Witnessed unsterile procedure and feeling terrible about it

[cblake4293]

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.

[lilaclover6984]

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

No, I'm not a brand new nurse. I've been working as a nurse a little over 4 years now in a few different areas. Long enough to have seen the realities. Prior to being a nurse I worked in several different fields and have never seen the backstabbing that I do in nursing.

I just can't stand the whole tattle tale mentality. What are we all 6? I have provided the best pt care I can to my Pts in my 4 years as nurse and not once have I felt the need to go running to management.

[LillyBud]

Follow your chain of command. I do believe it is recommended that you speak to the nurse first. You can do this casually, as in discussing the proper technique because you want to learn the best way (Ex: "I have seen so many different ways it is performed, show me how you do it"...then question if it is supposed to be sterile) I know this sounds as if you are acting "dumb", and essentially, you are. That way it will open up a discussion on the best way to do the procedure. I would avoid going directly to mgmt, and perhaps discussing it with her first. As hard as it may be, that LPN will respect you a TON more for bringing her error to her attention before she hears it from her boss...good luck :)

[Stephalump]

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.

I learned the same way in school and my facility has the same policy.

I, the nurse (or student nurse/tech in my case) use a sterile technique inserting a catheter. The pt may use clean technique cathing themselves. I don't get to leave sterile technique behind because the pt does.

If the pt gives themselves a UTI, it's "on" the pt. if I give them a UTI, it's on the hospital. And therefore, me.

[NewbieNeedsHelp]

Let your unit educator know that you have witnesses unsterile/improper cath technique and suggest an inservice... Or fill out an anonymous variance and don't dont don't name the nurse in it. This is a good balance between making sure she and others know it is wrong and not letting everyone know you snitched.

I mean seriously people we work with mostly women and i can understand fearing retaliation haha...

I can't tell you how many times I've seen caths inserted like 5 times, in the wrong hole or meeting resistance etc etc only to have them pushed right back in after they have coiled up in the lady parts. I've done it in exasperation and it's not right when it comes down to it.

[pookyp, LPN]

Sterile technique?

"Ain't nobody got time for that"

Lol I'm kidding btw

Lmao!!!

[Still Standing]

Your concern is why you are a nurse and a good one, more people like you are needed in the field, if it's not right it's not right I don't care who is who and how long they been where or who is going to look at me wrong, I'm not there for them I'm there for me and the patient, I would rather go to sleep at night peacefully than to be worrying about someone that I was in care for could possibly get sicker or actually gets sicker than they already are because I didn't stand up for them and do what was right. If State was in the building she would've put on those gloves. Personally I would've stopped her and provided her with the sterile gloves. People get too wrapped up in worrying about how someone is going to treat them or if they are going to talk about them. So What, they talked about Jesus. If you lose your job or they try to slander you they have layers for that, but trust and believe you will find something bigger and better.

[mariebailey, MSN, RN]

LTC residents are already at higher risk for UTIs d/t their age & immune status; UTIs are one of the most common infections among LTC residents. If someone wants to complain a/b the cost of using sterile gloves for each straight cath, think of the potential cost savings from preventing UTIs & unnecessary antibiotic use.

I think you should not stay out of it; it needs to be addressed because it affects patient care.

[cindjo717]

Can you find out what the statistics are for your facility pertaining to HAI? Also how long has this LPN worked there - it would seem to me if she has worked there for years, and does a lot of caths... they would have been on to her by now.

[cindjo717]

Also nursing homes are much different than hospitals.. I did my clinicals at nursing homes, and it is a chore just to find sterile gloves! They did not perform sterile technique to my knowlege.

[nurseprnRN, BSN, RN]

I can't tell you how many times I've seen caths inserted like 5 times, in the wrong hole or meeting resistance etc etc only to have them pushed right back in after they have coiled up in the lady parts. I've done it in exasperation and it's not right when it comes down to it.

Time to reprint my handy-dandy, never-fail, no-lady partsl-contamination Foley-insertion trick.

When you are prepping the woman, tuck the last betadine-soaked cotton ball into the introitus. Not deep, just enough so it blocks the lady parts. Then when you are trying for insertion and you miss, the cath only hits the sterile cotton ball and you can keep trying (ask for a cough and look for the "wink" or a little urine output) because it isn't contaminated. Retrieve the cotton ball when all is secure and cleaned up.

I never went lady partsl with a Foley again after learning that. Works every time.

[brithoover]

If you report every nurse for not doing it the way you were taught in school you are going to have a very long career..

[imintrouble, BSN, RN]

Time to reprint my handy-dandy, never-fail, no-lady partsl-contamination Foley-insertion trick.

When you are prepping the woman, tuck the last betadine-soaked cotton ball into the introitus. Not deep, just enough so it blocks the lady parts. Then when you are trying for insertion and you miss, the cath only hits the sterile cotton ball and you can keep trying (ask for a cough and look for the "wink" or a little urine output) because it isn't contaminated. Retrieve the cotton ball when all is secure and cleaned up.

I never went lady partsl with a Foley again after learning that. Works every time.

Thanks for the reprint. Wish I'd known that a week ago.