Vent about toiletting patients

[SleeepyRN]

I will start off with a disclaimer that I am NOT saying that nurses should not have to toilet patients.

I'm pretty new to a sub acute rehab facility. 3 months there now. Many of the patients, specifically being there for PT, are non weight wearing and require total assist. This of course means that it takes a good chunk of time toiletting a patient.

So at the end of shift today while giving report, 4 of us nurses were at the nurse's station when one of our ADONs came to us with an inservice sheet saying they have received a LOT of complaints lately that nurses, particularly one (I'm pretty sure it was me) are answering call lights and saying that a CNA will be with them after they are finished with what they are currently doing.

The sheet we had to sign stated that we are all nurses, and that we all know how to toilet patients and must toilet a patient if that is the reason for the call light.

The majority of call lights I answer are for toiletting.

Well....we were PISSED, and all of us spoke up. However, we had our different reasons for being upset. I was upset because our facility strongly emphasizes never passing a call light un-answered. So I always knock and much of the time, yes, I let them know a CNA will be with them. That is after already having toiletted, say, 3 patients, knowing the CNA is working his/her butt off too.

But I can only spend so much time toiletting patients! A CNA made a good point today that MY work has a legal time limit. I'm always always cutting it extremely close with med pass BECAUSE I'm also answering call lights, or a situation occurs. My facility is NOT LTC. Acuity is higher. Two of my patients both had BPs over 200 at the same time the other day at the exact same time a post op patient spiked a fever. LOTS of time spent contacting the doctor, entering new antihypertensive orders, administering the meds, checking and rechecking the BPs during a good 6 hour period for both patients... I eventually sent one to the ER. When I'm not doing med pass, I'm still:

- answering call lights for pain meds (even though they say no when I'm doing med pass...grrrr,)

- doing dressing changes

- working on my admission, (almost every day there is at LEAST one per nurse)

- trying to chart

- give neb treatments

- change PICC dressings

- change ostomy bags

The list continues. I CANNOT toilet every patient I answer a call light for. I do on average 3 a shift. I have on average 15 patients. The reason I'm pretty sure they were talking about me, was because I notice I'm usually the only nurse who answers call lights. All this is going to do, seriously is make me stop answering as many call lights.

ANYway, the other nurses, as I was, were in an uproar saying that the CNAs were lazy and aren't answering call lights. That irritated me. Yes, there are a few CNAs like that. But that for the most part is not the problem. The problem is ridiculous CNA to patient ratios and unrealistic expectations of patients.

Thoughts? Suggestions? We are starting monthly meetings beginning this Friday. When this happened today, I said to the other nurses, "Fine. If they want monthly meetings, then we all need to address this Friday." Well they addressed it right then. The ADON had walked by again. They told her, in a definitely upset manner, that they need to talk to the CNAs. That they are lazy and not and not answering call lights. That's not what I'm seeing the majority of the time. I'm seeing 4 call lights at the same time during my med pass, each waiting to be toiletted. Each getting angry about the wait. These are rehab patients. They are slow. It takes time. Yes, a patient may wait 45 minutes. All the ADON could say was, "I know. I feel you guys. I'm with you." She's pretty much just the messenger of this. This is coming from the DON and other ADON. I get that. It changes nothing.

I try and help the best I can. But 12 out of 15 patients are going to be irritated with ME, because when I have to tell them a CNA will be with them, they all roll their eyes and say, "no one will come."

This is certainly not a unique problem. But now we had to sign a paper saying we will always toilet a pt. when answering that type of call light. It is extremely unrealistic. But they are HUGE, like everywhere else, on customer satisfaction.

[SleeepyRN]

Thank you everyone for your advice and support. I work for a pretty decent facility compared to where I've worked in the past. I have no intention of leaving. But I'm going to cover my butt if a nursing task gets pushed off because I end up in a room with a patient with bilateral femur fractures toiletting him/her. I am going to ask for the paper back, and next to my signature add what was suggested. Agreeing that I will toilet patients by using assessment, prioritization and delegation as I see fit as that is my scope of practice. I'm going to from now on document each and every ADL I perform for a patient. I don't care if it's getting them water. It's taking time doing it. I'm going to document it. Im going to address this professionally, as (of course) I will get push back from management. I will state valid points that no sane person can even begin to argue with. I'm not expecting change. But I want to cover my bases so I don't get in trouble. Thanks so much, everyone.

[anewsns]

I wouldn't take the paper seriously . They are clearly short staffed even though you aren't allowed to say it out loud. Im not even sure what kind of weight a paper like that holds if it's not a law, just a facility policy. They cant discipline you if they need your help and you answer call bells more than other nurses. Your above plan sounds good too.

[Oh'Ello, BSN, RN]

I always say "Someone will be in shortly" or "We'll be right there", always taking care NOT to identify if I'm a nurse, aide or otherwise. That way if theres a reasonable delay no one group of people looks lazy or like they're at fault.

[ORDC]

Seems to me, your facility needs to hire more CNAs.

[cocoa_puff]

https://petitions.whitehouse.gov/petition/provide-federal-legislation-nurse-patient-ratios

Sign this petition for Safe Staffing in hospitals, LTC and prisons. We need 100,000 signatures by 10/17/2015 to garner a video response from the President.

Signed and shared.

[Julius Seizure]

Id be inclined to make a lot of notes in my charting like "med given late due to RN being unavailable while answering call lights promptly per management".

Doesnt solve anything, its just what I feel like doing when I'm annoyed. I wouldnt really. Probably.

[icuRNmaggie, BSN, RN]

Signed and shared.

Maybe they'll have us on the View.

[Glycerine82, LPN]

One thing that everyone should try to do is anticipate the patients needs and try to toilet them before they need to call for help. If more CNAs did this less patients would suddenly call needing to go urgently.

If they're safe to be left unattended you can always use the BSC and have them ring when finished.

Knowing the fastest most efficient ways to transfer specific patients can also save a ton of time, as can multi-tasking on the part of the CNA, as can a seasoned CNA move a lot faster. For example, when I get a pt on the toilet I get their bottom half dressed and ready to go while they are on the commode so that I'm not having them sit down and stand up more than once, etc.

[rnICU303, BSN, CNA, RN]

I agree with the fact that as an RN you have work that only you as the nurse can do. CNA's cannot pass your meds or do your charting, call the doctor etc. So of course we all help out when we can but there are times you need to focus on your 'nurse only' work and that is protecting your license and unfortunately the way it is.

[nursingaround1]

It sounds like your average surgical ward. I had a fempop bypass graft fail, and the patient in agony while we wait for the surgeon to rush back and take him to theater, at the same time my IHD patient was having some serious chest pain, despite the GTN. I was saved by my more experienced colleagues.

Sadly there never seems to be enough staff, whether RN or assistant, but what I have found when emergencies occur, is that a good team helps each other out. With my graft fail patient, I got so tied up in that, I completely forgot my angina patient. It was after returning to the ward that after rushing the patient to the operating room that I remember the angina case, and I hurriedly went there expecting the worst. But he was happily eating dinner and pain free. He said the other nurses took care of him.

I found out that the most experienced nurse had given out all the meds for my other patients, and taken care of all there needs.

This happened in my first year of nursing, in a combined med-surg ward. When I went to thank the nurse, she said 'no problem, that's what we do here, we look out for each other.' It was the best place I've ever worked.

[mmc51264, BSN, MSN, RN]

The buzz phrase I have been hearing lately is "working to full scope of our license" and someone explained to me that this management-speak meaning not just to the top of our scope, but to the bottom as well. That means toileting pts. I work on an ortho floor and toileting is one of the biggest issues and the #1 cause of falls. But the #1 complaint is the nurse not bringing pain meds fast enough. It sucks. can't win for losing.

I try to put them on the BSC or bedpan and then go get the meds and give them after finishing toileting.

[NurseSpeedy, ADN, LPN, RN]

So, you have your assignment that is set up for a team nursing ratio...you answer every call light that you walk by, and now you have to toilet every patient out of 15 that is calling for a bathroom visit...which is probably the most common reason for using a call bell (followed by PRN med request)....how do they even expect you to safely complete the tasks that cannot be delegated to a CNA...sure, if the patient cannot wait or they'll have an accident I can see helping those patients and not delegating and helping with some of the toileting with your other responsibilities but the staffing has to be arranged so that it can be done safely....with this set up I'd rather go back to primary care nursing and have the ratio reflect it.

A facility that I worked at had a meeting when I wasn't there (one of two nurses for the entire facility). Management said that if the CNA could not get to the task immediately then the nurse had to do it....and the aide had no problem informing me of this. At that time I was not only the nurse but also the medication tech because they did not show up...I took my 4 med carts for 110 residents held out the keys (no I wasn't going to really give them to her) and said, "all of these have to be passed in the next hour...would you like to do that while I go answer the bell (which was for a toilet)?"....she didn't like the response but she shut up.