Witnessed unsterile procedure and feeling terrible about it - page 3
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... Read More
Feb 13, '13A nursing home may be considered a "home" environment, but sterile procedure is still required for foley catheter insertion.
Feb 13, '13Quote from CapeCodMermaidShe needs to check the policy at her facility. I know both of the LTC facility's I used to work in ( in BC Canada) required only clean technique for wound care and In/out caths. They were very specific about this. And stated that it was becAuse the facility was considered a home environment since the pt. was in their own surroundings and germs all the time.A nursing home may be considered a "home" environment, but sterile procedure is still required for foley catheter insertion.
I know this is confusing to people that have only ever worked acute.
Feb 13, '13Why didn't you just ask the nurse when she was doing it anyway? It didn't have to be a confrontation like " you're doing that wrong", just a question as to why she was doing it that way.
Feb 13, '13I know! I wish I had just asked her in the moment! Dont reallly know why I didnt say anything in the moment. I guess I had already intervened alot and felt a little intimidated saying anything else. I did ask her if she had sterile gloves when preparing and looking back, I realize she never answered. I also asked her if she had iodine, she didnt answer. I found it in the drawer and asked her if she wanted me to put it on. I had asked her if she got something to put the trash in. I asked her if she had lubricating gel. Which she did (and touched the packaging with clean gloves and then pulled the foley out of the package and touched that). And I started to doubt myself, thinking maybe its ok since he self caths at home. Next time I will just ask in a nice way! And save myself this headache!
Feb 13, '13Quote from cblake4293I think that's a good planI know! I wish I had just asked her in the moment! Dont reallly know why I didnt say anything in the moment. I guess I had already intervened alot and felt a little intimidated saying anything else. I did ask her if she had sterile gloves when preparing and looking back, I realize she never answered. I also asked her if she had iodine, she didnt answer. I found it in the drawer and asked her if she wanted me to put it on. I had asked her if she got something to put the trash in. I asked her if she had lubricating gel. Which she did (and touched the packaging with clean gloves and then pulled the foley out of the package and touched that). And I started to doubt myself, thinking maybe its ok since he self caths at home. Next time I will just ask in a nice way! And save myself this headache!
Feb 13, '13It takes time to build courage , and stand up for the patients ! It sucks when you are a new grad and in orientation it is hard to speak up! Many people do not have the courage to speak up when someone is not following the policy, or when you see something wrong because of fear, fear of losing the job! So sad !
Feb 13, '13OP, you come off to me as a very bright nurse whom really don't want to start any trouble. If in any doubt, clarify this with the nurse or charge nurse if you don't feel comfortable. Shame on other nurses for saying "stay out of it". Yes, you need to pick and choose your battles, however when you are new you don't know what battles to pick and choose. The convo with the LPN could have went something like this" Hey Nurse Nancy, I realize that you are very experienced and I apprecatiate all you have taught me so far, I just need some clarification.... I was always taught to use sterile gloves during catherization is this techinique not used in HH/LTC?"
If she blows you off or is rude about it, go to the charge nurse, not to REPORT but to CLARIFY.
Feb 13, '13OP, I remember being a new nurse, and it sounds like you are a smart, wonderful nurse who really cares about your patients. I'm a NP in peds urology (primarily outpatient). We do sterile in-and-out caths when collecting urine to check for UTIs, but all of our children who self-cath on a regular basis do it as a clean procedure both at home and at school. For those who cath via stomas, we even use clean technique in the clinic if they come because they are having difficulty cathing. We also use clean technique in clinic when we are teaching children/parents how to self-cath.
But, if we have an inpatient who is having an indwelling foley catheter placed post-op or while in the hospital for whatever reason, that is always done with sterile technique. Same with children who do not self-cath and are having a catheter placed for a VCUG or other procedure.
Hang in there, before you know it future new grads will be coming to you with questions and I'm sure you'll have great answers and be a great mentor!
Feb 14, '13One of the hardest things about nursing is to learn to speak up in the moment.
Your going to have to learn it, you are in charge of a lot of staff as a nurse in LTC.
And always speak to the person you have issue with before running to your supervisor, unless there is a compelling reason you cannot.
Each time I've changed jobs, I have asked for clarification on a thousand things before I felt comfortable, no one has ever accused me of being a terrible nurse for it.
"I noticed while we were in the room taking care of that pt, I saw you...."
"Why do you do it that way, I have always seen it done this way.."
"Would you like help with that? I can run and get you some gloves...if you want them..."
"Is there a medical reason we are doing it this way..."
"I just dont feel comfortable doing it this way, because....."
ect ect you get the picture.
Feb 14, '13If sterile gloves and betadine are readily available, why *wouldn't* you use sterile technique? To be honest, I have no idea what my facility's official policy is re: sterility vs clean and straight cathing. But since I got a supply room full of sterile supplies, I'm sure as heck gonna use them.
With all that said, the OP definetly should NOT report this nurse to his supervisor. For crying out loud, we don't even know if the nurse in question was violating facility policy. Everyone telling the OP to run and tell the DON is giving *terrible* advice. Do you all want the OP to be completely ostracized as a new nurse?!?
Maybe, just maybe, the OP could discretly discuss it with the LPN before stabbing her in the back? Just a thought.....Last edit by BrandonLPN on Feb 14, '13
Feb 14, '13I am with GrnTea and leslie on this one. The bladder is sterile and that is not going to change anytime soon. I agree you need to learn to speak up BUT is all about technique so you can maintain the dignity of the other health care worker. This can be difficult if you are not in a position of power or one in which it is considered you job to monitor and uphold policy.
Your highest priority is always to be a patient advocate. You must speak up and do what is best for them but do it in a professional manner. Would you want someone to do the same for you or a loved one if you were the patient?. If your answer is yes..then you know what you need to do! You are a valued member of the team and what you have to offer is valuable.
Feb 14, '13Take this as a lesson on confidence. I know you are new, but if your facility p&p states sterile then your best practice is to go with p&p. It's there for a reason. If you see someone not following p&p then by all means speak up. You will have to get used to this and it will become second nature.
A similar situation happened to me as a new grad. I'm very anal and read the p&p often. Well a policy had just changed and the nurse that I was helping was doing it the old way which was wrong. I pointed this out. I told her before she reached the patient that she has the wrong supplies for this procedure. She pulled me out of the room and "attempted" to chew me up and spit me out. I stopped her about a 1/4 of the way through her butt chewing and made her go with me to a poster in the med room and pulled up the p&p page. She turned so different colors of red that I could have named some new red shades and marketed them. But with that said I was in management at a prior job before coming a nurse. So I was used to dealing with issues like this. But I can see where it can be very intimidating. But intimidating or not if it harms a patient then that is a different story. Someone should speak up.
If all else fails look up the policy and if it is sterile ask your facility educator to hold an in service about UTI's and sterile technique.
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