Nursing Staff

One issue that's come up on my clinic this week is what to do when nursing staff aren't doing their job.....quite literally. We had a patient this week who we had booked for 9am....As we were trying to get the ward into a routine, we saw this pt at 9am every day for the 4 mornings we were there. The first morning we had to wait 45 minutes to get the pt as he was still getting ready for the day - showering, shaving etc.....we were quite annoyed but also considerate that the nursing staff can't do everything you wish.....however it was written in both the ward diary, the board and had been discussed with nursing staff the afternoon before. We had also been assured from both the physio staff and the nursing staff that having a pt ready for 9am should not be a problem.

The second day we went in to ask the nursing staff at 8.30 if they would have our pt ready, we were told 'yes, yes ready for 10am' DESPITE it being written again in the diary, on the board, and handed over the day before......and it was the SAME nurse from the day previously, SO our supervisor interrupted the 'getting ready' process and negotiated with our pt to have a shower etc when he got back from physio....which wasn't a problem. Despite the pt being a little upset he hadn't had a shower before physio, he was still happy to come.

The next day, we went in to see how he was going at 8.30ish.....and the pt was still in bed! (same nurse again too). So again, we took the pt to physio, also assisted the nursing staff with transfers etc of him and other pt's in the same room, and took him to the gym. He complained that he did not get a shower the day before due to physio and that he would prefer to have a shower before physio as if he didn't have a shower between 9 and 10 - he simply wouldn't get one for the day....and this was the second day. So....we reassured the pt that the nursing staff would shower him when he got back, and that we would see why he didn't get a shower the day before. You can't really say to someone 'you should have at least received a shower yesterday' and undermine nursing staff.....and you can't simply just say 'oh they must have been really busy' because really - it's a shower!! I was also wondering if I should believe my pt.....he is of considerable age and he is suffering some communication problems.....and I was also concerned that he may have just made it up to try and get out of physio. I didn't want to jump up and down about it if he hadn't received a shower - I was a bit unsure of what to say and do about it - so I decided to wait and see if the problem continued. We liaised with the nursing staff looking after the pt and he reassured us he would be ready by 9 the next day. I also wrote in the 'S' part of our notes that the pt had c/o not receiving a shower the previous day- hoping some kind of response would be in there....to no avail.

The third day.....we went to pick up our pt....he was on the commode....still not showered. So again we helped the nursing staff with transfers....and took the pt to the gym for physio. Not wanting to look like I didn't care, and feeling quite confident that the pt would've received a shower the second day I asked him if he got a shower the day before....to which the answer was no. By looking at the pt's hair and face, it was clear that he hadn't washed his hair (which during he first week was washed every day) and was also not cleanly shaven as per usual as well - so that confirmed it to me that he wasn't receiving a shower, and this pt was not unreliable with anything else. I found myself feeling quite angry that a) this pt's BASIC care was not being carried out and b) it was also contributing to the pt not wanting to attend physio - which it was hard enough trying to get the pt to attend and concentrate.

The pt was trying to negotiate with us to come at 9.30 as the nurse simply didn't have time to get him ready, and continued as to how the nurse was quite rude and rough with his hemi sided shoulder....which we had also witnessed. So...my action was to reassure the pt that he was getting a shower with the OT assessment following physio (he was really worried about not having a shower - this was day 3 and his family were coming in to take him out to lunch), and that we would discuss with the nursing coordinator and tell them that he was not receiving a shower. We also had to reassure the patient that he was supposed to receive a shower each day while he is in hospital.

I carefully approached the subject with my supervisor- not wanting to look like a 'dobber'....and just said....that our 9am pt was complaining of not having a shower for a couple of days....due to attending physio at this time....She immediately asked me if it was the particular nurse involved....and then made it very easy and clear that she would discuss it further with the nursing coordinator as she also had some other issues to raise regarding that nurse. SO...in the end - I didn't have to discuss staff performance with the nursing coordinator (which was a bit of a relief I must admit), and the pt has since been practicing showering with OT each day. The supervisor also reassured me quite adamantly that it should NOT be a problem that a pt is ready for 9am.

One thing that has surprised me, is that our role is not only as 'physio' to provide treatment etc, but we also are required to be an advocate for our pt's in particular scenarios.......So I learnt that it is more than acceptable to stand up for your pt's in this kind of situation - despite being students and it is actually the 110% right thing to do!

Mads