dilema

[ohbet]

What do you do when you observe other nurses,say breaking sterile field,or not even bothering with it,when irrigating bladder thru a foley. Or say not bothering with sterile field,or breaking it,say with sterile dressing change or foley insertion,or say attempting venipuncture on a patient more than 3 tries?

[psnurse]

I don't find that I often have the time to critique the work of others when I am on shift. But if I were to observe such breaking of sterile technique a friend of mine who works in the OR offered her solution.

As a circulator, evidently part of her job is to keep a watchful eye on the sterile field and report if it was broken. If she is told she is crazy that sterility was not compromised, then she is supposed to walk up and place her non sterile gloved hands on things, making the break in sterility obvious. I can only imagine the cursing that would ensue following such an act. But the argument that sterility was not compromised would be rendered silent.

As for more than 3 venipunctures... I find I am often the court of last resort for IV starts. The patient has usually had more than 3 attempts by more than one nurse before I am called. I have a personal limit of two attempts before I start looking for a central line inserter.

Unless there is a hospital policy limiting the number of attempts, or the patient kicks all the nurses out of his/her room, you could technically stick as many times as necessary. I don't think this would be the best example of good judgement or good personal ethics, but technically I am not sure there is anything you can do about it.

[mopsi]

when i first read your post i got am immediate attitiude and wanted to respond in a sarcastic manner....since i'm not doing that i obviously gave this a little more thought. here's what i came up with.. if i am just winging something and someone has said "hey, let me show you a better way to do that" and then shows me..i usually incorporate the technique into my skills. if i get wind of them tearing me down and critiizing me to other nurses, i usually can find 20 things they did wrong and just as nicely point those out...no that won't win me nurse of the year but it has been effective in getting someone to back off and do their own assigment and not try to critique me...if it's constructive and non confrontational everyone benefits..if it's snide and cruel no one wins..i have even had little practice sessions where a group of nurses practice sterile technique. i am the first one to say "what's this med for?? or look it up and tell everyone..i get so upset with med errors from stupid orders..i try to fix those..but i am not "supernurse"..i have also found a large number of nurses simply do not care. they are just doing their time..8..12..double and want to get out of work with the least ammount of energy expended..(burnout signs) if this is where they are at mentally you aren't going to get them to suddenly act like they're back in nursing school..hmmm back in the perfect world of nursing school we only had one or two patients and someone to help us ..answer questions ..show us better ways to do things....happy thanksgiving

[ohbet]

Thank you for your insiteful responses,God, I love this site.

[Aerolizing]

As for the breaking of sterile technique, I would simply say, ooops, you touched this or that. Then I would offer to open up or go get sterile supplies if I was there doing the assisting.

As far as iv sticks, some patients are so hard, even the expert iv starters have trouble. I think that the inexperienced people should get two tries and then let someone else try. Experienced iv stickers, I would let them keep trying cuz if they can't get it, we have to call in the docs who are brutal.

[nurs4kids]

I'm finatical about sterile situations. I can answer this easily, because it's happened several times. The first time, I casually mention to the nurse, "ahem..did you realize you broke sterility?" Then I discuss how and what would have prevented contamination. The second time, I'm a bit more stern, "You MUST be careful to maintain sterility." Third time, it becomes public humility time. We're all sterility finatics (post-op floor), so third time around (some coworkers are not as nice, first infraction is public humility time ) I tell them in front of coworkers, "You contaminated that foley/cvl/dsg AGAIN. These kids are infected as it is, they don't need our contribution!" Fourth time, it becomes a unit "joke". If it hasn't been corrected by then, all the nagging and joking usually makes them more conscientious.

I remember one nurse, years ago when I was in nsg school and working as a clerk. She was trash, and it showed in her physical appearance and her work. She was plain nasty. Anyhow, we had a kid, sick as everything, getting ampotericin, gent, clinda..anyhow, I looked around and she's walking with the kids hyperal and lipids thrown over her shoulder, the tubing trailing on the floor behind her. I, the clerk, dang near died. I said, "uh, I KNOW you aren't going to hook that to Anne's CVL after you just DRUG it across this nasty floor!!?? Her reply, "ohhh, she's on abx. What could possibly hurt her??" She left a few months later, thank God (we still laugh about her eating rice off the nurses station counter where she'd drop it while eating..yuck, she was gross!)

[hoolahan, ASN, RN]

I don't care if you are nice or nasty, the point has to be made b/c we are all pt advocates. Thank God you didn't allow that idiot to hook that TPN line up the line.

Me, I take the nice appraoch, unless someone has been nasty to me first. I just say, whoops, that just touched ______, I'll go get you a new one, and I snatch whatever it is, and "offer" to take it to the trash, before the person can say anything.

Once helped a doc insert a swan in a new hospital, I was agency. He was not wearing a mask or gown. I said here doc, I have your gown and mask all ready for you. He said that won't be necessary, it's not important. So I publically humiliated him by saying, Oh gee, silly me, you're right, why let a stupid thing like infection control get in your way. He looked at me like he wanted to kill me b/c he had residents with him and another new nurse was in the room. He said, well, since you went to the trouble, we'll go ahead and do it your way, and smiled a very tight little smile. It worked. I mean for him to say something so very stupid deserved an unprofessional reply!