Anybody else seeing this at clinicals?

[Nepenthe Sea]

I'm just curious about this. I know that NS is different from the real worls, and that we will see nurses doing things that we were taught differently and all, but....I did my first four week rotation at a local hospital recently and it appears that the nurses, for the most part, do not actually use any of the precautions that we were taught to use for patients. And I'm not talking about standard precautions for all patients as far as using gloves with everybody. Everyone I saw used gloves. But there were patients on contact precautions for VRE, MRSA, c-diff, etc. And I would be the only one wearing the gown and mask (if indicated) in addition to the gloves. It made me feel a little queasy! Have any of you seen this happening? Maybe it's just different in the real world.

Also, there was one patient I was helping with. He was not assigned to any of us so none of us knew his history. I had been doing stuff for him all morning and then another student and I went in to bathe him and I asked her if she thought we should wear gowns. She asked if he was on any special precautions and I said no. Well, the patient spoke up and said, "You're going to want to wear a gown - I have c-diff." I thought maybe he was confused or something, because there were not any signs up in nhis room or on his door the way that there had been for everyone else on precautions. I asked his nurse and she said he did have it, but he had just been admitted the day before and they hadn't had a chance to post the precautions on his door!! I was not too happy about that, needless to say. :angryfire

I thought maybe it was just the hospital where I was, but my friends that were assigned to other hospitals said that it was the same way there. They said alot of the nurses didn't even bother wearing gloves at all. Is it just me, or is this kind of icky??

[craziechiq, BSN, RN]

That is disgusting. The hospital where I am at in San Diego would never allow that. Everyone goes in with whatever precautions are posted and our instructor and the staff all watch us like hawks. I cannot believe they did that, eww infection control please.

[VICEDRN, BSN, RN]

Have made the rounds at all of the Atlanta area hospitals and, uh, I think what you are seeing is an aberration. Remember, if they catch C-diff, nurses go on leave, burning up their vacation time and unpaid leave without pay. Bummer. (or at least what I have heard from them.) Is that what you want?

The only exception I have seen is when the patient is colonized or has had past infection with MRSA but doesn't have an active infection. In that case, I have seen patients on isolation and the nurse plays a little fast and loose with the precautions when stepping into the room to look at an infusion or a faulty EKG lead.

[shescoolie]

NOPE you are definitely not alone. In my last rotation I saw a doctor roll up in a pt with MRSAs room with NOTHING on AAAAND he unwrapped his wound which was bleeding, oozing, infected and not healing. I was like WTH?! I have seen PCAs, RNs, Lab Techs "run in real quick" without putting on anything more than gloves. Some of them even touch the beds and sheets. I'm like not me! I don't care if by the time I'm gowned up your done! I'm not trying to get sick out of convenience!

[diane227, LPN, RN]

I have been a nurse for 31 years and I have seen all kinds of violations of isolation standards so no you are not alone and what you are seeing is not correct. These people are violating the standards that you have been taught. C-diff patients should always be on isolation until they have stools (at our facility 3) that come back negative. C-diff is very easy to catch. I place any patient I am concerned about on isolation on my floor until we are sure they don't need to be. I can't tell you the number of times someone gets admitted from the ED with "cellulitis" and it turns out to be MRSA. If you are ever in doubt, gown and glove up. No matter what everyone else is doing. Protect yourself and your other patients. And also, I (guess because I am old) don't use those alcohol based hand cleaners. They do not make my hands feel clean and they will not kill c-diff. I use soap and hot water. When I go into a patients room I wash and put on gloves. When I leave, I dispose of the gloves and wash again. Just a habit I guess.

[Nepenthe Sea]

NOPE you are definitely not alone. In my last rotation I saw a doctor roll up in a pt with MRSAs room with NOTHING on AAAAND he unwrapped his wound which was bleeding, oozing, infected and not healing. I was like WTH?! I have seen PCAs, RNs, Lab Techs "run in real quick" without putting on anything more than gloves. Some of them even touch the beds and sheets. I'm like not me! I don't care if by the time I'm gowned up your done! I'm not trying to get sick out of convenience!

Yeah, a wound care nurse at the facility I mentioned previously was changing dressings, and would put her gloved hand INSIDE of a trashcan and pull it over to her, and continue to change the dressing like nothing had happened...

[Nepenthe Sea]

I have been a nurse for 31 years and I have seen all kinds of violations of isolation standards so no you are not alone and what you are seeing is not correct. These people are violating the standards that you have been taught. C-diff patients should always be on isolation until they have stools (at our facility 3) that come back negative. C-diff is very easy to catch. I place any patient I am concerned about on isolation on my floor until we are sure they don't need to be. I can't tell you the number of times someone gets admitted from the ED with "cellulitis" and it turns out to be MRSA. If you are ever in doubt, gown and glove up. No matter what everyone else is doing. Protect yourself and your other patients. And also, I (guess because I am old) don't use those alcohol based hand cleaners. They do not make my hands feel clean and they will not kill c-diff. I use soap and hot water. When I go into a patients room I wash and put on gloves. When I leave, I dispose of the gloves and wash again. Just a habit I guess.

I crossposted about this over in the general nursing forum, and most say this is not normal or right. But of course, there are a couple who say that it's not realistic to gown and mask up every single time you go in, and that when the patient is being transported the germs are spread, etc. I can see what they are saying, but you know...you're not just protecting your self and your family by wearing the PPE. You are protecting other patients, esp. the immunocompromised ones. So I don't know where you draw the line and say "It will take me all day to gown and glove up for every patient I have on contact precautions every time I go in, so I'm just going to let it slide." I guess I will see when I am out in the real world, but I sure hope I don't become as sloppy as some of the people I have seen!

Also, doesn't it occur to anyone that Medicaid and/or Medicare has decided not to pay for the treatment of hospital-acquired infections? How do they think those infections are caused?

[DolceVita, ADN, BSN, RN]

I am interested to know what you CI has to say about this.

I start my NS clinicals next week. I have, however, seen some very odd things in my volunteering career and CNA clinicals (as well as when family have been in hosp.).

[Nepenthe Sea]

I am interested to know what you CI has to say about this.

I start my NS clinicals next week. I have, however, seen some very odd things in my volunteering career and CNA clinicals (as well as when family have been in hosp.).

Well, I don't think she said much. She was present for the dressing changes where the nurse stuck her hand inside the trashcan, and she knows about all the other stuff. She agrees that it isn't right, and we talked about it to the entire class when we met for post-conference. She may have said something at one point, because after I bathed the pt. with C-diff I noticed that Infection Control was there and putting up signs on his door and the hand sanitizer dispenser next to it. This was the first time our school had ever had clinicals at this facility so I don't know if she was just afraid to make them mad or what. In pre-conference one morning a student said that some of the nurses acted kind of snippy with her, and she wondered if word had gotten back to them about what we were saying. Then our CI said that she also thought they had heard about it. Oh well! If you're going to do stuff like that, then I really could care less if you get mad when I talk about it! I was sure to mention all of my concerns in my evaluation at the end of the rotation, and our CI said she was going to, also.

[studentnursejulie]

This happens to me all the time at clinicals. But as a cna for 8 years I know that you never question gloves always were them, and sometimes one is not informed on what the patient has we just have to make sure standard precautions are in place.