So I am a newer nurse and I need advice on handling things that I see that believe to be wrong. I want to say something to the people, but feel nervous about over stepping. Examples: I got a pt from someone that has been a nurse for 7 years. The patient was on a heparin drip, only had one IV site, and was receiving several IV meds. So she was pretty much giving him a bolus q 3-4 hrs.
Another example: There is a CNA that has been working at this hospital longer than I have been alive. I helped give a bed bath, and she went from wiping the behind, to cleaning the back, to cleaning the legs and toes all with the same towel. I felt sooooo grossed out just watching, especially because there were obvious skid marks. I told her I would grab her some more towels, but she didn't even bother to use them.
I have only been on this floor floor for a pretty short time, and don't want people thinking I'm a know it all. There have been other situations similar to this, and I don't know how to handle these situations.
What were you doing helping the CNA with a bed bath? I would call that a mistake being in there with the CNA. That is your downtime!
On our unit we often "help" the CNAs with bathing. A lot of our patients are too heavy for one person to turn alone, and most of them are unable to turn themselves. Also, I always feel that no one is "too good" to do any part of patient care. And bathing is a great time to assess patient skin.
It is actually a good thing she was there to see what the CNA was doing. Such lack of hygiene is disgusting and an infection risk. Very bad care. I would report that to the manager and perhaps phrase it in terms of the CNA needing some education in this area. Personally if I were the manager I would dehire the CNA. It just makes one wonder what these CNAs are doing when the nurse is not there to see them. Poor vulnerable patients in their care.
Being a new nurse is always difficult. There are always the "dinosaurs" who have always done things a certain way and are not willing to learn or change. I would be checking the Policy and Procedures manual for Heparin drips, calling pharmacy, and talking with your unit educator to see what the correct procedures are for running heparin drips along with other meds through a single IV site. That way, if you run into this situation again, and I am sure you will, you can institute the change if needed on your shift, and in that way, help educate the others on your unit who are entrenched in doing it the "way we have always done it." Nothing makes me sadder than when I hear older and experienced nurses say that. You could also do a presentation at a staff meeting, or a bulletin board for nurses to look at demonstrating the evidence based practice methods. Nursing is a progressive profession that is constantly changing and evolving along with new research, advances in medicine and technology. To stop learning is to stop growing. No nurse knows it all, despite some thinking they do. I have 30 years of experience and I learn new things every time I work. I am constantly looking up new research and trends in nursing and sharing it with my peers.
As for the PCT, as a nurse, you have a responsibility to your patient to receive the best care possible. I would bring two basins and separate washcloths the next time you do a patient bath with her, and from the onset, explain that the two of you will work from the head down and leaving the peri/anal area for last. If she balks, ask her how she would feel if she used a washcloth on her peri area and then washed her face with it seconds later. Patients deserve the same care that we would want for ourselves. Sometimes it is just a matter of reminding people of that. She was either taught incorrectly or has seen other nurses bathe that way and assumed it was okay. This is your chance to step up as a leader and take corrective action. You don't have to be rude or defensive, just quietly provide the rationale for why baths are given in a specific way and let her know that those are the expectations. Having 7 years experience of being a PCT doesn't mean she is doing everything correctly.
Never be afraid to question things. There are always more than one way to skin a cat, but your hospital policy and procedures are designed to create a continuity of care in what is deemed the best practice. You cannot go wrong if you are following it.
You could most certainly ask your pharmacist about the IV medications--If it is a large bore IV (or is it a central line/PICC/Port?) and the meds are compatible (which is the key to all of this) I may not think it my best practice, but again, I would be sure with using your resources and asking. Also assessing the IV site, and making sure you are flushing appropriately.
Heparin has a specific protocol. And bears watching. Which may not be in line with say an antibiotic. What is the policy regarding obtaining a second IV site? Use your resources and ask. You do not have to involve anyone else's practice when you take over a patient. So just ask for your own practice.
As far as the CNA--I would have just made sure there were 2 basins as well as plenty of washcloths. One specific to the peri area. Before you begin doing anything. And say "I did up a basin for the peri area--here's one for the rest of the body". Sometimes I think that some CNA's don't realize what they are doing as it is so "robotic" for them. Plus for any number of years, disposable wipes were used for peri clean up, and sometimes even wipes for baths. So they would use and throw out. Then they have gone back to basins and washcloths. But then there's always a conversation about "laundry" and laundry expenses, and the unsanitary condition of laundry....and then things sometimes revert back to disposables.....
Sending best wishes. It is going to take awhile before you get your own groove. And look at it that way--you want to refine your own practice so that you are correct. And that is what I would say should anyone balk at your need to know.
I agree somewhat. I believe the aide should have been given the proper instruction in their education process. I have been a health care aide instructor and if any of my students did this, and did not correct their actions, they would not have graduated from the program. Employers expect the aides know their stuff on graduation and that they don't need such supervision on the job. They should be able to function independently by that point. Most nurses are so bogged down with paperwork, etc. these days they would not have time to help the aide bathe the client and do the teaching. It would be nice if they did but where I work it just would not happen. The nurses can barely get their own work down in the allotted shift time due to limited staffing. Missed breaks and unpaid overtime are the norm. Health care aides never miss a break and usually leave on time at the end of their shift.
I think these things are reportable not to be punitive, but to provide safe client care and the managers need to be aware if staff have deficiencies in performance. As a manager, I would be upset if these things occurred on my unit and I was the last to know about it.
Being a new nurse is always difficult. There are always the "dinosaurs" who have always done things a certain way and are not willing to learn or change. I would be checking the Policy and Procedures manual for Heparin drips, calling pharmacy, and talking with your unit educator to see what the correct procedures are for running heparin drips along with other meds through a single IV site. That way, if you run into this situation again, and I am sure you will, you can institute the change if needed on your shift, and in that way, help educate the others on your unit who are entrenched in doing it the "way we have always done it." Nothing makes me sadder than when I hear older and experienced nurses say that. You could also do a presentation at a staff meeting, or a bulletin board for nurses to look at demonstrating the evidence based practice methods. Nursing is a progressive profession that is constantly changing and evolving along with new research, advances in medicine and technology. To stop learning is to stop growing. No nurse knows it all, despite some thinking they do. I have 30 years of experience and I learn new things every time I work. I am constantly looking up new research and trends in nursing and sharing it with my peers.
As for the PCT, as a nurse, you have a responsibility to your patient to receive the best care possible. I would bring two basins and separate washcloths the next time you do a patient bath with her, and from the onset, explain that the two of you will work from the head down and leaving the peri/anal area for last. If she balks, ask her how she would feel if she used a washcloth on her peri area and then washed her face with it seconds later. Patients deserve the same care that we would want for ourselves. Sometimes it is just a matter of reminding people of that. She was either taught incorrectly or has seen other nurses bathe that way and assumed it was okay. This is your chance to step up as a leader and take corrective action. You don't have to be rude or defensive, just quietly provide the rationale for why baths are given in a specific way and let her know that those are the expectations. Having 7 years experience of being a PCT doesn't mean she is doing everything correctly.
Never be afraid to question things. There are always more than one way to skin a cat, but your hospital policy and procedures are designed to create a continuity of care in what is deemed the best practice. You cannot go wrong if you are following it.
I agree with you statement about nurses saying they have always done it that way so no need to change. I just cringe whenever I hear that. But it isn't only old nurses who do this. New grads can be some of the most rigid nurses out there, following the book to a t, not thinking outside the box, not able to adapt to novel situations, mainly due to lack of experience and fear of repurcussions. It is about an attitude towards change, adaptability, flexibility. These are qualities that should be sought in admitting students to nursing programs and should be nourished during the education process so they don't have to be newly acquired on the job.
The "we have always done it this way" is usually about the culture of the organization not the individual nurse. Maybe the old nurses were bright and flexible when they started with the organization, but then they were beaten down, stuck in a rut and just went with the flow because changing jobs was too difficult.
she is a great cna to work with. She does an awesome job on just about everything, and I've learned that if I delegate something to her, it WILL get done and correctly. That is also part of the reason I don't want to upset her. I would much prefer her to be on my team.
She can't be that awesome if what you said is true.
Aren't you supposed to be an advocate for your patient? smh
Just being on a heparin drip by itself is not a reason for a second IV. The volume of a peripheral IV is typically a fraction of a ml, so flushing the IV, giving a medication, and flushing again does not produce a clinically significantly bolus. IV's are not benign and should only be inserted when actually indicated.
The CNA part however is gross, my usual method would be ask if cleaning people by rubbing their own poop all over them is a new thing.
Oh come on. I thought it was funny, and if I had started this thread, I would have laughed hysterically at that. Sometimes you just have to be able to laugh at yourself. Otherwise we'd all go nuts.
Oh come on. I thought it was funny, and if I had started this thread, I would have laughed hysterically at that. Sometimes you just have to be able to laugh at yourself. Otherwise we'd all go nuts.
dec2007
508 Posts
On our unit we often "help" the CNAs with bathing. A lot of our patients are too heavy for one person to turn alone, and most of them are unable to turn themselves. Also, I always feel that no one is "too good" to do any part of patient care. And bathing is a great time to assess patient skin.