A Nurse who doesn't wash hands

[GFzalez, BSN, RN]

I am a new grad working on LTC and still on orientation. I have noticed that one of my preceptors doesn't wash her hands...like ever during the shift. It's incredibly disgusting. She has been working at the facility for almost a decade and she is only in her mid 40's and doesn't even use the foam sanitizer that is stationed at the door of each resident's room. According to everyone she is a good and compassionate nurse, but how can that be possible is she doesn't wash her f'ing hands!

Also she doesn't even look up the meds that she is giving! I know that in LTC you "know the residents" and probably have all the meds memorized but still, you can miss something and not even know it because she pours all her meds, gives them to the patient, and then signs all her meds and everything at the end of the shift. In the meantime she surfs on facebook and plays Farmville.

What's worse is that we have blister packs for our meds that we pop into little plastic cups, she pops the pills out into her unwashed hands and puts that into the cup! Totally defeating the purpose of popping pills into cups! Also for eye drops she not only doesn't wash her hands but also doesn't wear gloves! And then she would go and pop more pills into her hands for the next patient's meds! Needless to say on the rare occasions when she does wear gloves she doesn't wash her hands afterwards.

Even grosser recently I saw her after putting eye drops in a resident (sin gloves, of course) , then go directly and eat take out at the nurses desk!!!! I see her eat constantly without washing her hands and I gag a little in my mouth each time.

During a shift I only saw her wash her hands once before a doing a dressing change prior to putting on gloves, then afterwards she didn't wash her hands! Am I missing something? How the heck does this happen? I mean I don't want to get my preceptor in trouble because she will know it will be me who said something but what should I do?

I mean who wouldn't be offended when you say "hmmmm excuse me don't you think you should wash your hands, like more than once during a shift or more like in between each resident, before and after you basically do anything with a patient?" Also this nurse has a reputation for being moody and I don't want to get on her bad side while I'm still orientating with her.

Suggestions...?

[resumecpr]

Not only is your preceptor putting herself at risk for infection, etc, she is also putting her patients, family and other hospital employees at risk. I would politely remind her about infection control and possibly cite hospital policy or procedure. If she truly does care about her patients, then she will take your reminder in a positive way and hopefully change her habits for the better. If you are uncomfortable doing this yourself, find a colleague who has also witnessed her lack of hygiene to support you while witnessing the intervention. You have absolutely nothing to lose. Good luck!

[tyhmar6]

Ask questions sincerely, like, so after doing this procedure it's no important to wash my hands? She'll get the idea. (remember sincerely)

[HealthShepherd]

You have absolutely nothing to lose. Good luck!

Unfortunately, I think you do have something to lose here.... it's a tough diplomatic situation when she's more experienced than you and in charge of you. You don't want to get a reputation as a new grad who thinks she knows better than the veterans... even if you're clearly in the right!

Instead of confronting her about it, I'd suggest more subtle ploys, if you feel your acting skills are up to it. For example, when you're together, you could reach out to touch a patient, then say, "Oh, whoops, I forgot my hands," then go wash before proceeding. After you do a procedure and take your gloves off, say "Ugh, I hate the powder," then go wash before you touch anything. Maybe this will remind her to wash herself, or will make her raise the topic herself of why she doesn't wash enough (maybe she has sensitive skin?)

That reminds me of an incident when I was a new grad. My preceptor never wore gloves for IV starts (which wasn't necessarily that big a deal in a special care nursery - the other nurses didn't wear them either). However, when I saw that she was about to start an IV on a baby who was suspicious for HepB, I went to get gloves for myself, and asked, "What size do you need?" She said, "Yeah, I guess that's a good idea for a baby with HepB." It was a spur of the moment idea, but I still think that was a lot more diplomatic than for me to say, "Don't you think you should wear gloves this time?"

[XB9S, BSN, MSN, EdD, RN, APN]

The previous poster has an excellent suggestion, and it's one that I've used successfully. I always make a big thing about washing my hands if I'm concerned about another members of staff hand hygiene. SO where as usually I would just carry on and wash my hands without comment if I'm with someone I'm concerned about I would say "I'll be there now, I just need to wash my hands" See if your behaviour can have a positive influence on hers. If this doesn't work then you need to address it with your manager, it's not for you to deal with performance issues so speak to your nurse in charge with your concerns and let someone more senior deal with it

[RNStephanie]

That is disgusting. I know the constant washing is such a pain, but holy hell- touching eyes and then other pt's meds?! GROSS! I would put up such a stink if I knew my family member's nurse wasn't washing her hands between pt's. I put up a stink when my own MD/NP doesn't wash their hands when they are visiting with me. I know others would say that its hard to change a vetran, but come on- MRSA, VRE, C. Diff... that could make someone very sick and its over something as simple as not purell-ing. I would bring it up to someone you feel comfortable telling, like your manager or educator. Tell them not to use your name, but rather in a way that gets her to change her behaviors such as handwashing audits. Our hospital does it randomly to make sure everyone is staying above 95% and in the NICU- 100%! Good luck and remember, you'll be on your own and practice the way you want to soon, so keep up the good hand hygiene!

[scoutsmom]

Oh my!! and with all the antibiotic resist. bugs out there, ?! I wonder what the state survey folks would say if they saw this?, Do you guys ever get an inside audit?, where someone watches you for awhile? Maybe they should do one!!! like yesterday..

[caliotter3]

I would go to the nursing supervisor and inform her, stating that you didn't want to cause trouble by speaking directly to the person, as you are in an awkward position.

[mesa1979, BSN, RN]

Leave a typed anonymous letter in the DON and Administrator's boxes or under their doors. Make sure you are not seen. This way they can watch her for themselves and your name won't come up, unless they ask you after the fact what you seen, then tell them.

[lisamc1RN, LPN]

You are, unfortunately, going to be the example to her. Always wash your hands and put your gloves on when appropriate. Heck, I've entered the room with some people and handed them the gloves myself. I will leave the water running after I wash my hands and walk toward the door so that they get the hint. It really sounds like she has gotten into some very bad habits and is of the mind that the risks are not worth the effort. Maybe you could suggest to your manager an inservice on infection control? You wouldn't have to name names, but just say you've noticed that infection control has become a little lax at the moment.

[GFzalez, BSN, RN]

Thank you everyone for your suggestions. I will definitely be asking the nurse educator about hand washing audits for a start! Hopefully it will help this nurse get her act together.