Witnessed unsterile procedure and feeling terrible about it

Nurses General Nursing

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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 sterile gloves. I asked if she had sterile gloves and the iodine that is necessary (we didnt have a kit so all items had to be gathered seperately). I found the iodine and brought it to the bed side. She then asked for a packaged wipe on the bedside to clean the insertion area. I asked her if she wanted me to do the iodine and she replied that she was just going to do the wipe but I could if I wanted to. I did and realized that she never put on sterile gloves only clean gloves. She completed the procedure without ever applying sterile gloves and I am feeling absolutely awful that I didnt stop her and tell her she needed sterile gloves. The whole procedure was totally against what I learned in nursing school. I am thinking about going to the nurse in charge of training and telling her what happened in confidence. Thinking maybe she can hold in inservice on proper techinique. I do not feel comfortable talking to the nurse who did the procedure about it. It would not go well. I have been stressed about this for the last 24 hrs! Any advice? I'm afraid I could be held responsible for not intervening as well.

If 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.....

Specializes in Infusion Nursing, Home Health Infusion.

I 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.

Take 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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Thank-you to everyone for all of the advice! While I have gotten mixed answers, I appreciate all the feedback. Honestly, this has been the best therapy for me! One thing is for sure...there is no clearcut answer and I think that often happens in nursing. We have to go with our gut on many things and do our jobs in a way that will leave us with a clear conscience. I will let you know what happens....

I think the first thing I would do is read the policies to make sure that my own personal practice was in line with the policies. And then I think I would speak to your manager or educator about doing some follow up education. All you need to say is something like: "I have been observing and working on my skills with several people, and I have seen many things done different ways. Would it be possible for us to get a refresher on this? Just to make sure we're putting our patients' safety first?" The other thing is, if this is a patient that usually self caths, and they prefer not to break out the betadine and all, I would document their refusal of you providing nursing care at the "standard" per policy. They have the right to refuse care (they may need more patient education and coaching, but that's not the immediate matter of concern).

Ultimately, if you are ever called into court, they will examine state law and facility policy. Remember that. Make your practice fall in line with your policies, and you won't have a problem with that respect. Also to think about, when a lawsuit is brought, the legal team representing your facility will sit down with the involved staff and determine if you followed policies/procedures. Just a handy dandy FYI for future reference for you. The other thing to consider is what are your responsibilities regarding delegation. You are an RN, in LTC/SNF - how many LPNs are you working with? Yeah, they have to practice to their scope, but if you are delegating, you are responsible for supervising and/or "following up" on what you've delegated... Just some food for thought.

And the last comment the original poster wrote, your conscience will never fail you. If you have a gut feeling something isn't right, it probably isn't. It will get better. Really it does :)

Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

Leslie said it well. I can stop cringing now.....

Specializes in geriatrics.

I also work LTC and we follow the P and P which is the same as a hospital. Yes, it is their home but as nurses we are held to the same standard of care that the hospital is. When in doubt, check your policies and/or speak with the NM. An inservice sounds like a great idea, without actually calling anyone out.

just maybe, the OP could discretly discuss it with the LPN before stabbing her in the back? Just a thought.....

for the life of me i will never understand nurses loyalty to ea other, more so than their loyalty to the pt.

it's just not right.

no one wants to get anyone in trouble.

but when your concerns (re standards of care) are valid and reasonable, remaining silent will not help the situation or the pt.

this sister/brotherhood force is for the birds...when it interferes with quality care.

leslie

for the life of me i will never understand nurses loyalty to ea other, more so than their loyalty to the pt.

it's just not right.

no one wants to get anyone in trouble.

but when your concerns (re standards of care) are valid and reasonable, remaining silent will not help the situation or the pt.

this sister/brotherhood force is for the birds...when it interferes with quality care.

leslie

This is what makes nursing such a miserable job sometimes. Nurses that wont stick together. Why can't we work together to optimize pt care without stabbing each other in the back? Discuss things as a team and work it out. The holier than thou attitude that I see a lot in nursing gets old.

Don't get me wrong either, I'm all for providing the best possible pt care. I just don't see why that can't be done while maintaining loyalty and camaraderie with our co-workers. Sick of the whole kindergartenesque tattle tailing system

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
I just don't see why that can't be done while maintaining loyalty and camaraderie with our co-workers. Sick of the whole kindergartenesque tattle tailing system

Totally agree. I don't understand why people so often suggest talking to a superior before simply approaching the person involved. I'm guessing it stems from a fear of confrontation that so many women seem to have.

of course you should speak to the person first.

and if that works out, end of issue.

but if it doesn't, then it needs to go up the chain.

leslie

This is what makes nursing such a miserable job sometimes. Nurses that wont stick together. Why can't we work together to optimize pt care without stabbing each other in the back? Discuss things as a team and work it out. The holier than thou attitude that I see a lot in nursing gets old.

Don't get me wrong either, I'm all for providing the best possible pt care. I just don't see why that can't be done while maintaining loyalty and camaraderie with our co-workers. Sick of the whole kindergartenesque tattle tailing system

i haven't peeked at your profile lila...are you a new nurse?

while i do share your ideals of camaraderie, nsg is more often than not, a very back-biting business.

and it is the nurses who truly want to work as a team, are the ones who are also most often targets of other nurses' contempt.

i for one, do believe that it is r/t working with mostly women.

others do not share my beliefs - but to me, it is a highly back-stabbing business...

and it is the ones who want to do right by the patient, are the ones who are often bullied/harrassed by those who have more or less become burnt out, aeb shabby habits and standards.

not all, but many.

i would love to work in a utopic nsg workplace, where we all hold hands and gaze at rainbows.

but for the most part, we have a looooong way to go before even something remotely similar occurs.

leslie

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