6 weeks into school, I got stuck and i don't know what to do

beaRNwhenIgroUP · Oct 29, 2002

hi to all...i just wanted to let everybody know that after i wrote a letter to the driector of the entire nursing college and involved the dean, the school has agreed to pay my medical bills!

i am still a bit nervous about how i'll be treated after making a fuss - but at least my bills are paid!

also, i just want to say that i couldn't have done this without allnurses.com! all of the research and support y'all provided really made the difference!

thanks to all!

abrenrn · Oct 29, 2002

Sarah,

I just read through this thread with great interest. I have seen this issue from several sides, I'd like to go over some. I know a lot of people on the board will disagree with me. You sound like someone who might read what I say and then decide if you agree or disagree.

1. No matter what anyone says, I can't imagine any situation where the risk of needlesticks is 0%. Since AIDS the incidence has decreased significantly but there are too many vaiables. That's why the CDC has post-exposure prophylaxis guidelines.

2. Strict rules like, never recap needles, do not always work. Every once in a while I found myself in a situation where I had a used uncapped needle and no disposer present (yes I should have made sure there was one there and not filled everytime I needed to use a needle - sometimes the world is not perfect). There was a strict rule, at the time, to never re-cap needles. But, I also did not want to walk around with an exposed needle. I asked another nurse what to do, she said put the cap down on a surface, work the needle in.

This made sense, minimal risk to me, minimal risk to others and that's what I did - even though it violated the rules and I risked loss of a job. It was my and other nurses compromise to the rules and the reality. Recently, I had to take the NYS infection control test. There newest rule: best to dispose immediately, otherwise place cap on flat surface and re-cap that way to reduce danger of walking around with exposed needles.

3. My own indirect experience with high risk needle sticks happened under the best circumstances possible.

a) My brother, a medical student in 1984 in Brooklyn, was drawing blood from a patient with end-stage AIDS (they had only recently discovered the virus and were still fighting over name, no antibody testing available). The guy jerked his arm, the needle went flying into my brothers arm. He and my family were terrified.

Fortunately, this occured in Brooklyn where the epidemic had been rampant for at least five years. One of the infectious disease guys there realized, very early on, that this could present a sigificant problem. By 1980 I think, he started collecting reports and following up. By 1984 he was able to tell my brother that for at least four, possibly five, years, he had been monitoring people after needle sticks from diagnosed AIDS patients and, so far, no one had gotten sick or shown any signs of AIDS or ARC. Remember - these were the old days, first article in about AIDS was in 1979. We knew a lot was not known but it gave my brother and his family a glimmer of hope.

Fortunately, Dr. Landesman continued testing and monitoring. When antibody testing was available, my brother was called back in every six months or so. He's negative. Dr. Landesman now has the largest database in the nation re outcomes from needlestick injuries. That's where most of the CDC data about rates of conversion comes from.

b) The first time I heard about post exposure prophylaxis was from a very good immunologist who got involved in pediatric HIV. His advice to anyone who had a needlestick was to go to the pharmacy first, take the first dose of the meds (usually triple now, I'm surprised by double), and then figure it out. The point of prophylaxis is to get the virus before it goes into one of its "hiding places" where the meds don't touch it. That needs to be done fairly quickly.

So, just from this, I've learned: the risk of transmission is relatively low (my brother is lucky, his exposure fell under highest risk category by todays standards - known HIV with high viral load - blood piercing skin); it is possible to prevent, should start as soon as possible if going to. Note, I deduced all this from the two experiences I had but they match recommendations completely. As someone else said, better to start meds within 3 hours.

Because of getting the information the way I did, I think I might be less upset by a needlestick - still anxious but not terrified, able to look at alternatives with some knowledge. I would expect everyone would be told this, facilities prepared - I learned about PEP and need to take first dose quickly in mid 1990's I think - it came out shortly after triple therapy did. Yet I recently tried to work in a pedi HIV residence, asked about their PEP guidlelines, was told, "Oh, we just send them to emergency room." I thought they would have a more specific protocol with prepared packets of the first dose available - like at the hospital with the smart immunologist. They did not. Few places do.

4) Unlike others, I do not know enough to blast your instructor. I have worked in the real world of nursin and community health. When I started in home health, pts were sent home with insulin and syringes and disposed of used syringes in garbage (that's why junkies use insulin syringes so much - they would find a nearby diabetic and go through garbage). We encouraged clorox bottles - still put in garbage (though less danger to junkies). Eventually, at our prodding, red boxes provided, returned to facility. So, I don't know if your instructor had experienced that environment before - schools will send hapless instructors wherever they can. She made a poor decision - then, it appears to me, sought advice from the school itself (why else change what she had said?). The school could have easily provided a large red box so gloves and all could be thrown in - they didn't. I'd hate to see an instructor lose her license because of one bad decision under pressure. If she has a history, yes. At one time, I could have lost my license for recapping needles the way I did - many nurses on this board seem to feel I should have. Now when I do this, I am following guidelines. The situation hasn't changed - I was facing a problem before the guidelines kicked in. Fortunately, the nurses I worked with had developed a safe technique.

Finally, I am glad you accepted some responsiblity for what you did - you knew it was wrong but did it because someone else told you (and you couldn't think of another alternative as you had no experience). My greatest regrets as a nurse is when I have succumbed to pressure from above, below or around me and done what I know is not right. But, recognize the pressure and the situation, use it as a learning experience. I think the same may be said for the instructor.

And, in the end, the school is the most accountable. Like many others in health care, they behaved in a short-sighted, "cost saving" manner. You probably can sue them. It's the only nursing program around. Can you help them work past their attitude and use this to help them become educated about appropriate responses to needlesticks - how to minimize risk, what to do if it happens anyway?

I ask more of you than I am willing to do myself. I give up on nursing, it has become too hard, I've tried to long. I suspect any response that may come from this will be highly critical of one or more things I said. That has been my experienced. Or else my post is ignored. It is a bit long, who has time?

Anyway, good luck whatever you choose to do. Yes, you don't have a license yet, you can report the instructor, maybe she'll lose hers. If you already had a license and bowed to pressure, you would be at equal risk. You have every right to sue the school - the anxiety, problems you experienced should not have happened. Yet, they happen most places I've been at. Perhaps a lawsuit will cause them to take note, and change things. Can you afford the emotional toll and time it would take for a lawsuit? This is not discouraging you from that course - simply advice that you think it through. The people advising you to sue will not be there for any fallout that may happen to you. So it is your choice. You are intelligent. Gather as much information as possible before making a final decision is my recommendation. Also, you might want to find a good infectious disease MD to discuss your PEP.

Anne

beaRNwhenIgroUP · Oct 31, 2002

hi anne. i appreciate the input. and yes, i am a novice so i am going blind at this...but i went to the director's office and told her exactly what you said - that i want the students to be protected in the future. i also said that i didn't want some huge amount of money - i just wanted the school to acknowledge (have no idea if i spelled that right) their role by helping me pay my bills...

i really think it was a shortcoming of the school - we are a "community based" program - so imho they need to take extra measures to make sure that the 100 juniors they are sending into the "community" are safe and protected. which, i still don't think they are doing on many levels.

anyhow, i appreciate any input i just want to be as well - informed as possible.

would you mind telling me why you are giving up on nursing? i would be interested to hear that as well...not nosey - just curious

beaRNwhenIgroUP · Oct 31, 2002

hi anne. i appreciate the input. and yes, i am a novice so i am going blind at this...but i went to the director's office and told her exactly what you said - that i want the students to be protected in the future. i also said that i didn't want some huge amount of money - i just wanted the school to acknowledge (have no idea if i spelled that right) their role by helping me pay my bills...

i really think it was a shortcoming of the school - we are a "community based" program - so imho they need to take extra measures to make sure that the 100 juniors they are sending into the "community" are safe and protected. which, i still don't think they are doing on many levels.

anyhow, i appreciate any input i just want to be as well - informed as possible.

would you mind telling me why you are giving up on nursing? i would be interested to hear that as well...not nosey - just curious

abrenrn · Oct 31, 2002

Sarah -

After fifteen years of experiencing what you experienced over and over I am discouraged. Like you, I try to get information before I make judgements, I am willing to recognize errors in judgement or action (it is the best way to learn), and find myself blamed for everything that went wrong in my vicinity because I don't believe covering my ass is in the patients best interest.

You are new to the field - I see a whole lot of promise. I hesitate to encourage you to face the types of things I can no longer face but you seem better prepared to handle them. Selfishly, I hope you stay. Someday I will get sick and I will need a nurse just like you.

abrenrn · Oct 31, 2002

Sarah -

After fifteen years of experiencing what you experienced over and over I am discouraged. Like you, I try to get information before I make judgements, I am willing to recognize errors in judgement or action (it is the best way to learn), and find myself blamed for everything that went wrong in my vicinity because I don't believe covering my ass is in the patients best interest.

You are new to the field - I see a whole lot of promise. I hesitate to encourage you to face the types of things I can no longer face but you seem better prepared to handle them. Selfishly, I hope you stay. Someday I will get sick and I will need a nurse just like you.

abrenrn · Oct 31, 2002

Oh - I would not have recommended backing off on lawsuit had I not seen that the school had agreed to pay your bills. When I posted, I had read that. I should have pointed it out at the time. If they had stupidly refused to pay, I would have recommended that you do sue.

I have had to mention lawyers on one or two occasions to force employers to do what they should have done in the first place. I expect that employers that are smart enough to respond by doing what they should have done in the first place are smart enough to make my life difficult if I go ahead and sue them. I expect they will say, "but we did what she wanted, why is she suing us?"

Just wanted to make that point clear.

abrenrn · Oct 31, 2002

Oh - I would not have recommended backing off on lawsuit had I not seen that the school had agreed to pay your bills. When I posted, I had read that. I should have pointed it out at the time. If they had stupidly refused to pay, I would have recommended that you do sue.

I have had to mention lawyers on one or two occasions to force employers to do what they should have done in the first place. I expect that employers that are smart enough to respond by doing what they should have done in the first place are smart enough to make my life difficult if I go ahead and sue them. I expect they will say, "but we did what she wanted, why is she suing us?"

Just wanted to make that point clear.

beaRNwhenIgroUP · Oct 31, 2002

thanks anne...& good luck to you...

beaRNwhenIgroUP · Oct 31, 2002

thanks anne...& good luck to you...