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.

[RschIVF40]

While I can certainly commiserate regarding the frustration of being pulled in many different directions, and the periodic lack of CNA support. I've been in the same situation many times before and I have also found that discussing these issues with my DON regarding needing more support / responsiveness from the CNAs I work and have worked with, has allowed me and the RNs I work with, to focus on dispending meds as well as caring for our patients in addition to providing the CNAs with a sense of direction / expection. The CNAs that I work with are better able to anticipate needs as they have a set of expectations that includes a checklist with hourly / daily duties. The RNs work more closely with the CNAs as well so the CNAs know what to expect.

On the other hand, I also have had the unpleasant experience of being a hospitalized patient (in a different hospital than I work in), which was not the most pleasant experience, so I can definitely see both sides. Although I wasn't in ICU, in my case, I had a joint replacement surgery, so I was in severe pain.. Due to some complications, my hospital stay was extended. Once the catheter came out, it was all I could do not to cry until someone, anyone (I didn't care who), can to assist me. I was not keen on using a bedpan, but I was rudely informed on the first day after my catheter was removed that I HAD to use the bedpan as there was no one who could take me to the bathroom. As I had a joint replacement, I was not able to maneuver well, and yes, I tipped my bedpan as I was getting off of it...definitely not a good thing to have a wet bed, especially when you can tell the RN who came to change the bed was angry. I didn't say anything or tell her who I was or where I worked. After sitting in a wet bed for 30 mins, I was roughly "assisted" to a chair while I screamed from of pain.

All I can say is, although it can be challenging to be overwhelmed with work and lack of support, I think it is important to at least take a deep breath before helping each patient and remember why we all went into the helping profession in the first place. I don't think anyone wants the patients to "feel" / "sense" the angst we're going through especially because we won't be able to fully focus on their needs if we're overwhelmed and not feeling supported ourselves. Although some days are worse than others, if things don't get better then it's either time to speak to the higher ups regarding the situation or perhaps time to look for new opportunities.

Best Wishes!

[enchantmentdis, BSN, RN]

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.

One of the top reasons I ran from acute care when I had the chance.

[SubSippi]

You are right. I work in a hospital, and if an employee were to leave the pt they would be in trouble. So if the RN tells the pt, "I'll go get the CNA to finish up here. You take your time," they would be in trouble if the pt happened to get up and fall.

We only use commodes for the people who cannot walk all the way to the bathroom, or if it's an isolation issue. I happen to despise them, but I can see the necessity.

They cannot honestly expect you to stand there and wait for the patient to poop. Isn't that what those little strings are for? A confused patient is another story, I'd wait for them.

Sometimes I stay in the room and chart. Otherwise I tell them to pull the string when they're done.

I am also a fan of having a talk with my patients about what would happen if they fall. I let them know it will often cause a longer hospital stay, and not to worry that they might be "bothering" us, because it would be much more bothersome if they end up getting hurt. I don't think I've ever had someone try to get up on their own once I've had this talk with them.

[Karou]

All I can say is, although it can be challenging to be overwhelmed with work and lack of support, I think it is important to at least take a deep breath before helping each patient and remember why we all went into the helping profession in the first place. I don't think anyone wants the patients to "feel" / "sense" the angst we're going through especially because we won't be able to fully focus on their needs if we're overwhelmed and not feeling supported ourselves. Although some days are worse than others, if things don't get better then it's either time to speak to the higher ups regarding the situation or perhaps time to look for new opportunities. !

Good point!

[amoLucia]

They cannot honestly expect you to stand there and wait for the patient to poop. Isn't that what those little strings are for? A confused patient is another story, I'd wait for them.

Oh, yes they do!!! Any pt who is identified as a falls risk (the yellow bracelet, falling leaf/star, etc) cannot be left alone. Some places actually require staff to stay in the bathroom while the pt sits there and pees/poops!

I'll use my judgment for the safer pts as I will be outside the BR with the door cracked open a little as I lean on the wall to wait. But we all know how quick pts can be, and if pt were to fall...

It's a rare pt in LTC who is NOT identified as a falls risk for some reason - like 75% are 'risk' pts. So yes it is a time management issue if you walk in room after room and everyone has to hit the BR. You'll NEVER finish!!!!

[duskyjewel]

Boy, the CNAs sure are taking it in this thread. I won't defend lazy ones or bad attitudes, but that's not always the reason we're not available. I know when I worked in the hospital, on a tele unit that almost always had only two aides for 26 patients, 1/4 to 1/3 of whom were on contact precautions at any given time, if I wasn't available it was usually because I was already toileting, changing, or bathing someone. And so was the other aide.

[Been there,done that, ASN, RN]

Boy, the CNAs sure are taking it in this thread. I won't defend lazy ones or bad attitudes, but that's not always the reason we're not available. I know when I worked in the hospital, on a tele unit that almost always had only two aides for 26 patients, 1/4 to 1/3 of whom were on contact precautions at any given time, if I wasn't available it was usually because I was already toileting, changing, or bathing someone. And so was the other aide.

How are the CNA's "taking it?

I see discussion as how to tag team required toileting and suggestions as to how improve communication towards that goal.