Female Foley and Witness

[jive turkey]

Does anybody work at a facility that has a policy requiring you to have a witness for a foley start? I'm on a travel assignment, fairly new to my current facility. Someone (who was not a superior or lateral to me "rank" wise) decided to suggest I get a witness after they discovered I started a foley alone, then later decided to inform me it is policy after I explained to them I rely on my judgment to decide when it is necessary.

Policy can't be argued, not looking for an angle there. Not looking for a lecture as to why it is a good idea to have one. I get it, and trust me I get a witness more times than not. I do have a gripe requiring it to happen every single time for various reasons.

Interested in the discussion

[azhiker96, BSN, RN]

Worked at hospitals by three large employers and none of them have that policy.

I recently had a female pt who was very uncomfortable with 900cc of urine in her bladder. She had none of my usual triggers to motivate me to get a witness (psych, dementia, youth, expressed desire for a female RN, spidey sense) so I did a straight cath. She was very appreciative and would not have wanted to delay until a second nurse could be free to come witness.

[Isakolistic]

2 RN's?

Seems a bit excessive. I understand 2 people (RN and a tech/CNA) for placement, but requiring 2 RN's seems to be a waste of resources.

The hospital I work in requires an additional staff member to be present; doesn't require the staff member to be an RN. Ditto to the aforementioned comments that it helps to be accountable to aseptic technique (if it is an RN). This is the only procedure that 2 staff members are required to be present for in my facility to my knowledge.

[/username, BSN, RN]

You're a traveler. If it's the policy, it's the policy. There's no discussion to be had...

When in Rome....

[C0SM0]

In my unit, if a male nurse was going to insert a foley in a female patient, it is strongly encouraged to have a female witness the action. At any time a female patient can accuse the male nurse for sexual assault.

Just curious, but why is it only "strongly encouraged" if it is a male nurse/female patient scenario?

[cyc0sys]

I think one of my old nursing instructors said it best, "If you like being a nursing, always have a witness when you're 'getting all up inside someone's business'. That way everyone knows what 'didn't' happen". I'm a male nurse so I've never really considered it to be an option anyway.

[Nurse SMS, MSN, RN]

My facility requires two nurses in the room. One to perform the task, the other to watch for a break in sterile field. If this happens, they are to quietly say to the nurse performing insertion "Let me get you another kit" as a way of stating they saw sterile break. It is intended (and is working very well) to prevent CAUTI.

[BSN16]

I don't get it. So should a male RN have a witness every time he cleans someone up, puts them on a bed pan, puts on ekg patches? where does it end?

[gonzo1, ASN, RN]

Our new foley insertion policy requires 2 RN for foley placement. It has something to do with reducing CAUTI rates. No body likes it, but we do it.

[jive turkey]

You're a traveler. If it's the policy, it's the policy. There's no discussion to be had...

When in Rome....

There's always that one person that doesn't thoroughly read through a post before making a comment.

Go back and read what I said, especially as it relates to policy then revisit the discussion. Thank you.

I see that some facilities require witnesses to prevent CAUTI. That's great. I'm skeptical if that's the real reason or if it's a more obscure way to have a witness present to prevent accusations. Are we going to have to get a witness to start an IV to make sure we prepped the skin correctly? How about a witness for every IM and SUBQ injection? Does the PICC nurse need a witness now too? How about a hand washing witness?

This is generally very unfortunate. As if we don't have enough challenges tending to patients in a timely fashion due to charting, patient volume, patients all being in pain, thirsty, need the restroom etc. at the same time, needing witnesses for narcotics and insulin...just like another poster said, where does it stop?

And what about the patient? Do we ever consider how some of them may be more embarrassed at the volume of people standing over them while they're exposed?

[Orca, ADN, ASN, RN]

Just curious, but why is it only "strongly encouraged" if it is a male nurse/female patient scenario?

Even if it wasn't required I would still do it. The potential consequences of allegations of improper conduct, even if they were totally false, is reason enough for me to do what I can to avoid them.

[Dany102]

And what about the patient? Do we ever consider how some of them may be more embarrassed at the volume of people standing over them while they're exposed?

Hello jive turkey,

I'm glad to see some nurses are thinking of the patients in that regard. Too bad you seem to be the only one doing it in this thread so far.

For what it's worth, thank you.

Dany

[Accolay]

Our hospital policy is also to have a witness in an attempt to decrease CAUTI.

As far as having a volume of people standing over a patient: I think that may be why it's important to have two RNs and not other ancillary staff doing the observing/holding of flashlight, and performing necessary education with the patient. Another reason also important to try and keep those bits covered until necessary.

Interesting ethical discussion though- when does the hospital policy to keep down infection rates override pt's privacy in this instance? I think we would educate on the reasoning but if a patient continued to refuse the observer we probably wouldn't push the issue and document. Unfortunately for some female patients, I really did require extra hands to place a foley.

Discuss amongst yourselves.