Hello all! Today I completed week four of my training as a dialysis nurse. So far, I think I like dialysis, at least in theory. My questions and issues are in regards to the blatant disregard for basic infection control, (hand) hygiene, and other protocols that I have observed from most PCTs and some of my nurse colleagues at my clinic. Should I just look the other way and simply follow protocols in my own practice? Can their negligence negatively effect me or my license? Do PCTs work under under my license like CNAs? (I suppose I need to check with my BRN.) Should I just get my training and some experience and go work in acute care or change to PD? I spoken up a few times about these issues. Some PCTs have acknowledged, for example, that they should wear gloves and use hand sanitizer or wash their hands. They'll do it for a minute while I'm there and then go back to their very potentially harmful ways (given that infection is the second highest cause of death in HD patients). After I watched a PCT dump a bunch of bleach into our bleach crusted cleaning containers (they're suppose to be cleaned daily) instead of using the beaker beside her to measure the amount to make 1% and 10% cleaning solutions, I thought maybe it doesn't matter if the solutions much more concentrated. However, according to the Scripps Research Institute (https://www.scripps.edu/newsandviews/e_20060213/bleach.html and this article https://www.ncbi.nlm.nih.gov/books/NBK214356/) it does. The 1% and 10% solutions that we are suppose to make are the mark to clean and disinfect and "Improper use of bleach, including deviation from recommended dilutions (either stronger or weaker), may reduce its effectiveness for disinfection and can injure health-care workers." The next day I mentioned using the beaker to another PCT. She shrugged and said we're always in a rush. I understand that not long ago our clinic was chronically short, but that hasn't been the case since I have been there. People get their breaks and there is downtime on the floor. I'm planning how to bring my concerns to my FA, but as he has made clear to me, he has no clinical background and pretty much leaves that stuff to us. I am not trying to make enemies, but I think that is what will happen if I push for change. As an RN what I know does matter is hand hygiene. Time also cannot be used as an excuse for acrylic nails. Half of the nurses and PCTs in the clinic wear acrylic nails, which is against company policy. The PCT who I followed today had overgrown nails that needed to be filled and were visibly brown and unclean underneath. To make matters worse I did not once see her wash her hands or use hand sanitizer between bare hands and gloves and she only wore gloves when she could potentially come in contact with patient's blood. She didn't want to put her gloved hand into the bleach saturated water to grab a clamp because "there some blood in there and you know." At least she wore gloves when she set up the machines. The day before I watched a PCT put a machine together without any. (I mentioned that she should and she agreed. She put some on, but later I saw her without any again.) How important is it to wipe the graft or fistula with betadine for 60 seconds. I recall that in the OR betadine is "painted" on and that it is the contact time, not dry time that matters?? (I'll have too look that up too.) Then again it's not like I've observed a PCT wait for the betadine dry after their two or three seconds of wiping. They do like to repalpate that wet betadine... I regularly hear about our patients dying. Three this month. Three last month. Maybe that is normal with this job given the state of so many of the patients. But I don't want to hasten anyone's trip to the grave due to carelessness. Then again, I figure these things will go on whether or not I am there. I don't have the finesse to change this culture and I think it would be dumb to try. Can what they do negatively affect my license and career? If not, maybe I should stick around just worry about the standards to which I hold myself. Be the change? Then again, maybe I should just bide my time so that I don't fall into the habits of those around me. What do you think? Thanks!!