Witnessed unsterile procedure and feeling terrible about it - page 10

by cblake4293

14,036 Views | 106 Comments

I am a new grad and have been working as an RN for 5 months. Everyone I work with is very experienced and I am definitely the newbie. Yesterday I witnessed an LPN with 30 yrs experience straight cath a male without using... Read More


  1. 0
    Quote from imintrouble
    Suffice it to say, that each of our realities are not the same.
    Kudos to all of you who have never found yourself working where they don't even have alcohol preps.
    May you never have to.
    if that is the case, i pray these facilities are the exception and not the norm.
    and, they should be shut down and/or severely penalized...which i'm pretty sure they would be.

    Quote from BrandonLPN
    The honest-to-God reality, though,
    is that many nursing homes have minimal sterile supplies and have policies stating clean technique for straight caths. Please don't imply that nurses performing clean caths in such facilities are lazy or taking shortcuts. That's unbelievably unfair. What would you have them
    do? And please don't say they should quit, that's such impractical advice. If every nurse quit Medicaid facilities because of less than ideal conditions, there'd be no one left. Sick people in crappy medicaid nursing homes need care just as much as sick people in posh Medicare homes....
    skilled nursing facilites are highly and tightly regulated by the state.
    i just cannot imagine those facilities having a policy where clean technique is to be used with straight cathing.
    it makes me wonder how that facility's state views this?
    i would be incredibly surprised to learn that the state okays this.

    the bottom line is our elderly need a hell of a lot more advocacy than they get...
    and poorly-run ltc facilities are just plain unacceptable.
    yes, i agree that we can't all abandon such workplaces...
    but seriously...what kind of support are these residents getting if nsg doesn't even have the most basic of necessary supplies?
    the nurse could be the most competent and compassionate person out there...
    which will do little good when pts are getting infections (et al) because of substandard care.

    leslie
  2. 0
    Quote from imintrouble
    Suffice it to say, that each of our realities are not the same.
    Kudos to all of you who have never found yourself working where they don't even have alcohol preps.
    May you never have to.
    Where do you work? Lesotho? Myanmar?
    Maybe you work in nineteen dickety two. We had to say dickety because the kaiser stole our word for twenty. (line from The Simpsons)
  3. 0
    I agree with people saying stay out of it. Damage already done for whatshisface patient, right? Idealism aside, you're in a crappy spot and have no way to come out unscathed, so I'd take matters up privately with the LPN and not be the rat.
  4. 0
    Quote from cblake4293
    Thank you to all who responded to my post about the unsterile cath I witnessed. After a couple of sleepless nights, I did what I felt I could live with. Talking with the nurse directly was not an option for me. I was not going to see her for another week and I felt that too much time had passed. She is somewhat confrontational and I predict it would not have gone well. I should have said something in the moment but you know what they say about hindsight. Lesson learned. Some nurses I have developed a good relationship and

    "we often txt outside of work asking how pts are"

    or bouncing things off each other. I would have definitely gone to one of these nurses if they had done it. So....I went to the nurse educator and asked her about the facility policy and if there were any exceptions. She said no. Straight cath is always sterile. I told her what happened and suggested an inservice without pointing anyone out. I also said we dont have kits which would have made the gloves readily available. She didnt realize we were out of kits . The end result is she is ordering kits, attaching a memo about correct technique and has no plans to single this nurse out in any way and my name stays out of it! To those who talked about being a tattle tale....yes I do feel like one! But this is about safety, and if this is how she always caths someone is going to get sick and I wouldnt want it to be my grandmother. I see shortcuts taken everyday at work, we have to somehow get a million things done in 8 hrs! I had clinical instructors say "this is how we do it in school but this is how its done in the real world". Loved those clinical instructors! Trust me I get it...
    ... be careful about that stuff
  5. 0
    Quote from Liddle Noodnik
    cblake, I am so sad that you have to be faced w/ this, your coworkers are supposed to be showing you the way things should be done, not the risky path. I would go to the supv and ask to see the proper procedure in the proc. manual and then tell her it is not being done that way. I am not impressed lilaclover w/ your response and that of some others. I KNOW new grads can be noodgy, I was one once, and I know after 30 years of experience I might take some shortcuts, but you don't independently decide to make a sterile procedure a clean one, oh my goodness, esp. a cath! w/ the kinds of bugs we have nowadays? No wonder there are superbugs if this kind of thing is going on routinely

    and yes I know we are stressed and short staffed but you are taking one short cut and potentially adding new tasks (collecting samples, adding antibiotics, additional monitoring, you know that sx of infection can become critical, cause confusion, etc etc etc... and maybe have to add a PRECAUTION room to the list of interventions... to say nothing of the discomfort of a UTI...).

    The OP said enough things to lead the nurse to know that she (the OP) knew she was doing it incorrectly ... the nurse had the opportunity to correct herself but she didn't seem to care...
    Agreed. I am actually shocked by these posts about facilities where clean caths are acceptable. In all my years I have never heard of such a thing. My mind is boggled.

    At first I was kind of conflicted about how the OP handled this situation, but after reading all of these posts I think she did the right thing.

    Management needs to be reminded that if they are aware of these practices, the issue needs to be addressed, not just because of one nurse, but because the facility is promoting a culture where infection control is not being taken seriously.

    We nurses should never resign ourselves to a situation simply because that's the way things go and there is nothing to be done about it. If I were working in a facility where there were no resources to do sterile caths, I would be asking a whole lot of questions about it.

    I'm not sure I would even be comfortable staying there.
  6. 0
    The honest-to-God reality, though,
    is that many nursing homes have minimal sterile supplies and have policies stating clean technique for straight caths. Please don't imply that nurses performing clean caths in such facilities are lazy or taking shortcuts. That's unbelievably unfair. What would you have them
    do? And please don't say they should quit, that's such impractical advice. If every nurse quit Medicaid facilities because of less than ideal conditions, there'd be no one left. Sick people in crappy medicaid nursing homes need care just as much as sick people in posh Medicare homes....

    In any event, kudos to the OP for finding out what the policy actually WAS at her facility and for finding a way to educate w/o putting anyone on the spot. I'm glad everything worked out.[/QUOTE]

    Best response I've read here
  7. 2
    As I said in a previous post, I work LTC and our P&P is STERILE technique for caths. We have sterile cath kits that contain everything needed to do a sterile technique. My mouth is hanging open at the posts from other LTC nurses who are saying their facilities don't have the items needed for sterile tech. I did clinicals in some really 'low end' LTC facilities that were nasty (and that had poor scores during their inspections that were close to being shut done) and yet they had all the supplies/kits needed to do sterile procedures (whether or not they were used with sterile technique by all the nurses, I can't answer. I know WE students did).

    I'd think I'd want to high tale it out of a place that didn't supply the needed sterile items to do procedures that required sterile technique.

    GrnTea, I think YOU might have been one of the nurses I worked with during my days as a student LPN (kidding). While doing a cath on a woman, I ended up with the cath in the vagina. As I went to take it out and open a new cath kit, she instructed me to leave it there as a way to know where NOT to go with the next one. She also gave me the tip that you suggested of leaving the cotton ball/swab in as a way to block entering the vagina with the cath tubing. I always remember that and have never placed the tubing in the vagina.
    twopurpleskittles and GrnTea like this.
  8. 0
    The moral of this story is make sure you have ALL the facts before you go on a crusade. I love the plan to get with training/p&p to find out the proper technique then moving forward.
  9. 0
    This happened to me...I was a new rn w a preceptor. I tried to Cath and missed (embarrassing) ...so my preceptor did what she had to do to get the urine...UNSTERILE!!!... The pt was a healthcare wker familiar w the procedure....my manager called us n a mtg the next day!...anyway,protect your license. But realize real world nursing, sometimes u do what u gotta do.
  10. 0
    Quote from leslie :-D

    really guys?
    really???
    stay out of it???

    sure why not.
    we nurses needn't be accountable to anyone but ourselves, right?
    let's look the other way, even if the pt becomes septic because we chose not to advocate for them.

    grntea is 100% right.
    in the hospital setting, sterile technique IS the standard of care, for the very reasons she cited.
    it would be totally the nurse (who chose to remain silent) fault if pt became infected.

    op, yes, you are in a tough, tough situation and it would eat at me too.
    in the home setting, the same rules do not apply...
    but in an acute setting such as the hospital, sterile technique should always (always, always!!) be done.
    i suppose you could have asked this nurse (privately), why she chose not to use sterile gloves, and share your discomfort?
    i really do sympathize with you, and i hope you always aspire to the highest standards of nursing care as long as you're a nurse.

    you need to follow your heart and act accordingly.
    nosocomial infections are disgustingly high, partly because of apathy and shabby habits.
    and who pays for all this?
    our pts of course, but in the larger picture, we all pay.

    "stay out of it", imo, is dangerous and irresponsible...
    and is a big problem in u.s. society in general.
    so many people would be much better off, if bystanders were moved to respond proactively instead of indifferently.

    God bless you, op...
    and stay on the high road.

    leslie
    Can I get an AMEN!!!!!!


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