Do you cut corners in your daily nursing practice? - page 10
by madwife2002 Senior Moderator | 27,551 Views | 109 Comments
Do you cut corners in your daily nursing practice? Or do you do everything according to the ‘book’. Do you police yourself in your everyday care of a patient, what do I mean by police yourself? I mean always follow the correct... Read More
- 2Dec 9, '12 by RNfasterBrandon - friction doesn't kill C diff spores, it's just more likely to remove the spores from your hands and send them down the drain. Here's another interesting item: "Commonly used hospital cleaning agents, such as quaternary ammonium–based (and other surfactant-based) detergents, are not sporicidal and may in fact encourage sporulation." Measures to Control and Prevent Clostridium difficile Infection
One other thing... one of the things I tell my patients on admission to the unit is that if they or their families/friends have any questions or concerns to feel free to say something to any of us. I give them an example: if you think we missed washing our hands, say something. I tell them that speaking up is an important factor in patient safety. And I have sanitized my hands again in front of the patient in response to a voiced concern.Last edit by RNfaster on Dec 9, '12
- 2Dec 9, '12 by RNfasterQuote from Paco-RNPaco-RN - check this out regarding C diff being airborne...Yep, I readily admit to cutting corners. Because I have to. Do I gown up every time I enter the room of a C. diff patient? No, not if I don't expect to come in contact with their bodily fluids (like if I am bringing them a pitcher of water and leaving right away). But I still do wear gloves and I do wash my hands with soap and water. I don't think this is a severe corner cutting, as last I heard C. diff is not airborne.
The Potential for Airborne Dispersal of Clostridium difficile from Symptomatic Patients - "Conclusions. Aerosolization of C. difficile occurs commonly but sporadically in patients with symptomatic CDI."
Airborne Spread of Clostridium difficile.
- 1Dec 10, '12 by Ntheboat2Quote from RNfasterI'm pretty sure when people are speaking of general hand hygiene practices they aren't including the well known exception of C-diff. Obviously.Brandon - friction doesn't kill C diff spores, it's just more likely to remove the spores from your hands and send them down the drain. Here's another interesting item: "Commonly used hospital cleaning agents, such as quaternary ammonium–based (and other surfactant-based) detergents, are not sporicidal and may in fact encourage sporulation." Measures to Control and Prevent Clostridium difficile Infection
One other thing... one of the things I tell my patients on admission to the unit is that if they or their families/friends have any questions or concerns to feel free to say something to any of us. I give them an example: if you think we missed washing our hands, say something. I tell them that speaking up is an important factor in patient safety. And I have sanitized my hands again in front of the patient in response to a voiced concern.
- 1Dec 10, '12 by RNfasterQuote from Ntheboat2Agreed.... this is what I was responding to:I'm pretty sure when people are speaking of general hand hygiene practices they aren't including the well known exception of C-diff. Obviously.
Quote from BrandonLPNJust felt it important to clarify...those C. Diff spores are quite robust...... (obviously, for c-diff, I wash at the sink because the friction is what kills the spores)
One other interesting tidbit - some studies have found handwashing preferable to sanitizing in combating norovirus... Hand Sanitizers May Actually Cause Outbreaks Of Norovirus
I try my best to comply with hand hygiene... My poor hands are parched and require loads of hand cream....
I do focused assessments as the situation merits.
I think the OP was trying to get folks thinking and writing. It worked.
- 4Dec 10, '12 by anotheroneI dont like the gel or foam sanitizers. I feel gross after using them. The one my facility uses is very drying and my hands get cracked very fast. Also with all the handwashing talk and cdiff , I see most pts not even wash hands before eating or after using the bathroom. I made a thread on it. I shouldn't have to remind ao3 completely with it adults to do this , but i do. This should have been taught to them as toddlers and it is not some grand secret either. The visitors do what they want . and all of these patients are mostly discharged right back into the community. People are gross.
- 1Dec 10, '12 by tokmom, BSNQuote from BrandonLPNUmm, no. This is contract. We are union. WE the nurses have low census hours that WE created to help round out paychecks when census is low. Our staffing on a med/surg floor runs at the maximum of 5, usually 3-4. Pretty darn good, when you throw in 2 CNA and a CN that does all discharges/education and helps on the floor when able and a float nurse.I dont blame the nurses, i blame the people implementing such nonsense. If hospitals are going to pay extra money for nurses to come in and work, they should just put them on the floor in an assignment. God forbid there actually be an extra nurse on the floor once in a while... Sounds like more imaginary jobs thunk up by more clueless people whose jobs, by all rights, shouldn't exist in the first place....
The nurses have the choice to either stay home and not come to work, and some choose to get some easy hours by doing audits that our organization demands.
I personally support the audits they do. We have a couple of nurses that were reprimanded because they had to be stopped over and over to do simple handwashing.
So no. We don't need these low census nurses on the floor. Our staffing is adequate, thank you.Last edit by NRSKarenRN on Dec 15, '12 : Reason: fixed quote
- 3Dec 10, '12 by tokmom, BSNQuote from BrandonLPNThat is why you wash/gel before you go into the room, right? So anything you touched like the chart, keyboard etc.. is washed or gel'd off your hand once you walk into that room?I use hand sanitizer every time I exit a room, and after touching a resident. It's a good habit to get into. But saying we "need" to wash our hands because we don't know who touched that IV pump is taking it too far. We don't know who touched that chart. Or that keyboard. Or that doorknob. Or that elevator button. If we follow that line of thought to it's logical conclusion, some "study" will dictate it's "best practice" to wash before touching a chart or table or chair or telephone. And then some policy will dictate that we all sanitize our hands in between *every* single action like OCD crazy people.
And yes, you should wash or gel after touching an IV pump. Do you trust the keyboard of the machine is clean? I don't.
- 1Dec 12, '12 by WhereIsMyCallBellI will whole heartedly admit. I am the patient's best advocate and management's frustration. = / In my experience, especially as a floor nurse. I take time with med. administration, dressing changes, various procedures and so on. I have never been, nor will I ever be an RN "corner cutter". Sure I have had my share of being "called out" on my "time management" skills. (or so called lack there-of). I take full responsibility for being "slow". But thats because I am reading the MAR, making sure what is ordered for my patients by the MD is exactly what they are getting at the time ordered. Even the little 97 yr. old lady that takes pills one at a time and feels the need to blow her nose after every pill, or two. I will be patient... knowing "an ounce of prevention is worth a pound of cure as they old saying goes. Our patients get their meds to manage their specific disease process and the s/s associated with it. Therefore 9/10 times our patients remain stable, or improve. If corners are cut and meds aren't given consistenly. Their condition worsens, then their care becomes more time consuming, their overall needs become greater and the couple of minutes you initially saved. Come back to bite you in the behind. I hope I communicated that in a way that made at least some sense. Same with wound care. A wound not taken care of properly and consistently per MD orders will more than likely cause yourself, or another nurse more work when it becomes infected or, doesn't heal according to plan. I may not go "by the book" at all times. I sure avoid cutting corners though, it makes sense to me. I am the nurse who is last to get my charting done alot of the time, not always. It's okay... I know my patients got good care that day and that I did my best for those entrusted to my care. I will take some guff from mgmt. about my "time mgmt issues.". I know better, the nurse to patient ratio is undeniably out of whack, that's the real ISSUE. I refuse to take it personal when they moan and groan at me about time management.
- 1Dec 12, '12 by monkeybugQuote from tokmomSecret shoppers? Are you freakin' kidding me? Once more, some suit trying to turn healthcare into retail. I wash my hands, a lot. Between every patient contact. But often I wash them in the hall because families like to pile crap on the sinks. If it's a family that has made a point of making me wash in front of them, then I happily dribble my soapy germy water in their Coach purses, open cups, make up cases, or whatever else they've piled around. We didn't have gel in the rooms, only in the halls, and I utilized that often, too. Our infection rate, when I worked in the hospital, was very good, too. One of the few areas we got praise regularly. Amazing, since most of us washed in the hall or nurses station.Is it OCD or is it keeping yourself, as a patient, safe, from God knows what?
Come to my hospital and you would be out the door in less than a month. It's taken seriously. Very seriously. There are secret shoppers watching nurses come and go. I prefer not to be written up and the pt's actually say they like seeing people wash their hands. We also boast a zero infection rate.
- 0Dec 12, '12 by NJnewRNThe Commuter, I hear you. I feel the same exact way. It's literally like arguing with a brick wall. I get such bad anxiety. I'm afraid that one day something bad is going to happen on my watch and I'm going to be blamed for it. I just can't live with that. So I've managed to stay away now for 9 months. Good luck to you. I would rather push papers that be a floor nurse.