Sterile technique is essential, but I do think nursing instructors go a bit nuts on things. You don't absolutely, positively have to do it their way, you just have to maintain sterile technique. I've watched some of the instructors teaching in our unit, and I try not to stand their shaking my head. You don't have
to make the outer container your little garbage bag. You don't have to use that stupid fenestrated drape in a female foley kit. One day you will be doing this without someone breathing down your neck, and you will find your own way. That said, it can be very, very difficult to cath a woman sometimes. Not everyone looks like the text book. In fact, most people don't. I had a precepting student with me last year, and she was going to do a straight cath on a pregnant patient. She was freaked out about it, but I did a little cheerleading and we went in the room. And she couldn't find the meatus. So I gloved up, got a new kit, turned on the exam lights, and I
couldn't find it either! So we covered the patient, apologized and walked out of the room, with me pointing out that experience doesn't always mean much!
I got a colleague, we went back in, and my nurse coworker just stood and stared, shrugged, and poked where it should have been, and voila, it went in. And she admitted later that she couldn't see a dang thing, she was just giving it a try.
I got a UTI after I had my baby from the Foley. I know the nurse who put it in, and I've worked with her many times, so I know how good her technique is. I think cath care while the Foley is in is essential, and I think it falls by the wayside. I don't blame anyone for my UTI, it is just a risk of having a Foley. Your job as the nurse is to do your absolute best to maintain sterility at all times in the way that works best for you. And never, ever, be too shy to ask someone to come in and hold for you, especially if you have a huge patient! That can really help you clean the area well and stay sterile, if you can completely visualize the urethra.