Bleck...how to bring it up?

[Coffee Nurse, BSN, RN]

I just reached my one-year mark on the floor (), and while there's a ton of stuff I still don't know, I'm finally starting to feel like I've got sort of a handle on things -- I'm not chasing my tail constantly during shifts, or feeling like I'm constantly running late on what I should be doing. One of the best parts has been when I've worked with the next cohort of new grads, and they occasionally ask me questions that I actually know the answers to. Awesome feeling!

That said, here's my dilemma. I worked with one recently who needs a little direction re: cleanliness (i.e. I observed her touching pumps while sterilely gloved for a line change, brushing back her hair while wearing clean gloves, etc.). What do you think my best course of action would be, now that it's after the fact? I'm very conscious of the fact that I only have six months' experience more than her, so I feel awkward calling her out for something like this; on the other hand, the idea of tattling to the charge nurse feels wrong, too. How would you approach this, if you were in my Danskos?

[fiveofpeep]

How about proposing handwashing/gloves audits to the nurse manager? That way you dont isolate the one nurse and can help improve quality and identify weaknesses throughout the whole unit. Where I've seen this done they usually give you a tiny piece of paper with a silly little joke on it about being caught and reminding you about handwashing and glove etiquette. It's kinda silly but it might help people realize they were lacking without making them feel singled out or punished.

[HouTx, BSN, MSN, EdD]

First of all, don't discount your ability to teach others just because you aren't a 'grizzled veteran' with decades of experience. I have found that relatively new nurses often make the best preceptors because they remember what it was like to be 'new'; they are more patient and present information step-by-step in a way that is understandable to a newbie.

To me, this seems to be a typical case of inability to apply theoretical knowledge (infection control) in the clinical setting. This is very normal for students and new graduates. She just has not yet gotten to the stage where she has internalized the knowledge by changing her behavior. This is why preceptors are so important. You should immediately intervene whenever patient safety is an issue, but do it in a way that provides a learning opportunity.

I would advise you to approach this from a "positive" perspective... assume that she wants to do her very best & cause no harm to the patient. You could start with the general phrase of "I am sure you did not realize it at the time, but you accidentally contaminated your glove when you ...". If she has difficulty grasping the concept, you might want to try coaching her pior to a procedure - ask her questions that cause her to think about her actions including any problems that could be anticipated and how they can be prevented. Questions like:

- How were you taught to avoid contaminating your gloves when you change lines?

- What have you found to be the most difficult aspect of trying not to contaminate your gloves?

If she is resistant to coaching & continues to have problems -- then you should tattle.