While You are In Here..I May As Well Try To Go To The Bathroom....

[Nurse SMS, MSN, RN]

Argh. I had a shift from HELL yesterday and it has left me in quite a funk. I am on a PCCU floor and the patients are generally able to ambulate, but have multiple lines, chest tubes, drains etc and need assistance to the bathroom simply to keep from dislodging all this stuff. Obviously the biggest challenge is the elderly, who also have a walker and need extra support, are super slow, etc. I had three of those yesterday and every single one of them, no matter what I went in the room for, wanted to use the restroom every time I went in. One of them wanted me to wait at the bedside, as they were on hold with their MD office to cancel an appointment they had forgotten about and got quite impatient that I would not stand there at the bedside waiting for their issue to be taken care of before starting the tedious, lengthy process of lining up all the tubes and lines so they would not get pulled out before fetching the walker, at which time another set of adjustments had to be made.

These little potty trips took for.ev.er. I am sure it was just a misalignment of the stars that I got three of these patients at once, who all had multiple med times, blood sugar checks and all the usual things that clutter up a shift. One of them would only allow me to toilet her and shunned letting the tech help. And with as frequently as I had to go into these rooms, even with clustering care, I was running like a mad woman. My Fitbit said I went 6 miles at work yesterday.

What do you do in these situations? By the end of the shift I was ready to pull my hair out. Literally not ONE med got given on time yesterday. As we were doing bedside handoff at the end of the day, one of them asked me again to take her. I asked her to wait until the end of report and then the oncoming nurse or tech would be happy to help her. It felt mean, but geez. I understand they were afraid to wait to ask when they actually had to go because of the time it took to organize everything, but with that many, that often....I was so frustrated I was ready to cry. I didn't even open a chart until 1 PM.

How do you handle these situations? Is there any way to prevent or manage the chaos yesterday was? I have been a nurse for a few years now but never had a shift this bad. I can't imagine telling a person who asks to go to the restroom "no" or saying "I will call the tech for you".....but honestly, I could not get on top of ANYTHING with all these requests going on. Advice? On more than half the requests the patient said they didn't have to go but "may as well try". Gah.

[ChipNurse]

I work in an ICU so I don't have to deal with ambulating patients to the bathroom as we just simply don't have them, but can you bed pan some of them once in a while or a bedside commode when you need to expedite the process? I wouldn't use that route everytime, as it is important for the patient to ambulate, but if they are refusing the aides to help them, then a compromise needs to be made. You cannot be everywhere at once and cannot take 10 minutes to toilet a patient every time.

[iluvgusgus]

I had a male pt who needed to get up to the toilet every 2 hours to pee, he refused to use the urinal....that was aggravating! especially since he had a bunch of lines going on and he couldve used the urinal!

[imintrouble, BSN, RN]

Some patients simply want the NURSE to assist. They don't want the CNA. I used to deliberately time my assessment, minutes after the CNA left the room. I'd follow the CNA down the hall, entering as they were leaving. Cleverly thinking the CNA would take care of all the pt's needs before I got there. It rarely made a difference. The patient waited for me.

As hard as it is, sometimes you have to say "I'll hit your light, and somebody will be here to help you". I only do it as a last resort. Only when I absolutely don't have the time.

I consider potty patrol to be part of my job. But when the CNA is sitting at the desk, and I can't done, it makes no sense.

[Clovery]

I don't have any answers for you, but I feel your pain. I actually got into trouble with my manager once because the CNAs were complaining that I was calling them to get someone to the bathroom when I was already in the room. I went in to hang IV antibiotics, she wanted to go to the bathroom before I started them. The first time I helped her and it literally took 20 minutes because she needed to do everything SLOWLY and on her time "wait a minute! don't rush me!" I can understand that... in your 80s you're not jumping out of bed and skipping to the bathroom but I am a nurse and have other people to pass meds to at 9am. So I tell her I will get the CNA to help her to the bathroom and then come back. Then the CNAs started to complain about me saying that I had an attitude that I was "above helping people toilet" and that if I'm already in the room I shouldn't walk out and tell them to do it. So the nurse manager took their side, despite my protests that I literally only have time to pass meds between the hours of 8 and 10am and my main concern is getting meds out on time. She basically told me to make time and toilet the people myself. The aids were mad because it was interfering with their breakfast break! (have you ever heard of a nurse going down to the cafeteria, fetching breakfast, and then leisurely eating it in the break room?!) Sorry for the rant, but I understand how frustrating it is to have to toilet patients during med passes.

[imintrouble, BSN, RN]

I don't have any answers for you, but I feel your pain. I actually got into trouble with my manager once because the CNAs were complaining that I was calling them to get someone to the bathroom when I was already in the room. I went in to hang IV antibiotics, she wanted to go to the bathroom before I started them. The first time I helped her and it literally took 20 minutes because she needed to do everything SLOWLY and on her time "wait a minute! don't rush me!" I can understand that... in your 80s you're not jumping out of bed and skipping to the bathroom but I am a nurse and have other people to pass meds to at 9am. So I tell her I will get the CNA to help her to the bathroom and then come back. Then the CNAs started to complain about me saying that I had an attitude that I was "above helping people toilet" and that if I'm already in the room I shouldn't walk out and tell them to do it. So the nurse manager took their side, despite my protests that I literally only have time to pass meds between the hours of 8 and 10am and my main concern is getting meds out on time. She basically told me to make time and toilet the people myself. The aids were mad because it was interfering with their breakfast break! (have you ever heard of a nurse going down to the cafeteria, fetching breakfast, and then leisurely eating it in the break room?!) Sorry for the rant, but I understand how frustrating it is to have to toilet patients during med passes.

If ever there was a time when I'd feel comfortable telling a pt "I'll get somebody to help you" it would be during med pass.

I'm surprised your NM didn't take your side.

[icuRNmaggie, BSN, RN]

To notdone yet,

Nip this in the bud by giving the CNA clear expectations. These pts will need you to help them to the bathroom, please offer that on your hourly rounds. You are the nurse in charge of the patient and you need to spell it out sometimes. If they shirk their responsibilities, speak to your immediate supervisor.

These patients do not need an RN to walk them to the bathroom. Put a commode next to the bed on the side of the monitor and say please call for Maggie your CNA, when your are done.

You get them up, if you are there, give them privacy and the CNA can return them to bed. It is a good opportunity to assess skin, mobility, activity tolerance and mentation.

It might help to explain that the nursing team is different than in the ICU and set some firm limits. You have to educate from the minute they come in the door.

The patient may not know that the CNA, who is an important member of the team, does hourly rounding on every patient. Let the pt know that he or she will assist you with toileting, bathing, brushing your teeth, and during meal times. I am responsible for everything else.

If someone said I might as well try as long as you're here, I would explain that I am not the CNA, please use your callbell for assistance when you are sure. Repeat your explanation that the CNA, Maggie will check on you hourly and offer to assist with toileting etc.

There is no way I would stand and wait for someone to make her personal phone call. That is rude. You are not a servant. I would have politely told her to call for the CNA when she finishes her phone call.

iluvgus: Explain to the male pt : here is your urinal just in case. We may not be able to to walk you to the bathroom as often as you would like but we will certainly try.

Frankly it sounds like your CNAs and some of these patients are running you. At my current facility they are required to log in and document their hourly rounds in each patient room and address the four Ps. This is a quality measure to prevent falls, pressure ulcers, increase pt satisfaction and management takes this very seriously.

It is sometimes necessary in these days of high ratios to set limits on patients and families who monopolize your time.

[No Stars In My Eyes]

Last facility I worked at, the med nurse was not allowed​ to help toilet a patient if they were passing meds.

[Been there,done that, ASN, RN]

Delegate! Have the CNA go in ask if they need to be toileted.

Explore their reasons for multiple bathroom requests, could be something going on. Gives you the opportunity to say something like " you just urinated an hour ago.....are you sure you feel the urge"?

Why is it an issue to send the CNA following a bathroom request? You could call for the CNA.. start the line shuffling.. and let the CNA finish the "job".

Did you find out the rationale that the patient only wanted YOU to toilet them? Might have been an off chance you could have done something there.

Just throwing out ideas, I wasn't there... feel your pain.

[brandy1017, ASN, RN]

I work in an ICU so I don't have to deal with ambulating patients to the bathroom as we just simply don't have them, but can you bed pan some of them once in a while or a bedside commode when you need to expedite the process? I wouldn't use that route everytime, as it is important for the patient to ambulate, but if they are refusing the aides to help them, then a compromise needs to be made. You cannot be everywhere at once and cannot take 10 minutes to toilet a patient every time.

Try finding a spare commode. LOL

[brandy1017, ASN, RN]

Delegate! Have the CNA go in ask if they need to be toileted.

Explore their reasons for multiple bathroom requests, could be something going on. Gives you the opportunity to say something like " you just urinated an hour ago.....are you sure you feel the urge"?

Why is it an issue to send the CNA following a bathroom request? You could call for the CNA.. start the line shuffling.. and let the CNA finish the "job".

Did you find out the rationale that the patient only wanted YOU to toilet them? Might have been an off chance you could have done something there.

Just throwing out ideas, I wasn't there... feel your pain.

Problem is the CNA gives you attitude for not doing it yourself and on top of that takes their sweet time going to help the patient! Most of the times when I request help they very leisurely get around to it! But I feel your pain many times "Why don't I go to the bathroom since you're here" is a frequent refrain from my patients too.

[brandy1017, ASN, RN]

We are required to get vitals which invariably leads to a potty patrol, while the CNA's wait for a call light. It is ridiculous because the patients don't put on their light, they just tell the nurse while you're here I have to go. It is very frustrating and med pass can easily get delayed. On top of that dealing with broken dinamaps, batteries dead, BP cuffs missing and the temp probes are almost always empty! I don't no how to motivate the CNA's to do their job let alone take pride in it. We can "ask" for help which is like pulling teeth and you get the run around and the only mode is slow mode. I'm so used to doing everything quickly to get my assessments and meds passed in a timely manner and it is frustrating to work with coworkers that drag their feet and take their sweet time when you try to delegate. If I hear a call light going off, I will try to finish up what I was doing quickly to check on the person, where as they will just keep doing what they are doing and feel free to ignore the call light. Management would get on us if we asked someone else to toilet someone and why aren't we answering the lights, it is all our responsibility. Just one of many pet peeves as nurses we are expected to do everyone elses job on top of our own, but no one else can or will do our job!