA's to turn my patients (Or feed, or toilet). I can do it myself and I know that it will get done the right way!"

Well, reality set in quickly! (God bless all you CNA's!)

We have a max of 5 nurses working in our ICU. We fired our CNA's last year due to budget contstraints. For various reasons, we have no secretary at this time. All it takes is one or two nurses to have an admission, a code, or a crisis, and our large patients aren't turned. Even if my patients are stable, I am not going to ask another nurse who is trying to keep her patient(s) from coding to help me turn my patient. It's not right, but that is the first thing that does not get done when we are busy.

We have a skin care team that rounds on patients and makes sure that we have charted our turns. It is very demoralizing to have them say to me, "You have not charted all your turns." If I have not charted a turn, that means I have not turned the patient. I am not going to chart something that I have not done. I feel like they should ask, "Why are people not turning their patients?" Instead the higher ups are concerned about what is documented.

I am frustrated because I want to provide excellent care, but I don't feel that I am. I am unable and unwilling to turn an obese patient by myself. I guess I thought that only the med/surg floors were shortstaffed, and the ICU's were immune (I can hear all the older ICU nurses laughing). I feel that my hospital looks at the bottom line rather than patient acuity when buying equipment or staffing.

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