Witnessed unsterile procedure and feeling terrible about it - page 6

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

  1. Visit  BrandonLPN} profile page
    3
    Quote from mariebailey
    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.
    It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence.

    But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is a fact, too. It's inescapable. To stubbornly insist "well, it isn't best practice, so they should change their policy!" is unproductive and childish. It sucks that there isn't adequate reimbursement to ensure best practice for every procedure, but it is what it is. There's nothing brave or noble about fighting a battle that can't be won. I mean, seriously, the OP should risk being on everyone's s*** list by trying to change a policy that anyone with a little savvy knows won't be changed anytime soon? Some new grad RN is hired and says "clean caths aren't nest practice" and suddenly management will see the light and order a truck load of sterile kits?? Come on.....

    And nurses who acquiesce to this policy aren't "lazy" or "bad". What, if we're not throwing ourselves on the sword and risking our jobs to protest every policy that isn't 100% like we learned in nursing school, then we're not good nurses? Things aren't as black and white as some posters here seem to think.
    Last edit by BrandonLPN on Feb 15, '13
    jadelpn, nursel56, and imintrouble like this.
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  3. Visit  mariebailey} profile page
    0
    Quote from BrandonLPN
    It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence. But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is just a fact of life. I'm lucky to work at a government facility where we have kits for every straight cath. Because of this, it has never even occurred to me *not* to use sterile technique. But many (if not most) private facilities simply do not have the reimbursement to provide sterile supplies for a resident who might need 4 straight caths every day. Do you want this LPN to use up all the sterile gloves on multiple straight caths only to have the facility run out when a Foley needs to be inserted? I have considerable disdain toward private nursing homes, but even I know they don't make such polices because they're evil or stupid. They do it because they have to. Until reimbursement laws are changed these policies won't change either. That's why telling the OP to fight this isn't necessarily good advice.
    So sterile supplies may be limited to Foley procedures. Darn shame. Gotcha. I am aware that it is well-established with plenty of evidence that asceptic technique is preferable. I think how I worded it may have led you to conclude otherwise.
    Last edit by mariebailey on Feb 15, '13 : Reason: clarification
  4. Visit  canned_bread} profile page
    0
    The question I ask myself is: would I want this done to me, or my mother? If the answer is no, then I would do something.
  5. Visit  jadelpn} profile page
    0
    At least in the hospital, and it could be in any Medicare facility, foleys are regulated strictly, and UTI's acquired from foleys.
    Catheter-associated Urinary Tract Infection and the Medicare Rule Changes

    So it is of one's best interest, and the interest of the patient to use sterile technique.
  6. Visit  lilaclover6984} profile page
    0
    Quote from 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..
    Exactly
  7. Visit  lilaclover6984} profile page
    0
    Quote from joanna73
    Honestly, it shouldn't be a chore to find sterile gloves. If you don't have a box handy, then use a catheter kit. Sterile gloves come inside the kit, and nursing homes have those. Aside from that, you should definitely speak with the coworker first. We worked with someone who often felt the need to go to management without saying a word to the person involved. Not fun, because no one likes to feel blindsided.
    I've worked at 2 separate Nursing homes in BC and neither one had cath kits.
  8. Visit  lilaclover6984} profile page
    0
    Quote from BrandonLPN
    It's undeniable that using sterile technique every time is best practice. That's a fact that's well established with plenty of evidence.

    But not all LTC facilities are capable of supplying sterile supplies for *every* single straight cath. This is a fact, too. It's inescapable. To stubbornly insist "well, it isn't best practice, so they should change their policy!" is unproductive and childish. It sucks that there isn't adequate reimbursement to ensure best practice for every procedure, but it is what it is. There's nothing brave or noble about fighting a battle that can't be won. I mean, seriously, the OP should risk being on everyone's s*** list by trying to change a policy that anyone with a little savvy knows won't be changed anytime soon? Some new grad RN is hired and says "clean caths aren't nest practice" and suddenly management will see the light and order a truck load of sterile kits?? Come on.....

    And nurses who acquiesce to this policy aren't "lazy" or "bad". What, if we're not throwing ourselves on the sword and risking our jobs to protest every policy that isn't 100% like we learned in nursing school, then we're not good nurses? Things aren't as black and white as some posters here seem to think.
    This!!!!
  9. Visit  joanna73} profile page
    0
    Just out of curiousity, what do you use for foley insertion? You're gathering separate supplies up? I thought most facilities had catheter kits, but apparently not.
  10. Visit  cblake4293} profile page
    6
    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...
  11. Visit  DebblesRN} profile page
    4
    My grandmother is in LTC and had to have a straight cath done. It was done clean instead of sterile (per documentation) and that sample grew nothing. 4 days later after the straight cath, she became confused, febrile, and she had a raging UTI that grew out antibiotic resistant bacteria (this was from a second sample as the first never grew anything). She ended up in the hospital for 2 weeks in ICU on BIPAP with urosepsis. Had a PICC put in and was on IV ABX for quite a while due to their "clean straight cath." So yeah--all of them should be done using sterile technique as far as I am concerned. And the policy changed at that facility after my mother and I had a meeting with administration.
  12. Visit  Liddle Noodnik} profile page
    2
    Quote from cblake4293
    I am a new grad and have been working as an RN for 5 months... 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.
    Quote from lilaclover6984
    Ahh new grads lol

    Yes this was poor practice but seriously? Lol
    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...
    leslie :-D and mariebailey like this.
  13. Visit  imintrouble} profile page
    1
    It looks to me like this argument has deteriorated into two camps.
    Hospital nurses/new grads who have never worked LTC.
    LTC nurses who have resigned themselves to reality.
    It would be beneficial if the hospital nurses, outraged over some of these posts, could work in LTC for 6 months.
    BrandonLPN likes this.
  14. Visit  Liddle Noodnik} profile page
    2
    Quote from imintrouble
    It looks to me like this argument has deteriorated into two camps.
    Hospital nurses/new grads who have never worked LTC.
    LTC nurses who have resigned themselves to reality.
    It would be beneficial if the hospital nurses, outraged over some of these posts, could work in LTC for 6 months.
    I have worked LTC. Years, not months. I still stand by what I said. I do understand! But, it is still unacceptable

    I will add though that I have retired from nursing, hopefully for the last time, and I'm only 54. It's a very tough profession to be in no matter what the specialty. Kudos for those who will continue to do it, and do it right. But when you can't help but take shortcuts such as these, maybe it is time to leave.
    leslie :-D and mariebailey like this.


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