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.
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.
That is the exact policy we have. So I answer, often with meds or tx for another patient in hand, and tell them their aide will be in. But apparently my nursing supervisors expect me to drop what I have prioritized to toilet them. Frustrating. I'm actually meeting with them over this, as it's....big shock, preventing me from getting very important work done that they are NOW coming at me about.
So I'm going to tell them. Which is it? Do you want my admission assessment in on time for the Joint Commission standards you are heavily heavily emphasizing being done and charted within an hour? Or do you want me to throw my prioritization and delegation skills out the window and toilet 5 patients in a row, being unable to not only not get the admission assessment entered, but....hello? My meds. My treatments. My assessments on other patients, all on time.
So you feel your too good to help a patient to the toilet just because you're an RN?!..
I'd bet you'd never tell a potential employer that at an interview.
I sincerely hope you weren't refering to my post. As I have stated, I DO toilet patients, but have to get my other work in too. That's why we nurses have a little thing called prioritization and delegation. If what I am in the middle of is of higher priority than toileting a patient AT THAT VERY MOMENT, then I say an aide will be with them, OR that I will be back if the aide is still not available.
So if this was NOT in response to my post, remember the quote feature helps prevent confusion.
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.
I apologize. I didn't see this before my latest response. Just remember, quote function is your friend ;-)
And while I do enjoy other NoADLs posts on this site, I do very much disagree with his opinion on, well, NoADLs.
That is the exact policy we have. So I answer, often with meds or tx for another patient in hand, and tell them their aide will be in. But apparently my nursing supervisors expect me to drop what I have prioritized to toilet them. Frustrating. I'm actually meeting with them over this, as it's....big shock, preventing me from getting very important work done that they are NOW coming at me about.
So I'm going to tell them. Which is it? Do you want my admission assessment in on time for the Joint Commission standards you are heavily heavily emphasizing being done and charted within an hour? Or do you want me to throw my prioritization and delegation skills out the window and toilet 5 patients in a row, being unable to not only not get the admission assessment entered, but....hello? My meds. My treatments. My assessments on other patients, all on time.
Having an assessment charted within an hour isn't even a standard in critical care. I can't imagine that's actually the case for TJC accredited LTC facilities. That may be a *company* policy that TJC holds the facility to following - but I can't imagine that's an actual TJC rule.
I agree with both. First, it is a matter of prioritization. It's the reason we have CNAs- to do the things that can be delegated to UAP so that RNs can focus on the stuff we can't delegate. It irritates the heck out of me that employers don't back us up on this.
Secondly, I agree with NoADLs. Not that I think RNs are above assisting with ADLs, but that I dislike assisting with ADLs. No ADLs for me! Of course, I do them when needed, and I won't pawn off the dirty work on the poor tech, but I certainly don't enjoy toileting patients. I'm not afraid to admit it.
You guys are mind-blowing. Goodness forbid something happened to you tomorrow, you ended up in a SNF & pooped on yourself because no CNA was available & the nurse thought she was too good to help you to the toilet.
I see it's time for me to checkout of this discussion.
Have you ever worked in LTC? If you haven't you're very quick to judge and don't know what you're talking about. If you have - methinks you're either delusional or in a country club-type private facility.
You guys are mind-blowing. Goodness forbid something happened to you tomorrow, you ended up in a SNF & pooped on yourself because no CNA was available & the nurse thought she was too good to help you to the toilet.
I see it's time for me to checkout of this discussion.
Only one person stated that he thought RNs were above toiletting patients. The other posters stated their nursing rationales for attending to another patient first. So relax on the plural "you guys are mind blowing."
Only one person stated that he thought RNs were above toiletting patients. The other posters stated their nursing rationales for attending to another patient first. So relax on the plural "you guys are mind blowing."
I agree. I can't believe that NOADLS was the only poster, pretty much, who said this, we told her that NOADLS always says this, and we agree to disagree with him, and she is still flouncing.
Having an assessment charted within an hour isn't even a standard in critical care. I can't imagine that's actually the case for TJC accredited LTC facilities. That may be a *company* policy that TJC holds the facility to following - but I can't imagine that's an actual TJC rule.
It's not LTC. It's an accredited Post Acute facility, held to different Joint Commission Standards, as I learned today in my Joint Commission training class. The 1 hour is what they want to see for care planning. I mis-spoke. I mistakenly crossed topics of what my facility wants regarding timing of admission assessment vs me toileting a pt documentation and care plan that JC wants to see within 1 hour.
Basically, in order to be accredited (whatever the word is, certified...) as a Post Acute facility, we have to prove we know what the first priority is for an admission patient.
Ex 1: Patient with LifeVest is admitted. Priority: Vest on pt properly, leads attached, ....plan: what to do if certain alarms go off, etc...
Ex 2: COPD as primary dx: priority: O2 hooked up, ready to go with all other respiratory equipment in room (neb tx...)
SleeepyRN
1,076 Posts
That is the exact policy we have. So I answer, often with meds or tx for another patient in hand, and tell them their aide will be in. But apparently my nursing supervisors expect me to drop what I have prioritized to toilet them. Frustrating. I'm actually meeting with them over this, as it's....big shock, preventing me from getting very important work done that they are NOW coming at me about.
So I'm going to tell them. Which is it? Do you want my admission assessment in on time for the Joint Commission standards you are heavily heavily emphasizing being done and charted within an hour? Or do you want me to throw my prioritization and delegation skills out the window and toilet 5 patients in a row, being unable to not only not get the admission assessment entered, but....hello? My meds. My treatments. My assessments on other patients, all on time.