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.
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.
Thanks. The point of the paper is so that if we don't follow through with what we signed that we would do, they could later easily show me my signature and discipline me.
Of course they can still discipline me, but I'm big on principles of things.
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.
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.[/quote']
Where do you work.. that you are not required to identify your ROLE? You are not realizing the main issue. OP in is a you-know-what hole.. and outrageously overworked.
Ignoring the issue, and blowing off responsible.. is not the answer.
Where do you work.. that you are not required to identify your ROLE? You are not realizing the main issue. OP in is a you-know-what hole.. and outrageously overworked.
Ignoring the issue, and blowing off responsible.. is not the answer.
On top of that, no matter what, we ALL end up looking bad. I can't believe that someone complained that I, the nurse actually answered a call light. But the majority of patients don't know the difference between our roles and just give a generalized complaint. "They." "No one." "Everyone."
Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.
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.
Actually, those "few" lazy CNAs are why you are doing lots of answering the call lights and toileting pts. Management needs to re-place the "few" lazy CNAs. I do not miss acute care for this reason.
My facility implanted a policy that we are never allowed to walk past a call light. Never.
I was once reprimanded, formally, for passing not 1 but 2 call lights even though I was passing those lights because someone had a rhythm not compatible with life and needed a code called.
That manager hated me and that's when I realized that many policies in my unionized hospital are there to give them a reason for discipline.
We have the stop for every light policy as well, and I completely disregard it every day I work. It's delusional. I'm not stopping for a light if I have a narcotic in hand to pass, or going to check on a pt tele just called v tach on, or I know I have a doctor waiting for me in another room waiting to do a dressing change with me.
We have the stop for every light policy as well, and I completely disregard it every day I work. It's delusional. I'm not stopping for a light if I have a narcotic in hand to pass, or going to check on a pt tele just called v tach on, or I know I have a doctor waiting for me in another room waiting to do a dressing change with me.
Yeah, I've worked at places with that rule. It's really made because managers don't want to confront the two or three people, usually CNAs, who ignore call lights.
I was stopped once for passing a call light. I reminded the manager that part of my interview was based on prioritization, then listed out the six things I was doing and asked her which of those was less important than answering the call light, which I knew was for getting a coke.
A hospital I worked for tried to implement a policy that ALL staff must answer every call light they see....including housekeepers, maintenance, etc. The non-clinical staff attended an inservice on how to basically tell the pt what many of you aren't supposed to, "someone will be right in" and which staff to notify when the pt wants toileting/pain meds/food/family wants updates etc. I think technically it's still a policy but exactly no one does it, mostly because they (rightly) feel that being slightly faster to move someones obt, turn off the tv or the few requests that anyone can help with does not balance out the majority of pts just being annoyed at having someone walk in and tell them to wait. Plus it is a waste of staff time.
You are in charge of your practice and prioritization. How juvenile to ask you to sign a document that mandates you to answer call lights and perform the CNA duties.
Maggie - While I totally understand where the OP is coming from, I gotta disagree with your post. Since when did it become *only* the CNA's duty to answer a call light? I don't care what kind of nurse you are, you are not above answering a call light or helping a patient to the toilet.
I do however, understand where the OP is coming from and it sounds like the problem is more of a staffing issue than lazy CNAs.
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imintrouble, BSN, RN
2,406 Posts
Now I see it's to replace the "old" nurses, who simply don't want to nurse on a tightrope.
The result is being back to square one. Not enough staff.