I'm a little more than half way through an LPN tech school course. We are taught a lot of behaviors and ideals that, based on my clinical experience and personal and family hospitalizations, are largely ignored or bypassed out in the real world.

From simple stuff like failure to adhere to good prophylactic handwashing and keeping an "aseptic conscience" in supposedly sterile procedures, to outright fraudulent charting, re-labeling of old dressings, covering up med and other errors, there seems to be a rather large gulf between what we are taught, and what we will be allowed and maybe even expected to do (or get away with) in practice.

I hope to be able to keep to my own standards and still stay employed, and I know I am a long way from being even a minimally competent nurse and have seen a very small part of the medical world to date. But what can one do about all the nosocomial-inducing, abusive, dishonest and downright stupid actions and failures to act that are what we are told to just expect in the "real world?"

Another recent peeve is in the area of "patient teaching." Leaving aside the frequent charting fiction that "pt instructed in xyz, return indicated comprehension," the teaching I have seen is sometimes either perfunctory in the extreme or merely a matter of handing the pt or caregiver a set of pre-written standard instructions and pushing the wheelchair out the door. That applies of course to MDs as well as nurses at all levels. I expect some institutions do it better, but maybe the dollar-driven race to the bottom line, coupled with maybe a decline in the basic quantum of fellow-feeling, empathy and civility, makes so much of this inevitable.

What can nurses do to stem the decline, other than in their own little circle of action on the job on their shift and floor?

Hi jtmcphee, I have 1 semester left in an RN Program and have absolutely observed everything you discussed in your post. In school we are taught to be so careful, take precautions not only for your patient, but also to protect your own health, etc. Good handwashing is paramount, gloving when necessary - most of it is common sense, but unfortunately not always observed by the Nursing Staff on the floors who should know better and who we are looking towards to be our role models.

Of all the clinical rotations I've been through, the scariest thing I've seen is several Nurses in L&D starting IV's (without gloves) on brand new patients to the floor (their health histories were unknown and they could potentially have had any number of diseases). One patient's new IV blew her vein and the Nurses hands were covered in blood. What she did would have a Student Nurse tossed out on her head, but she was a Staff Nurse and was supposed to know better (so much for gloving/handwashing, etc.). This was an emergent patient and I was there with my Instructor to give the patient a shot of betameth. - as emergent as it was, I took 2 seconds to put on a pair of gloves before giving the shot. The Nurse with the bloody hands was looking at me like I was some sort of paranoid nut (taking the time to put on gloves), but my Instructor looked at me and said "you did the right thing" - and her words were all that mattered to me. That same day another "ungloved" Nurse tried to hand me a big container full of a patients urine to take to the lab. I told her I'd run get a pair of gloves and the lab bag it's supposed to go in and gladly take it - she said "forget it, I'll do it myself". Thankfully, my Instructor told her that students aren't allowed to touch "bodily fluids" without gloves...

She discussed this with me later and said that although some health care professionals still take chances, she was glad to know that I was doing what I was taught to take precautions. And, as she said - it all begins with "US" - just "One Nursing Student At A Time" - we are taught the right way and it's up to us to follow through. Once we are out there practicing - we can get sloppy or use aseptic technique. One sloppy job can potentially ruin a lot of lives that are in our hands - cross contamination and all that not so fun stuff.

I discussed this with my Brother - he's been a Trauma Nurse for years. Turns out the ding dong never uses gloves to start IV's, draw blood, etc. - because he claims he can feel veins much better without gloves. So, even my own brother is a knuckle-head, but I plan on remaining "anal" and taking every precaution necessary to protect my patients and myself. I certainly don't want to contract some disease (simply because I wasn't cautious) and end my Nursing Career before it even begins...

I'm glad there are some folks out there who also want to do it right. I guess the statistics on nosocomial infection and other "bad outcomes" like dead patients (and sick nurses) speak for themselves. As a former attorney, it seems to me sort of stupid for the medical professional to rely on silence, inertia, and ego to cover booboos, and then for society to depend on a liability-based system as maybe the largest incentive to correct problems. Thanks for your response -- stay with the right way, if you can do so in the face of time and peer pressure. Regarding stuff like asepsis, turning, data gathering and charting, I expect I may be using the phrase "That's okay, but this is the way I was taught to do it" a lot once I'm out on the job.

As a long time registered nurse myself, I commend both of you...and all other nursing students, nurses, doctors, nurse assist, other patient care staff who abide by the "don the gloves" and "wash the hands before and after" technique when caring for our patient population. Do not ever feel nervous about following through with these practices, nor should you allow others to intimidate you or make you feel pressured into not following these very important techniques. :) Thumbs up to both of you, and all who fit into this category of doing it right!