Whad I do -- Whad I do??

[interceptinglight, CNA]

I got ripped a new one by a nurse the other night. I was working a 5-9 pm shift with my partner, it was our job to give the evening showers (this is a LTC facility). 15 minutes before my shift was over I was assigned to check on Mr. B, a resident who was on 'comfort care' because of non-compliance with care procedures and refusal to get out of bed, be bathed, or eat anything. He reportedly had a very large decubitus ulcer on his coccyx and was always belligerent and abusive to staff; he had recently hit his granddaughter who visited. Mr. B had a large wet spot on the front of his hospital gown that appeared to be urine.....an odd thing in a man with an indwelling catheter. It took both me and my partner to just change his gown because of how violent he was. I asked the nurse, an LPN who'd recently been reprimanded for something reported by one of the CNA's, I don't know what it was for. My partner and I had to, as gently as possible, reassure Mr. B as we held his hands back so that the nurse could check on his catheter. He slipped out of our grasp and grabbed ahold of the catheter giving it a good yank. Fortunately we got his hand off the catheter long enough for the nurse to get a puzzled look on her face.....it appeared there was something wrong but she couldn't tell exactly what. She mentioned that perhaps he needed a new catheter. She made a snap decision and ordered us to 'just put an incontinence pad underneath him and we'll tell the NOC shift. I don't have time to do a catheter before my shift is over, I have residents who need insulin right now.' It was nearly 2 hours before her shift was over, by the way. I just stared at her for a moment. He needed a complete linen change as he was lying in a wet substance and already had a large bed sore, but we were just to put a 'bandaid' over him and pass the whole mess on to the NOC shift. I thought her attitude sucked and I had a discussion with my 5-9 partner about it, she agreed. I would have been willing to stay past my shift to assist with the nurse taking care of the catheter change and even brave his fists during the linen change but I was overruled by Nursing Protocol.

The next day this LPN took me aside privately and got all red-faced as she told me that all the other nurses who heard about this told her to report me!!! Report me for what??! I asked....she said.....CNA's are not supposed to dictate to a nurse what the protocol is.....insulin is more important, according to her, than changing a catheter. OK fine, I said, but I didn't go blabbing and complaining to the nurses behind her back like that -- apparently someone overheard the conversation after the incident and went around telling everyone that I was 'all upset' and arguing with that nurse about how to do her job. I informed this LPN that I only discussed this with my partner and someone else who overheard was spreading intrigue the other nurses. Good grief!! Apparently if you don't like something a nurse does, or just don't understand 'Nursing Protocol' you're liable to get reported. Heck I better just keep my big yap shut from now on....or at least avoid that particular LPN. I think she was already on the defensive for getting upbraided about something. I apologized and reassured her that I have yet to report anyone and I don't plan on ever doing it unless a resident is being neglected or abused. After this incident I've tried extra hard to be nice to this nurse, because she talk to me privately about this instead of reporting me and I appreciated it. I still think I didn't really do anything wrong, other than project to her during the incident that I didn't agree with her 'protocol' and that just passing stuff you don't want to do on to the NOC shift is not cool.

[fuzzywuzzy, CNA]

I better just keep my big yap shut from now on

Ummmm... yeah. lol.

I'm sorry this happened to you; it sounds frustrating. But it doesn't seem that unusual-- a few people responded to a stressful situation by running their mouths and griping at each other. It might not be professional, but it's a normal reaction and I'm sure it will blow over.

I know it's not cool to pass things on to the next shift, but sometimes there's no other way around it, and it sounds like this nurse had a valid reason.

[CoffeemateCNA]

Medications *are* more important than catheters. You can wait to pee for 1-2 hours, but if you wait 1-2 hours for insulin, well, it's bad. The night shift's world won't end if they have an extra 10 minute procedure to do.

If you don't want other people to hear your conversations, wait until after work to talk, or whisper to each other in an empty room. There are ears everywhere.

[KimberlyRN89, BSN, RN]

You really have to watch your back. Like coffemate said, its best if you talk quietly. But me, I wouldn't say a word b/c you never know who you can trust.

[luvs637]

I disagree. You did nothing wrong. Insulin can wait 10 minutes until the linen is changed. Then she should give her insulin, then return to the catheter. No one should ever lay in urine soaked linen, that's disgusting.

[nursel56]

I disagree. You did nothing wrong. Insulin can wait 10 minutes until the linen is changed. Then she should give her insulin, then return to the catheter. No one should ever lay in urine soaked linen, that's disgusting.

Not even kind of true. In any case, it's not your decision to make. Everyone has a job to do, they know how many people they need to medicate, with what, and what needs to be done before the med is given. It doesn't sound to me like this nurse was the type who would not have done the entire linen change right then and there. Although 2 hours sounds like a lot of time to you, the last two hours of a busy night are crunch time.

Which is why I would never tell a CNA how to prioritize her tasks unless something out of the ordinary happened. OP- I don't think you did anything wrong. The issue was the eavesdroppers who decided to crank up the gossip mill. The LPN just may have been emarrassed and upset by all the talk. I would never criticize someone who was as concerned about the patient's comfort as you are. Maybe look around for people hiding behind doors next time? (kidding) :)

[JDZ344]

I disagree. You did nothing wrong. Insulin can wait 10 minutes until the linen is changed. Then she should give her insulin, then return to the catheter. No one should ever lay in urine soaked linen, that's disgusting.

That would be pointless. If the catheter is bypassing urine, which is sounds like it was, the sheets would be soaked again by the time the nurse returned to insert a new one. Then you would have to change the linens twice on a combative patient.

[interceptinglight, CNA]

That would be pointless. If the catheter is bypassing urine, which is sounds like it was, the sheets would be soaked again by the time the nurse returned to insert a new one. Then you would have to change the linens twice on a combative patient.

Yes, that's pretty much what I'm saying.......the nurse wanted us to put an incontinence pad on top of wet sheets underneath a resident with a leaking catheter, and the result was going to be a soaked incontinence pad on top of wet sheets for the NOC shift to change. There are less people available on the NOC shift as well.......several CNA's less and only one nurse. My partner and I could have done the linen change without the nurse's help anyway, even though we would have had to stay an extra 20 minutes to half-hour. As far as 'crunch time'....it was actually the quietest time of the evening when almost everyone had already been toileted and put into bed. There weren't a lot of call lights and interruptions to deal with at that time and it's usually pretty easy to get caught up on things before clocking out.

The other factor in this situation getting out of hand was the fact that the nurse in question had already been chewed out by the DON because of complaints by a CNA who has a particular disliking for her and perhaps she was nervous about all the fuss that got kicked up. Her method of 'damage control' was to beat me to the punch of threatening to have me written up.

If anything like this does come up again, I'll certainly be more careful about shooting off my mouth.

I'll just come here and grumble/gripe/complain/grouse/yammer/blabber/etc. to my heart's content.

[mazy]

You have a good work ethic if you didn't want to pass this off to the night shift so I understand your concerns.

However, I also understand the LPN's concern about getting her insulins done. For you things were quiet, for the LPN that time of shift can be make or break because the nurse's duties cannot be passed on to the night shift.

Nurses are under tremendous pressure to get the med pass done within an hour of when they are due -- which for an evening pass is usually by 9PM and no later, and that almost never happens because of all these crisis issues that can come up at the last minute. And the insulins are very important.

Usually by that time of night I am in a state of desperation and panic as I am pulled away from my cart for one thing after another.

And once you get into a patient's room and start doing a catheter change, especially on a combative patient, you have no idea how long it can take -- it could eat up the remainder of the shift.

Then end of shift rolls around and you haven't finished your patient care, and the next nurse is there impatiently tapping her foot because if one nurse gets behind then the next shift will start off already behind.

If I had been that nurse I would have finished my med pass and then gone in to address the catheter issue.

If I were in that position (and I used to be a CNA so I can see this from your side) I would have done a complete linen change and placed several incontinence pads, told the nurse I would be available to help when she was ready, and left it at that.

[luvs637]

I understand the priority of getting the meds passed, but my perspective comes from working in a hospital where the nurse and cna would both be written up without question and possibly fired for deciding to leave a patient laying in urine. As far as placing extra chux underneath the patient, we aren't even allowed to do that, especially not on someone who has a bed sore, no room for air to flow in and out--at least that is the policy where I am from.

[JDZ344]

I understand that it is never ideal to leave a patient lying in urine or soiled. Would you get written up regardless of what was happening at that time? I've had to leave people lying wet for a very short time before (maximum 30 mins)- but only because I've been caught up in something or helping with some emergency or more vital task. I always feel bad but CNAs and especially nurses do have to prioritise.

[loriangel14, RN]

Sometimes as a nurse you have to prioritize. Getting your med pass/insulins done would take priority over personal care for a patient.