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

[Nurse SMS]

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.

[kmarie724]

What I usually do is put the call light one and start the process of getting them to the BR and then let the CNA take over when they get to the room.

[brandy1017, ASN, 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.

I want to tell them I'll put the light on and the tech will come, but I just don't have the heart to do that when I know they may have to wait a long time for the call to be answered and I'm taking care of sick and frail elderly. I don't want them to have an accident or fall if they can't get to the bathroom quick enough because the CNA's didn't answer the light in a timely fashion.

[nursel56]

Gah. Can't add much to what has been said already but ((hugs)) not.done.yet.

[canigraduate]

I may be reading things into these posts, but I hear a lot of learned helplessness. "But so-and-so won't do this, my manager won't do that..." I know it is difficult, but you can start changing the culture. It takes time and a lot of perseverance.

If a CNA makes it difficult for you, remind them that while you can help them, they can't help you. It is YOUR responsibility to get your job done. If they start complaining, document and report to your NM after you have explained your position to the CNA. It is NOT OK for CNAs to shirk their jobs. In their defense, though, a lot of the time, they have no idea of what you are doing and think that you are being high and mighty.

I have had to sit down with CNAs and explain to them EXACTLY what I am doing and why I can't toilet someone. I am answering the phone, taking to docs, passing meds, looking up meds, and scheduling tests. Not to mention family calls, sparring with pharmacy, etc. These are things the CNAs cannot do, and I ask them, exactly which of these things shouldn't get done so I have time to take Mrs. Smith to the bathroom? They usually apologize to me at that point.

I have also emailed my NM the duties that can be delegated which are elaborated upon in our hospital policies, with a gentle reminder that while it is all ultimately my responsibility, the CNA needs to perform their job functions in order for the patient to be treated safely and effectively.

I may not be the most popular nurse on my unit, but my patients are usually well cared for, so I am OK with that.

With all that being said, I have a special place in my heart for the elderly and often put myself behind helping them out. I do, however, firmly establish boundaries when it affects my other patients.

Here are some practice phrases for you.

"I understand that you want to try to go, and I wish I could help you with that right now. I have a very time sensitive task, so I will call the CNA for you to make sure you get to the bathroom."

"I will be happy to assist you in thirty minutes, I must step down the hall for a moment. If you think that will be too long, I can make sure the CNA comes and helps you."

"Thank you for trusting me, but I assure you that CNA Mary will be more than capable of helping you with this."

For the CNAs: "Thank you for helping me, I have to do such-and-such instead."

Hope this helps some.

[Nurse SMS, MSN, RN]

Part of the problem is that this is a new job for me and I am still learning the culture. We use walkie talkie things to call for help but you have to use first and last name, which I don't know yet. Nobody has given me a list. I think I will make one for myself.

the one who only wanted a nurse didn't want the ethnic male aid helping her. Giant eye roll here.

i was very good at delegating at my last job. The techs here seem way better than where I was. I just have a learning curve to suffer through until things are smooth again. I love the idea f putting on the call light as I get things started. I am going to try that.

Keep the ideas coming and thank you SO much for the sympathy. I am dreading going in tomorrow though I know it will likely be better.

[Karou]

I get a better response with some PCT's if I make it clear to them why I asking them to do something. "Can you take Mrs. Brown to the bathroom? I need to give pain medication to Mr. Smith. Thank you so much, I really appreciate it!"

If I am time crunched, and the patient isn't a fall risk, I will get them to the bathroom and ask them to use the call light when they are finished, then I tell the PCT that I got Mrs. Brown into the bathroom but need to do xyz, so can they watch the call light?

I am always, always expressing to them how thankful and grateful I am for the things they do. Attitude makes a massive difference. When I have the time I also try to help them with tasks or ask them if they need anything. If I see they are busy I will do my own I&O's, daily weights, blood sugars, ect... I have heard that people really like working with me because of this.

I can't believe your manager didn't side with you. Totally agree with a PP who said that while you can do a PCT's job, a PCT can't do yours. And you certainly can't be expected to do BOTH on your own.

[martymoose, BSN, RN]

ugh had this happen tonight.

I still had to pass other meds.

Called tech to help, and did explain II had 4 more minutes to give other person's meds or they woukld be late.Tech understood.

Pt did not.I don't think they ever do.Even if you explain your reasoning why.

They don't care if you have other patients to attend to.

[icuRNmaggie, BSN, RN]

Part of the problem is that this is a new job for me and I am still learning the culture. We use walkie talkie things to call for help but you have to use first and last name, which I don't know yet. Nobody has given me a list. I think I will make one for myself.

the one who only wanted a nurse didn't want the ethnic male aid helping her. Giant eye roll here.

i was very good at delegating at my last job. The techs here seem way better than where I was. I just have a learning curve to suffer through until things are smooth again. I love the idea f putting on the call light as I get things started. I am going to try that.

Keep the ideas coming and thank you SO much for the sympathy. I am dreading going in tomorrow though I know it will likely be better.

Everyone organizes their day differently but I would suggest you introduce yourself to the CNA, get the first and last name, and go over the assignment and ask if she has any questions. Find out when her break times are. Ask how he or she organizes her day as far as baths, VS, FS, I&O, and rounding.

Just try educating each patient at the start of the day to explain how your nursing team functions and to use the call bell. Make sure they know that they CNA checks on them every hour at a minimum.

The LOL who refused the male CNA would be told that Jose does an excellent job and we are fortunate to have him. I personally would not give in to that request.

Patients in cardiac are scared and extra needy. Give them a reality check. " What you have is treatable and you will go home and have a perfectly normal life." Explain that they are being continuously monitored as a precaution. They sense when we are stressed. They want someone who is in charge and in control and who provides structure and a routine. Med teaching happens every time I give them a pill.

I am a firm believer in quiet hours from 2 to 4. All of these people are sleep deprived. There is scientific evidence that cells multiply and heal during sleep. Make sure they know that too.

My sister is a school teacher. Every teacher starts the year off by being very strict and backing off that once the rules have been established. As nurses we can use the same approach with patients and visitors. I am very matter of fact with people. I don't care if they like me but they know I know what I'm doing. I don't do customer service. I do patient care.

Starting a new job is stressful, good luck tomorrow.

[No Stars In My Eyes]

The flip side of the lol's not wanting 'that man' (nurse or CNA) taking care of them, is that once he's been assigned to them, they don't want ANYBODY ELSE for the remainder of their stay! Nothing like being met with a groan from the patient and greeted with, "Oh, I was hoping it would be 'Joe' taking care of me today."

[icuRNmaggie, BSN, RN]

This reminds me of a gentle giant I once worked with named Danny. These little Pennsylvania dutchified old ladies, who barely spoke English, and who had never been around people of a different race, were always asking for Danny and saying go get Danny when it was time to get up.

[amoLucia]

SORRY! You can't have it both ways!!!

Sadly, you want them to be safe; they wear the yellow bracelet. You give them the call-bell and you preach to the choir but ... Nobody has figured it out how to time-coordinate it so that the urge to go is timed to exactly match the time when the healthcare person comes in.

Sheesh, I can see myself in the same situation in my future!!! I take medicine now for OAB and a mild diuretic - holding it can be tough. So when I pass a BR, I stop in for a visit. So in the future, if I'm in a hospital bed, I know I'll be asking the same request.

Gonna' happen!

[SubSippi]

You could get them to sit in a chair that would be closer to the bathroom. Either that, or have bedside commode chairs and bring them next to the bed when they have to go.