Delegation is a precarious thing. Ask in the wrong tone and you're in the doghouse. Ask too nicely and you're ignored. I once read it's not about getting them to do what you want but getting them to do what they think they want. While there is some truth to that, the same doesn't apply at all times in nursing. It is not possible to make a nurse's aid/tech think they WANT to change a poopy diaper. (Oh, and in nursing school, they threaten you under penalty of expulsion to use "incontinent product" instead of diaper.) Face it. It's a diaper. It's not degrading to call it what it is. People have to tinkle and drop the kids off at the pool and need something to catch it. You can label it fancy names but if they're wearing an "incontinent product" it's because they can't hold their post-products long enough to make it to the throne and that's nothing they would ever choose. It shouldn't be an embarrassment or something to be politically correct about. It's life and if you kindly refer to it as a diaper outside of the patient's room, it's not demeaning. But all the same, I doubt I'll ever meet a tech who gleefully races in to fecal matter. Be nice. Be firm. Offer to help. Be the nurse who the techs love to work with and in time, you'll find that most will respond by taking good care of the patients without your having to ask.
And there's ethical/legal dilemmas to conquer as well. I have a patient this week who's been bedridden for 17 years. He has Parkinson's, some Alzheimer's, and is contracted from not using his muscles. His elderly wife has been taking meticulous care of him all this time...feeding him, changing him, caring for his skin, and now is in charge of his feeding tube. She told me about the many different medical supply companies she uses to get bargains to afford the enormous amount of full-time care that her beloved husband requires. One item she pointed out is particularly costly. It's a moisture barrier for patient's perineum area so that the tinkle and fecal stuff doesn't break down his skin. Comes in a small tube but is very costly for this fixed-income family. Legally, she can take leftover supplies with her because they have already been charged to her husband's bill. So whatever is in the room is technically hers. He's also on contact precautions for MRSA so whatever enters the room stays.
Legally, I crossed the line. Ethically, I stand by my actions. When she came in to sit vigil, she was talking about the additional cost of the feeding tube supplies. I asked her to look in his nightstand. She opened the drawer to find that two tubes of the moisture barrier had magically appeared during the overnight shift. "Gee, once something enters the room, it's really the patient's, so, you know, if you wanted to take those home so they don't go to waste, I think it'd be alright." She had tears in her eyes and held them like they were Coach bags. Legally, I know I can't do this often. Ethically, I bless that woman for the consuming care she gives her beloved. Life's not always about doing what's right by the legal world. At least she won't have to eat as much mac and cheese this month.
This same woman asked that the tech change her husband's "incontinent product" without dropping the bed totally flat because she truly feared he would aspirate, even with the feeding tube temporarily turned off. The tech balked and did it per hospital routine. Delegation was tough but I had to request that my favorite tech leave the bed at 15 degrees to allay the fears of the patient's wife. It wasn't easy to go up against my favorite tech, one who's been at the hospital for six years. But it wasn't harmful to the patient and gave the wife enough peace of mind to leave early to get sleep. She told me she has never left early. But she knew that because I followed her meticulous care routine, she could trust that her husband would be just fine. Delegation and leadership are not easy. Especially when I'm the new guy. The tech grumbled but agreed with my explanation that this patient is so loved by his wife in the care she gives him that it's probably worth doing things a little bit differently this week.
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