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.

Specializes in Complex pedi to LTC/SA & now a manager.

Threads merged for continuity.

Glad to see you have an amicable resolution.

That's good news. She wasn't singled out and everyone will learn the proper technique. I didn't feel like you were a tattle tail. When it comes to patient safety you need to speak up.

Even though I'm a middle aged burnt out nurse I still make patient safety a top priority.

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Specializes in ICU/CCU/CVICU.
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...[/quote']

What en excellent outcome for such a tricky situation... You did a great job and sound like a fabulous nurse!

Specializes in Alzheimer's, Geriatrics, Chem. Dep..
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.

that's pretty bad imin ... :(

... 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...

wow excellent!

What en excellent outcome for such a tricky situation... You did a great job and sound like a fabulous nurse!

yep!

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 toughprofession 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 suchas these, maybe it is time to leave. :(
Well, where I work we do have straight cath kits, fortunately. So, yes, I use sterile technique every time.

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.

Specializes in Alzheimer's, Geriatrics, Chem. Dep..
Well, where I work we do have straight cath kits, fortunately. So, yes, I use sterile technique every time.

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.

sorry, my reaction was a little more than it needed to be, I was just upset that people were dissing the new grad who did have a serious and valid concern. She handled it perfectly IMHO, checking on the current policy and suggesting a way that it be corrected. I'm SO glad and I sure don't want that nurse penalized, just, corrected if she is willing.

and no I pray that nurses don't quit just because it's hard. I need those nurses who are willing and able to hang in there, and so do a lot of other people! and yes all the facilities need them, not just the posh ones.

I had other extenuating circumstances but I would be right back at it if I could. It kills me that I am one more nurse who cares, but can't :(

thanks Brandon

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.

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

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)

Specializes in CCRN, ED, Unit Manager.

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.

Specializes in Hospice / Psych / RNAC.
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...

:unsure: ... be careful about that stuff

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.

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.

Best response I've read here

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